Introduction: Recurrent Abdominal Pain (RAP) is a frequent complaint in school children, and in 2/3 of cases is due to Irritable Bowel Syndrome (IBS) the rest being due dyspepsia either functional or of organic origin (Hyams, JPGN 1995). Diagnosis can be made on a correct collection of symptom characteristics or associated symptoms (Drossman, Gut 1999) but children or parents may give an incomplete history, because retrospective collection of past symptoms may be inaccurate. Aim: to evaluate diagnostic accuracy and usefulness of a structured 2-week diary card to prospectively collect symptoms and their characteristics in children with RAP. Methods: All consecutive children presenting with RAP had to complete a structured diary for 2 weeks with intensity, location and relationship with meals of each pain episode, associated symptom like nausea, vomiting, acid regurgitation and early satiety, and characteristics of bowel movements. An independent investigator assessed all the children and, when required, performed blood or stool tests or endoscopy. All children had a follow up of 3 to 12 months. Results: In 4 years 179 diary cards were obtained, 50 were excluded because of drug use or absence of pain during data collection or incorrectly completed; 129 were analysed and supposed diagnosis were: dyspepsia in 68, IBS in 50, functional RAP in 11 cases. They were compared with final diagnosis obtained by gastroscopy in 54 or by follow-up in 75, and were concordant in 49 of 54 cases of dyspepsia (sensitivity 90%) and in 70 of 75 of functional RAP (93%) An organic disease was found in 63 (49%) children with RAP. In 56 (43%) symptoms fulfilled the criteria for IBS (RasquinWeber, Gut 1999) Conclusion: A 2-week diary for a prospective collection of symptoms seems an accurate and useful tool to reach a diagnosis in children with RAP. An organic disease was present in almost half of our patients.