Once the diagnosis is confirmed, frequent examinations should be avoided because they may focus on or magnify the physical complaints or imply that the physician lacks confidence in the diagnosis. UTI, which may be experienced as abdominal or pelvic pain with no referral to the flank or the urethra, will be missed unless tested for specifically. Because pain may not occur for up to 2 h after ingestion of milk or a milk product, lactose intolerance may not be suspected initially. Laboratory Findings Laboratory studies should be ordered promptly to allay patient and parent anxiety. Prognosis and Treatment Psychogenic RAP has a guarded long-term prognosis, and no treatment regimen is universally successful.
Some children later develop other somatic complaints or emotional difficulties.
In organic or functional RAP, the prognosis depends on the underlying condition. Psychogenic RAP requires a trusting relationship between the physician and family. Even if the physician is fairly certain during the initial visit that the RAP is psychogenic, it is premature to suggest specific treatment. Most parents are concerned about an organic cause, and, unless reassured by the diagnostic work-up and interpretation of the findings, are unlikely to react favorably or consistently to a behavioral management plan. As soon as possible after laboratory findings are available, a follow-up appointment should be scheduled.