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MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
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  3. Aerophagia
Functional GI

Aerophagia

Rome IV — distension that increases through the day

Two months, in line with the rest of the child and adolescent chapter.

Often observable during the consultation, and frequently associated with anxiety, chewing gum or carbonated drinks.

The diurnal pattern is the diagnostic feature. Distension that is constant, or worse in the morning, points elsewhere.

The swallowed air has to leave by one route or the other.

The one paediatric disorder where the physical sign is a distension that changes through the day — flat in the morning, prominent by evening, and gone again after sleep.

When to use
Use it in a child with visible abdominal distension where the examination findings change depending on when you look. It is worth thinking of specifically in two settings: a child with anxiety and habitual air swallowing, and a child with neurodevelopmental disability, where aerophagia is considerably more common, frequently severe, and easily attributed to constipation instead. The single most useful question in the history — does the abdomen look normal when the child wakes up? — is rarely asked.
Why use it
Because the alternative to recognising it is a surgical work-up. A distended abdomen with gas throughout the bowel on a plain film looks like obstruction, and children with aerophagia are investigated for it, sometimes repeatedly and occasionally to the point of laparotomy. Severe cases genuinely can cause volvulus and, rarely, perforation, so the concern is not misplaced — but the diagnosis is available from the history at no cost. The second reason is that recognising it changes the treatment from something invasive to something behavioural: the gas is being swallowed, and stopping the swallowing is the only intervention that works.
Formula, evidence and interpretation

About the Rome IV Criteria for Aerophagia

Five criteria, all required, over at least two months. Excessive air swallowing. Abdominal distension due to intraluminal air which increases during the day. Repetitive belching and/or increased flatus. And, after appropriate evaluation, symptoms not fully explained by another medical condition. The second criterion is the one that makes the diagnosis: an abdomen that is flat on waking, becomes progressively more distended through the day, and is flat again the next morning. Distension that is constant, or worse first thing, is not aerophagia.

On this page

  • Formula
  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Formula

Aerophagia = ≥ 2 months AND excessive air swallowing AND abdominal distension due to intraluminal air, increasing during the day AND repetitive belching and/or increased flatus AND another medical condition excluded after appropriate evaluation
Increases during the day
The temporal signature. Air is swallowed only while awake, so the abdomen empties overnight and refills through the day — a pattern no organic cause of distension reproduces.
Intraluminal air
Distinguishes this from distension due to fluid, mass or organomegaly. Percussion is resonant throughout and plain imaging, if obtained, shows gas from stomach to rectum.
Repetitive belching
In children this overlaps with supragastric belching, where air is drawn into the oesophagus and immediately expelled — a related behaviour with the same behavioural treatment.
  • Rome IV places aerophagia in the nausea and vomiting chapter of the child and adolescent criteria, which reflects presentation rather than mechanism.
  • The adult Rome IV criteria have no equivalent standalone disorder; adults with the same behaviour are captured under belching disorders.
  • Aerophagia is substantially more common and more severe in children with neurodevelopmental disability.
  • Severe cases have been reported to cause volvulus and, rarely, perforation, so the distension is not always benign.

Interpreting the result

Meeting criteria should redirect the assessment towards behaviour and away from imaging. Address the identifiable contributors first, because they are easy and often sufficient: stop chewing gum, carbonated drinks and straws; slow the pace of eating; and check for mouth breathing and nasal obstruction. Then look at anxiety, which is a frequent driver and a treatable one — cognitive and behavioural approaches work here, and in children with neurodevelopmental disability a structured behavioural programme is more appropriate than a psychological one. Speech and language therapy input can be valuable where the swallowing pattern is habitual and needs to be unlearned. Be cautious about abdominal imaging: gas throughout the bowel in a child with aerophagia is expected, and reporting it as obstruction is a well-recognised route to unnecessary surgery. That said, the abdomen should not be dismissed — sudden severe pain in a child with known aerophagia deserves the same urgency as in any other child, since the mechanical complications are real. Where criteria are not met, the failing criterion directs you: distension that does not vary through the day suggests constipation, coeliac disease or carbohydrate malabsorption instead.

