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Pediatric patients present a challenge to EMS clinicians for a variety of reasons. As a rule, pediatric patients are not high‐volume users of the EMS system. In addition, infants and children may be unable to describe their symptoms, which is particularly problematic given the importance of historical data in establishing a cause. It is important to discuss the history of the patient’s symptoms and the reason why EMS was called with a parent or guardian familiar with the situation. Nonspecific findings such as irritability, inability to be consoled, and poor feeding may be the only signs of an abdominal problem in the very young. Vomiting, oral intake, urine output, last bowel movement, presence of fever, sick contacts, and vaccination status are useful points from the history. The birth history is important when treating a neonate. Questions that should be asked include whether the pregnancy was at term at the time of birth, did the mother receive prenatal care, were there any complications during the delivery, did the patient require an extended hospital stay after the birth, and have there been any subsequent hospitalizations since birth for any reason. Vital signs can be difficult to interpret in the pediatric population due to age‐related variations and the tremendous physiologic reserve that these patients possess. The examination can be compromised by the patient’s fear of pain and of the unfamiliar examiner. Finally, abdominal pain is a particularly common complaint in many extra‐abdominal conditions, as discussed above [41].

Age is a key factor in the evaluation of abdominal pain in the pediatric patient. For patients up to 1 year old, some of the considerations include infantile colic, Hirschsprung’s disease, necrotizing enterocolitis, intussusception, pyloric stenosis, volvulus, and incarcerated hernia. Bilious vomiting accompanying abdominal pain in an infant is particularly concerning, often indicating an acute surgical problem. Between 2 and 5 years old, consider testicular torsion, Henoch‐Schonlein purpura (HSP), intussusception, and appendicitis. Older children between 5 years and adolescence can have inflammatory bowel disease, testicular torsion, HSP, and pharyngitis. This is not an all‐encompassing list, but more of a differential diagnosis with which to start when obtaining the history.

On initial presentation, it may be difficult for EMS clinicians to distinguish a benign condition in children from a true surgical emergency. Up to one third of pediatric patients admitted to the ED fail to have diagnoses at the time of discharge, and a significant number of ED discharge diagnoses may be incorrect [41, 42]. Extrapolating such information to prehospital conditions makes it apparent that there should be a low threshold for transporting pediatric patients with abdominal pain.