The Cribsiders S7 Ep160: Gut Feelings: Navigating Pediatric Functional Abdominal Pain
Nov 26, 2025
Kaleeb Graham, a pediatric gastroenterologist and associate program director at Cincinnati Children’s, discusses the intricacies of functional abdominal pain in children. He shares insights on the gut-brain connection and how anxiety can amplify symptoms. Kaleeb emphasizes a 'function first' approach in treatment while exploring the roles of diet, psychological support, and neuromodulation therapies. He also highlights the importance of minimal diagnostic testing and compassionate communication with families about this often-misunderstood condition.
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Gut–Brain Miscommunication Explains Pain
- Functional abdominal pain sits within disorders of gut-brain interaction caused by miscommunication between the brain and the enteric nervous system.
- IBS includes motor bowel changes, while functional abdominal pain lacks consistent bowel-pattern changes and may present as isolated pain.
Diagnose By History; Screen Smartly
- Make a positive diagnosis of functional abdominal pain from the history rather than waiting to exclude everything first.
- Screen selectively with TTG IgA plus total IgA and fecal calprotectin to rule celiac disease and bowel inflammation.
How To Do A Focused Abdominal Exam
- Perform a focused abdominal exam: inspect, auscultate four quadrants, palpate for organomegaly, masses, and generalized tenderness.
- Expect a soft, non-distended abdomen with normal bowel sounds in functional abdominal pain.