Abdominal pain is a common presenting complaint among children and adolescents. Although psychological factors may be involved, their role is not clear and a diagnosis of functional pain is often made only after extensive investigations. Specific psychological characteristics have been associated with abdominal pain in children, but little is known about the nature of the pain itself. A retrospective study was undertaken to characterize the subjective experience and description of abdominal pain in patients hospitalized for investigation of abdominal pain. Thirty subjects with proven inflammatory bowel disease (IBD) and 32 diagnosed as having functional abdominal pain (FAP) were studied. The age, sex distribution, and duration of the pain in these groups were similar. Seven (23%) patients with IBD used imagery to describe their pain in contrast to 25 (78%) of those with FAP (P less than 0.01). Neither age nor duration of pain was associated with the use of imagery. The use of imagery was significantly associated with the diagnosis of FAP (P less than 0.01). A more detailed characterization of the way patients describe abdominal pain might assist in diagnosing its etiology.