A5-year-old male is brought for an office visit by his parent witha chief complaint of recurrent abdominal pain. the pain is reported to be worse in the morning before school but can come at other times during the day. the child has started to cry before school, complaining that he doesn't want to get "tummy pain."

Check for bruising on his abdomen, ask him about school, ask if the kids are nice, if he won’t answer that question, ask him again, if he looks to his parent, ask them to step out of the room, if it’s not any sort of bullying, which is what it could be, then have the parent come back in. ask what he eats for lunch. ask what he does during school. make sure he’s not being forced to do anything.

if it’s not any of that then it could be appendicitis, a kidney stone, or stress related abdominal pain. i’d ask the parent about his recent bathroom habits, make sure there wasn’t any pain with using the rest room, both ways around, i’d feel around in the related area and run an x-ray, and if that didn’t show anything then i’d run a ct scan and go from there. it could be a ruptured bowel, though that probably wouldn’t be only hurting in the morning.