Unifying Concepts

ROME II Diagnostic Criteria for Childhood Functional Gastrointestinal Disorders

The diagnosis of a Childhood Functional Gastrointestinal Disorder always presumes the absence of a structural or biochemical explanation for the symptoms.


G1a. Infant Regurgitation

  1. Regurgitation 2 or more times per day for 3 or more weeks;
  2. There is no retching, hematemesis, aspiration, apnea, failure-to-thrive, or abnormal posturing;
  3. The infant must be 1 to 12 months of age and otherwise healthy; and
  4. There is no evidence of metabolic, gastrointestinal, or central nervous system disease to explain the symptom.

G1b. Infant Rumination Syndrome

  1. At least 3 months of stereotypical behavior beginning with repetitive contractions of the abdominal muscles, diaphragm, and tongue, and culminating in regurgitation of gastric contents into the mouth, which is either expectorated or rechewed and reswallowed, and 3 or more of the following:
  1. Onset between 3 and 8 months of age;
  2. Does not respond to management for gastroesophageal reflux disease, anticholinergic drugs, hand restraints, formula changes, and gavage or gastrostomy feedings;
  3. Unaccompanied by signs of nausea or distress; and/or
  4. Does not occur during sleep and when the infant is interacting with individuals in the environment.

G1c. Cyclic Vomiting Syndrome

  1. A history of 3 or more periods of intense, acute nausea, and unremitting vomiting lasting hours to days, with intervening symptom-free intervals lasting weeks to months.
  2. There is no metabolic, gastrointestinal, or central nervous system structural or biochemical disease.

G2. Abdominal Pain

G2a. Functional Dyspepsia

In children mature enough to provide an accurate pain history, at least 12 weeks, which need not be consecutive, in the preceding 12 months of:

  1. Persistent or recurrent pain or discomfort centered in the upper abdomen (above the umbilicus);
  2. No evidence of organic disease (including at upper endoscopy) that is likely to explain the symptoms; and
  3. No evidence that dyspepsia is exclusively relieved by defecation or associated with onset of a change in stool frequency or stool form (i.e., not irritable bowel).

G2a1. Ulcer-like Dyspepsia: Pain centered in the upper abdomen is the predominant (most bothersome) symptom.

G2a2. Dysmotility-like Dyspepsia: An unpleasant or troublesome nonpainful sensation (discomfort) centered in the upper abdomen is the predominant symptom; this sensation may be characterized by early satiety, upper abdominal fullness, bloating, or nausea.

G2a3. Unspecified (Nonspecific) Dyspepsia: Symptomatic patients whose symptoms do not fulfill the criteria for either ulcer-like or dysmotility-like dyspepsia.

G2b. Irritable Bowel Syndrome

In children old enough to provide an accurate pain history, at least 12 weeks, which need not be consecutive, of continuous or recurrent symptoms during the preceding 12 months of:

  1. Abdominal discomfort or pain that has two out of three features:
  1. Relieved with defecation; and/or
  2. Onset associated with a change in frequency of stool; and/or
  3. Onset associated with a change in form (appearance) of stool.
  1. There are no structural or metabolic abnormalities to explain the symptoms.

Symptoms that Cumulatively Support the Diagnosis of Irritable Bowel Syndrome

  • Abnormal stool frequency (for research purposes “abnormal” may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week);
  • Abnormal stool form (lumpy/hard or loose/watery stool);
  • Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation);
  • Passage of mucus;
  • Bloating or feeling of abdominal distension.

G2c. Functional Abdominal Pain

At least 12 weeks of:

  1. Continuous or nearly continuous abdominal pain in a school-aged child or adolescent; and
  2. No or only occasional relationship of pain with physiological events (e.g., eating, menses, defecation); and
  3. Some loss of daily functioning; and
  4. The pain is not feigned (e.g., malingering); and
  5. Insufficient criteria for other functional gastrointestinal disorders that would explain the abdominal pain.

G2d. Abdominal Migraine

  1. In the preceding 12 months, 3 or more paroxysmal episodes of intense, acute midline abdominal pain lasting 2 hours to several days, with intervening symptom-free intervals of weeks to months; and
  2. Evidence of metabolic, gastrointestinal, and central nervous system structural or biochemical diseases is absent; and
  3. Two of the following features:
  1. Headache during episodes;
  2. Photophobia during episodes;
  3. Family history of migraine;
  4. Headache confined to one side only; and
  5. An aura or warning period consisting of either visual symptoms (e.g., blurred or restricted vision) or sensory symptoms (e.g., numbness or tingling), or motor symptoms (e.g., slurred speech, inability to speak, paralysis).

G2e. Aerophagia

At least 12 weeks, which need not be consecutive, in the preceding 12 months of two or more of the following signs and symptoms:

  1. Air swallowing;
  2. Abdominal distension due to intraluminal air; and
  3. Repetitive belching and/or increased flatus.

G3. Functional Diarrhea (also called Toddler’s Diarrhea, chronic nonspecific diarrhea, irritable colon of childhood)

For more than 4 weeks, daily painless, recurrent passage of 3 or more large, unformed stools, in addition to all these characteristics:

  1. Onset of symptoms begins between 6 and 36 months of age;
  2. Passage of stools occurs during waking hours; and
  3. There is no failure-to-thrive if caloric intake is adequate.

G4. Disorders of Defecation

G4a. Infant dyschezia

At least 10 minutes of straining and crying before successful passage of soft stools in an otherwise healthy infant less than 6 months of age.

G4b. Functional Constipation

In infants and children, at least 2 weeks of:

  1. Scybalous, pebble-like, hard stools for a majority of stools; or
  2. Firm stools 2 or less times/week; and
  3. There is no evidence of structural, endocrine, or metabolic disease.

G4c. Functional Fecal Retention

From infancy to 16 years old, a history of at least 12 weeks of:

  1. Passage of large diameter stools at intervals < 2 times per week; and
  2. Retentive posturing, avoiding defecation by purposefully contracting the pelvic floor. As pelvic floor muscles fatigue, the child uses gluteal muscles, squeezing the buttocks together.

Accompanying symptoms may include fecal soiling, irritability, abdominal cramps, decreased appetite and/or early satiety. The accompanying symptoms disappear immediately following passage of a large stool.

G4d. Functional Non-retentive Fecal Soiling

Once a week or more for the preceding 12 weeks, in a child older than 4 years, a history of:

  1. Defecation into places and at times inappropriate to the social context;
  2. In the absence of structural or inflammatory disease; and
  3. In the absence of signs of fecal retention (listed in G4c above).



  1. Douglas A. Drossman. ROME II: The Functional Gastrointestinal Disorders, Second Edition

This material was taken from the ROME II. It is intended for educational purposes only.


Created: Mar 19, 2005


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