The Use of Pictograms in the Evaluation of Functional Abdominal Pain Disorders in Children

Clara M. A. de Bruijn, Robyn Rexwinkel, Nicolaas K. Vermeijden, Ilse Hoffman, Jan Tack, Marc A. Benninga

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To evaluate whether the use of pictograms improves symptom evaluation for children with functional abdominal pain disorders (FAPDs). Study design: This survey study was conducted in 2 academic centers and included patients aged 8-18 years visiting the outpatient clinic for FAPD symptom evaluation. Patients were randomized to fill out the questionnaire without or with accompanying pictograms to assess gastrointestinal symptoms. Afterwards, patients underwent clinical health assessment by the healthcare professional (HCP). Subsequently, the HCP filled out the same questionnaire without pictograms, while blinded to the questionnaire completed by the patient. Primary outcome was the level of agreement between identified symptoms as assessed by patients and HCP. Results: We included 144 children (questionnaire without accompanying pictograms [n = 82] and with accompanying pictograms [n = 62]). Overall agreements rates were not significantly different (without pictograms median, 70% vs with pictograms median, 70%). Accompanying pictograms did not significantly improve the assessment of abdominal pain symptoms. Accompanying pictograms were beneficial for concordance rates for nausea and vomiting symptoms (without pictograms median, 67% vs with pictograms median, 100%; P = .047). Subgroup analyses for children aged 8-12 years of age revealed similar results (concordance on the presence of nausea and vomiting without pictograms median, 67% vs with pictograms median, 100%; P = .015). Subgroup analyses for children ages 12-18 years showed no significant differences in concordance rates. Conclusions: Pictograms do not seem to improve the assessment of FAPDs. However, the use of pictograms improves the evaluation of nausea and vomiting, especially for children aged 8-12 years. Therefore, HCPs could consider using pictograms in that setting during consultations.
Original languageEnglish
Article number113647
JournalJournal of pediatrics
Publication statusPublished - 1 Dec 2023


  • children
  • functional abdominal pain disorders
  • pictograms

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