Version July 2025
| Pain |
| When did it start? Is it better, worse, or about the same? |
| When does it occur? Is it sharp, dull, crampy? |
| Is it constant, or does it come and go? |
| Where does it hurt? Does it move to other areas? |
| How severe is the pain? |
| Does the pain wake the child from sleep? |
| How do you know that the child is in pain? |
| How do the caregivers and other adults respond to the child's pain? |
| Have any tests been done by other health care providers? If so, bring records. |
| Does anything make the pain worse or better (eg, passing bowel movements, walking, resting, medicines)? |
| Other symptoms |
| Has the child lost weight? Was it intentional or unintentional? |
| Are there other symptoms (eg, nausea, vomiting, gas, diarrhea)? |
| Do meals or specific foods cause pain? |
| Are there respiratory symptoms (eg, coughing, wheezing, hoarse voice)? |
| Habits |
| Have the child's eating habits changed (eg, restricting foods, binge eating, taking a long time to eat)? |
| How frequently does the child move their bowels? Are they ever "too busy" to finish a bowel movement? |
| Have there been episodes of unintentional fecal incontinence (stool in underwear) recently? |
| Social history |
| Has the child's attendance at school or social activities been affected by their pain? |
| Is the child or adolescent feeling stress (eg, recent move, new sibling, new school, illness or death, not doing well in school, experiencing bullying)? |
| Is the family experiencing stress (eg, divorce, financial stress, conflict, mental health challenges)? |