ScoreBandWhat it meansAction
Criteria metAerophagiaAir swallowing with diurnal distension, belching or flatus, over at least two monthsBehavioural approach — stop gum, fizzy drinks and straws; slow eating; address anxiety; avoid surgical referral for the distension itself
Criteria not met — distension does not varyPattern does not fitDistension constant, or present on wakingConsider constipation, coeliac disease, carbohydrate malabsorption and organomegaly
Criteria not met — organic cause foundNot aerophagiaAnother medical condition explains the distensionTreat the underlying condition

What the Aerophagia needs (5 inputs)

Criteria fulfilled for at least 2 months prior to diagnosis
Two months, in line with the rest of the Rome IV child and adolescent chapter and shorter than the adult durations.
Excessive air swallowing
Often observable during the consultation once you are looking for it. Common contributors are anxiety, chewing gum, carbonated drinks, drinking through straws, and eating quickly.
Abdominal distension due to intraluminal air which increases during the day
The diagnostic feature. The abdomen is flat on waking and progressively distends through the waking hours, because swallowed air accumulates while awake and is not swallowed during sleep.
Repetitive belching and/or increased flatus
The swallowed air has to leave by one route or the other. Either alone satisfies the criterion.
After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
Obstruction, coeliac disease, carbohydrate malabsorption and constipation all produce distension and need to be considered.

What it returns

Criteria met or not met
All five are required, including the duration rule.
Which criterion is outstanding
Reported when criteria are not met, since the failing criterion usually points to the alternative diagnosis.

How it is calculated

Small amounts of air are swallowed with every meal and every drink and are ordinarily dealt with by belching and by passage through the gut. Aerophagia is that normal process at pathological volume: air is swallowed repeatedly, often outside of eating, and accumulates faster than it can be cleared. Because swallowing essentially stops during sleep, the accumulated gas passes overnight and the abdomen is flat by morning — which is why the diurnal pattern is diagnostic rather than merely characteristic. The behaviour itself sits at the anxious end of habit: it is frequently seen alongside anxiety, and in children with neurodevelopmental disability it can be a repetitive behaviour like any other. The clinical significance is mechanical. A bowel loaded with gas is distended, uncomfortable and, in extreme cases, at risk of rotating on its mesentery, which is why the rare reports of volvulus and perforation exist. Everything about management follows from the fact that the gas is entering by mouth.

Facts & figures

Childhood abdominal distension — what the pattern tells you
PatternSuggestsDiscriminating question
Flat on waking, distended by eveningAerophagiaDoes the tummy look normal first thing in the morning?
Constant distension with infrequent hard stoolsFunctional constipationHow often are the bowels opened, and are stools large or hard?
Distension with faltering growthCoeliac disease, malabsorptionIs growth tracking along the centiles?
Distension after specific foods or drinksCarbohydrate malabsorptionDoes it follow milk, juice or particular sugars?
Distension with vomiting and painObstructionIs there bilious vomiting or absolute constipation?
Distension that is dull to percussionFluid, mass or organomegalyPercuss rather than inspect

Asking what the abdomen looks like on waking takes seconds and separates aerophagia from almost everything else on this list.

Evidence

Derivation — Rome Foundation, child/adolescent committee

2016

Consensus criteria from the Rome IV committee on childhood functional gastrointestinal disorders in the child and adolescent age band, published in Gastroenterology in 2016.

Consensus-derived. Rome IV retained aerophagia as a distinct paediatric disorder despite having no standalone adult equivalent, and built the definition around the diurnal pattern of distension rather than around the swallowing behaviour itself.

How it compares

Aerophagia vs Belching disorders

The adult home for the same behaviour — Rome IV splits supragastric from gastric belching in adults, and gives children a distension-based disorder instead.

The adult belching disorders require intraluminal impedance measurement to separate supragastric belching, where air is drawn into the oesophagus and immediately expelled, from gastric belching, which has no established clinical correlate. The paediatric criteria take a different route entirely, defining aerophagia by the abdominal consequence rather than by the belch. The reason is presentational: adults come with the belching, children come with the abdomen. In an older adolescent both frameworks may fit, and impedance testing is worth considering where belching rather than distension dominates.

Open the Belching disorders calculator →

Aerophagia vs Functional bloating and distension

Both feature distension, but only aerophagia empties overnight and requires the air to be swallowed.

Functional abdominal bloating and distension is an adult bowel disorder in which bloating or distension predominates without meeting criteria for another bowel disorder, and it need not have a diurnal pattern or any demonstrable excess of intraluminal gas. Aerophagia requires both — gas that is genuinely swallowed and distension that increases through the waking day. The distinction matters because the treatments diverge completely: behavioural interruption of air swallowing on one hand, and the dietary and gut-brain approaches used in functional bowel disorders on the other.

