Functional Abdominal Pain and Separation Anxiety: Helping the Child Return to School

Functional Gastrointestinal Disorders Program, Monroe Carell Jr. Children’s Hospital atVanderbilt University, NashvilleYou have just reassured Mrs. Lee that the medical evaluation is normal and that herdaughter, Angela, does not have a life threatening disease. You explain that Angela hasfunctional abdominal pain, a condition that causes real pain but does not require activityrestriction. In fact, children cope better with functional abdominal pain when they continuetheir normal activities. You tell the family that Angela may return to school tomorrow.“But what if my stomach hurts?” Angela asks with obvious distress.“Should I force her to go to school even if she really hurts?” Mrs. Lee asks.This scenario is especially common when functional abdominal pain (FAP) co-exists withseparation anxiety, a child’s extreme fear of potential or actual separation from parents andother attachment figures. In these cases, the pediatrician may see an escalating cycle of