Doctors sometimes struggle to figure out why children have belly pain—is it something serious or just stress and worry? Researchers studied 571 children with chronic belly pain to see if simple stool tests combined with questions about warning signs could help. They found that using three things together—asking about alarm symptoms, checking stool samples for a protein called calprotectin, and testing for hidden blood—worked really well at telling the difference between real medical problems and functional pain (pain without a clear physical cause). This combination was accurate about 84% of the time, which is much better than using any single test alone.

The Quick Take

  • What they studied: Can doctors use simple stool tests and questions about warning signs to figure out if a child’s belly pain is caused by a real medical problem or by stress and other non-medical reasons?
  • Who participated: 571 children with long-lasting belly pain seen at a hospital between 2017 and 2020. Of these, 347 had functional pain (no clear medical cause) and 224 had organic disease (a real medical problem causing the pain).
  • Key finding: When doctors combined three things—asking about warning signs, testing stool for a protein called calprotectin, and checking for hidden blood in stool—they could correctly identify the type of pain about 84% of the time. This combination caught 91% of real medical problems and correctly identified 70% of functional pain cases.
  • What it means for you: If your child has ongoing belly pain, doctors may be able to use simple, non-invasive stool tests instead of more uncomfortable procedures to figure out what’s causing it. However, this study was done in a hospital setting, so results might be different in regular doctor’s offices.

The Research Details

Researchers looked back at medical records of children who came to the hospital with chronic belly pain over a three-year period. They divided the children into two groups: those with functional abdominal pain (pain without a clear medical cause) and those with organic disease (pain caused by a real medical problem like inflammation or infection). The researchers then checked whether stool tests and warning sign questions could accurately separate these two groups.

They tested two different approaches: one using a cutoff level of 60 units for the calprotectin protein and another using 100 units. They also made sure families did the hidden blood test correctly to avoid false results. The researchers used a special statistical method called receiver operating characteristic curves to measure how well each test combination worked.

Many children with belly pain don’t have a clear medical problem, but doctors need a way to figure this out without putting kids through uncomfortable procedures like colonoscopies. This study tested whether simple, non-invasive stool tests could do the job. If successful, it could save children from unnecessary procedures and help doctors focus on the right treatment faster.

This was a retrospective study, meaning researchers looked back at past medical records rather than following children forward in time. This type of study is good for testing ideas but can’t prove cause-and-effect. The study was done in a hospital setting with children who had already been diagnosed, so the results might not apply to all children with belly pain. The researchers did use proper age and sex guidelines for interpreting the calprotectin test, which is a strength.

What the Results Show

The combination of alarm symptoms plus stool tests was the most accurate approach, with an accuracy rating of 0.841 (on a scale where 1.0 is perfect). This combination correctly identified 90.6% of children with real medical problems and correctly identified 70.3% of children with functional pain.

Children with organic disease (real medical problems) had significantly more alarm symptoms and abnormal test results compared to children with functional pain. Alarm symptoms alone weren’t as accurate as when combined with stool tests.

When researchers tested a higher cutoff level of 100 units for calprotectin instead of 60 units, the results were slightly different but still useful. The key finding was that combining multiple pieces of information worked much better than relying on any single test.

The study found that mild elevation of calprotectin in children with constipation was likely due to the constipation itself, not inflammation. This is important because it means doctors shouldn’t automatically assume a slightly elevated calprotectin level means serious inflammation. The researchers also noted that diet and certain substances can affect the hidden blood test results, so families need clear instructions on how to do the test properly.

Previous research has shown that single tests aren’t reliable enough to distinguish functional pain from real medical problems. This study confirms that combining information—asking about warning signs and using multiple stool tests—is a better approach. The accuracy rate of 84% is promising compared to earlier studies that relied on single tests or clinical judgment alone.

This study looked back at past medical records rather than following children forward, which is less reliable than a prospective study. All children were already diagnosed at a hospital, so results might not apply to children seen in regular doctor’s offices. The study didn’t include all possible causes of belly pain, and the warning signs used might not work the same way in different populations or settings. The researchers didn’t test whether this approach would work in primary care settings where most children first see doctors.

The Bottom Line

For children with chronic belly pain, doctors may consider using a combination of warning sign questions plus stool tests (calprotectin and hidden blood) as a first step before considering more invasive procedures. This approach appears to be reasonably accurate (moderate to high confidence) for distinguishing functional pain from real medical problems. However, this should be part of a complete evaluation by a healthcare provider, not a replacement for clinical judgment.

Parents of children with long-lasting belly pain should know about this approach. Pediatricians and gastroenterologists may find this useful for deciding which children need further testing. Children with warning signs like blood in stool, severe weight loss, or nighttime pain should still get thorough evaluation. This approach may be less useful in children with obvious symptoms of serious disease.

Stool test results typically come back within 1-2 weeks. If the combination of warning signs and stool tests suggests functional pain, improvement might take weeks to months with appropriate treatment focusing on diet, stress management, and lifestyle changes. If results suggest organic disease, further testing and treatment would follow.

Want to Apply This Research?

  • Track daily belly pain severity (1-10 scale), stool consistency, presence of any alarm symptoms (blood, weight loss, nighttime pain), and dietary intake. Record stool test results when available. This creates a clear picture over time to share with doctors.
  • Use the app to log warning signs and symptoms before doctor visits, ensuring nothing is forgotten. Set reminders for proper stool sample collection if testing is ordered. Track dietary changes and their relationship to pain patterns to identify potential triggers.
  • Over 4-8 weeks, monitor whether pain improves with lifestyle changes, diet modifications, or stress management. If alarm symptoms appear or pain worsens, flag for immediate doctor contact. Use the app to track whether recommended treatments are helping, providing objective data for follow-up appointments.

This research describes how doctors might use stool tests to help diagnose belly pain in children, but it should not replace professional medical evaluation. If your child has chronic belly pain, especially with warning signs like blood in stool, significant weight loss, or nighttime pain, consult a pediatrician or gastroenterologist for proper diagnosis and treatment. This study was conducted in a hospital setting and may not apply to all children or healthcare settings. Always follow your doctor’s recommendations for your child’s specific situation.