Alarm Symptoms & Red Flags
These findings require immediate attention and may indicate serious or life-threatening conditions. Always assess for red flags before considering functional diagnoses.
Bilious (green) vomiting
Action: Immediate surgical consultation - rule out malrotation/volvulus
Involuntary guarding or rebound tenderness
Action: Urgent surgical evaluation - peritonitis
Hematemesis (bloody vomiting)
Action: Urgent GI evaluation, check hemoglobin, consider endoscopy
Toxic/critically ill appearance
Action: Immediate resuscitation, IV access, broad-spectrum antibiotics
Significant rectal bleeding (hematochezia/melena)
Action: Check hemoglobin, type and cross, GI consultation
Involuntary weight loss
Action: Investigate for organic disease - CBC, ESR, CRP, celiac serology
Deceleration of linear growth
Action: Plot growth chart, investigate for chronic disease
Persistent right lower quadrant pain
Action: Rule out appendicitis - consider ultrasound
Nocturnal symptoms waking child
Action: Investigate for organic cause - less likely functional
Unexplained persistent fever
Action: Full septic workup, inflammatory markers
Family history of IBD
Action: Lower threshold for investigation - fecal calprotectin, ESR
Delayed puberty
Action: Investigate for chronic disease affecting growth
Perianal disease (tags, fissures, fistulae)
Action: Investigate for Crohn disease
Joint symptoms with abdominal pain
Action: Consider IBD, HSP, celiac disease
Dysphagia
Action: Consider upper endoscopy - rule out eosinophilic esophagitis
Clinical Pearl
The presence of ANY red flag should prompt immediate investigation and consideration of organic disease. Functional abdominal pain should only be diagnosed after thorough exclusion of alarm symptoms. Remember: "Bilious vomiting in a neonate is malrotation until proven otherwise."