Pediatrics. 2025 Feb 1;155(2):e2024067677.doi: 10.1542/peds.2024-067677.

Nicolaas Koen Vermeijden ^1 2 3 4, Leilani de Silva ⁵, Supun Manathunga ⁶, Daphne Spoolder ⁷, Judith Korterink ⁸, Arine Vlieger ⁴, Shaman Rajindrajith ⁹, Marc Benninga ¹

Author information

¹Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

²Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Center, Academic Medical Centre/Emma Children's Hospital, Amsterdam, the Netherlands.

³Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.

⁴Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands.

⁵Mindworx Psychology, Baulkham Hills, Australia.

⁶Department of Pharmacology, University of Peradeniya, Sri Lanka.

⁷Knowledge and Information Centre, St Antonius Academy, St Antonius Hospital, Nieuwegein, the Netherlands.

⁸Department of Pediatrics, Gelre Hospital, Zutphen, the Netherlands.

⁹Department of Paediatrics, University of Colombo, Sri Lanka.

Abstract

Context: Functional abdominal pain disorders (FAPDs) are debilitating disorders with unknown current prevalence.

Objective: To estimate global prevalence rates of FAPDs, their entities, and variations by diagnostic criteria, geography, gender, and age.

Data sources: Medline, Embase, CINAHL, PsycInfo, and Cochrane Library were searched through October 14, 2024.

Study selection: Epidemiological studies of birth cohorts, school based, and from general population samples reporting FAPD prevalence in children (aged 4-18 years) using the Rome criteria.

Data extraction: Two researchers independently performed screening, data extraction, and quality assessment.

Results: A total of 66 studies, encompassing 201 134 participants from 29 countries, were included. The estimated global pooled prevalence of FAPDs was 11.7% (95% CI, 10.5%-13.1%). The most prevalent type was irritable bowel syndrome (5.8%; 95% CI, 4.5-7.4%), while functional abdominal pain-not otherwise specified was least prevalent (1.2%; 95% CI, 0.7%-2.1%)). Prevalence was highest using Rome III (13.2%; 95% CI, 11.3%-15.3%) and lowest under Rome IV criteria (9.0%; 95% CI, 6.7%-12.0%; P = .05). Girls had higher prevalence (14.4%; 95% CI, 12.5%-16.6%) than boys (9.4%; 95% CI, 7.8%-11.4%; P < .01). FAPDs were nonsignificantly more prevalent in Asia (13.0%; 95% CI, 10.4%-16.3%) compared to Europe (8.3%; 95% CI, 6.4%-10.7%) and North America (7.7%; 95% CI, 4.3-13.6; P = .09). No differences by age (P = .14) were recorded. Contributing factors include anxiety, depression, stress, negative life events, and poor sleep.

Limitations: Language restrictions, significant interstudy heterogeneity, and underrepresentation from Africa.

Conclusions and relevance: FAPDs affect over 1 in 9 children worldwide, with higher prevalence in girls and those with psychological stressors.