Open the Functional bloating and distension calculator →

Aerophagia vs Paediatric functional constipation

The commonest alternative explanation for a distended child, and the one most likely to be diagnosed by default.

Constipation is far commoner than aerophagia and produces distension that does not follow a diurnal pattern, alongside infrequent, large or hard stools and often a palpable faecal mass. It is worth excluding properly rather than assuming, particularly in children with neurodevelopmental disability where both conditions are common and can coexist. Where they do, treating the constipation will improve the abdomen but will not abolish a distension that reappears every afternoon.

Open the Paediatric functional constipation calculator →Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150(6):1456-1468.

Pearls & pitfalls

  • Ask what the abdomen looks like on waking. Flat in the morning and distended by evening is the diagnosis.
  • Distension that is constant or worse first thing is not aerophagia.
  • Be careful with plain films — gas throughout the bowel is expected here and is regularly misreported as obstruction.
  • Aerophagia is much more common and more severe in children with neurodevelopmental disability, and is often attributed to constipation instead.
  • Look for the mechanical contributors first: gum, carbonated drinks, straws, fast eating, mouth breathing.
  • Anxiety is a frequent driver and is treatable; ask about it rather than only about the abdomen.
  • Percuss the abdomen. Resonance throughout supports gas; dullness points to fluid, mass or organomegaly.
  • Severe aerophagia has caused volvulus and perforation, so sudden severe pain still warrants urgent assessment.
  • Speech and language therapy can help where the swallowing pattern has become habitual.
  • There is no adult equivalent disorder in Rome IV — adults with the same behaviour are classified under belching disorders.

Critical actions

  • Ask specifically whether the abdomen is flat on waking and distends through the day.
  • Examine the abdomen at more than one time of day where possible, and percuss rather than only inspect.
  • Take a dietary and behavioural history covering gum, carbonated drinks, straws and eating pace.
  • Assess for anxiety, and in children with neurodevelopmental disability, for repetitive behaviours.
  • Check for nasal obstruction and mouth breathing.
  • Exclude constipation with a proper stool history and, where indicated, examination.
  • Consider coeliac serology and carbohydrate malabsorption where the pattern does not fit.
  • Avoid repeated abdominal imaging, and where a film is obtained, interpret gas distribution in the light of the diagnosis.
  • Refer for behavioural or speech and language input where simple measures do not resolve it.

Why this score exists

It is worth noticing that aerophagia exists as a named disorder in the paediatric criteria and not in the adult ones, where the same behaviour is folded into belching disorders. That asymmetry is not an oversight. In adults, excessive air swallowing presents as belching, which is socially conspicuous and is what brings people to clinic — so classifying it among the belching disorders captures how it actually turns up. In children the presenting problem is frequently the abdomen: a visibly distended child, an anxious family, and a plain film showing gas everywhere. Those two presentations lead to entirely different differentials and entirely different risks, and the paediatric one carries a real hazard of surgical intervention for a behavioural condition. Giving it a separate name and, crucially, building the definition around the diurnal pattern rather than the belching is what makes it recognisable before someone operates. The criteria are, in effect, designed to interrupt a specific diagnostic error.

About the creator

  • Jeffrey S. Hyams

    First author, Rome IV child/adolescent functional gastrointestinal disorders committee

    Chaired the committee that produced the child and adolescent criteria, including aerophagia.

  • Carlo Di Lorenzo

    Co-author; paediatric neurogastroenterology and motility

    Contributed to the Rome IV paediatric criteria across the chapter.

  • Annamaria Staiano

    Co-author; paediatric gastroenterology

    Co-authored the child and adolescent chapter of Rome IV.

Limitations

  • Consensus criteria with no validation study and no discrimination statistics.
  • 'Excessive' air swallowing is not quantified, and swallowing is rarely observed directly.
  • The diurnal pattern relies on caregiver observation at two points in the day, which is not always available.
  • No severity grading, despite severe cases carrying a genuine risk of volvulus and perforation.
  • The criteria give no guidance on when imaging is warranted, which is the main practical question they raise.
  • Overlap with supragastric belching is not addressed, and the two are managed similarly but classified separately.
  • Children with neurodevelopmental disability, in whom the disorder is commonest, may not be able to report symptoms in the terms the criteria use.
  • No adult equivalent exists in Rome IV, which complicates transition to adult services.

