A systematic approach to management of abdominal pain in preverbal and nonverbal children in the emergency department.

Abdominal pain is a common reason for pediatric patients to present to the emergency department. Pain assessment is especially challenging when patients are unable to communicate due to their developmental stage or medical conditions. Preverbal and nonverbal children are at increased risk for complications of delayed or missed diagnosis. Inadequate pain control is also a concern in this vulnerable population. This review provides guidance for assessment of abdominal pain in preverbal and nonverbal children, focusing on behavioral measures, which are more applicable and reliable in these patients, and on the effective use of parental input. Recommendations are given for a graduated approach to pain management, including nonpharmacologic and pharmacologic options.