If you are the patient

Aerophagia means swallowing more air than usual, so that it builds up in the stomach and bowel and makes the tummy swell. The giveaway is the timing: the tummy is flat when your child wakes up, gets steadily bigger through the day, and is flat again the next morning. That happens because air is only swallowed while awake, so it collects during the day and passes overnight. Along with the swelling there is usually a lot of burping, wind, or both. It is not caused by anything wrong with the bowel itself, and it is not a food intolerance. Some common habits make it much worse and are worth stopping first: chewing gum, fizzy drinks, drinking through straws, and eating quickly. Breathing through the mouth, often because of a blocked nose, also contributes. Feeling anxious is a frequent cause of the swallowing itself, so if that is part of the picture, addressing it usually helps the tummy too. One thing worth knowing is that an X-ray in this condition shows gas all through the bowel, which can look alarming and is sometimes mistaken for a blockage. That is expected in aerophagia and is not a reason for an operation. Having said that, if your child develops sudden severe tummy pain, that should always be checked urgently — very occasionally a lot of trapped gas can cause a real problem. The treatment is about changing the swallowing habit rather than taking anything for the gas, and it usually works.

Frequently asked questions

What are the Rome IV criteria for aerophagia?#

Excessive air swallowing; abdominal distension due to intraluminal air which increases during the day; repetitive belching and/or increased flatus; and, after appropriate evaluation, symptoms not fully explained by another medical condition — all fulfilled for at least two months prior to diagnosis.

What makes the diagnosis?#

The diurnal pattern. An abdomen that is flat on waking, distends progressively through the day and is flat again the next morning is aerophagia, because air is swallowed only while awake. No organic cause of distension reproduces that pattern, and asking about it takes seconds.

Why is it worth recognising rather than investigating?#

Because the investigation leads somewhere unhelpful. A distended abdomen with gas throughout the bowel on a plain film looks like obstruction, and children with aerophagia have been investigated repeatedly and occasionally operated on as a result. The diagnosis is available from the history at no cost.

Is aerophagia dangerous?#

Usually not, but not never. Severe cases have caused volvulus and, rarely, perforation, so a known diagnosis of aerophagia does not mean sudden severe abdominal pain can be dismissed. The routine distension is benign; an acute deterioration is not.

Why is it more common in children with disability?#

Because habitual air swallowing behaves like any other repetitive behaviour, and it is both commoner and more severe in that group. It is also more likely to be attributed to constipation there, since constipation is also common — so the diurnal pattern needs to be asked about explicitly rather than assumed away.

What treatment works?#

Behavioural measures. Stop chewing gum, carbonated drinks and straw use, slow the pace of eating, and address mouth breathing and nasal obstruction. Where anxiety is driving the swallowing, treating it helps the abdomen. Speech and language therapy can help unlearn a habitual swallowing pattern, and structured behavioural programmes are more appropriate than psychological therapy in children with neurodevelopmental disability.

Why is there no adult version of this disorder?#

Because adults with the same behaviour present with belching rather than distension, so Rome IV classifies them under the belching disorders instead. The paediatric criteria are built around the abdominal consequence because that is what brings children to clinic — and because it is the presentation that risks a surgical work-up.

What else causes a distended abdomen in a child?#

Constipation is the commonest and produces distension that does not vary through the day. Coeliac disease and other malabsorption typically come with faltering growth. Carbohydrate malabsorption follows specific foods or drinks. Fluid, mass and organomegaly are dull rather than resonant to percussion, which is why percussing rather than only inspecting is worth the extra few seconds.

Related calculators

  • Belching Disorders — Rome IV — supragastric vs gastric belching
  • Functional Bloating / Distension — Rome IV — bloating without other bowel disorder criteria
  • Paediatric Functional Constipation — Rome IV — two of six over one month, with overflow soiling as a criterion
  • Paediatric Functional Dyspepsia — Rome IV — four times a month, with PDS and EPS subtyping
  • Functional Abdominal Pain — NOS — Rome IV — the residual category, reached after the other three

References

Original / primary reference

  1. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150(6):1456-1468 (Rome IV).

Related adult criteria

  1. Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392 (Rome IV belching disorders).

Last updated August 1, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.