Recurrent abdominal pain in childhood
TL;DR: It is important to recognize that many patients and their parents are fearful of the pain as a symptom and are not easily able to incorporate a concept of disorder of a gastrointestinal function at the onset.
Abstract: One hundred and two children with recurrent abdominal pain were studied and followed through hospitalization. The pain in this group was variable, with no consistent pattern in time, duration, and intensity. It was located in the periumbilical region in 50 of the patients. Associated symptoms frequently included headache, pallor, nausea, vomiting, constipation, dizziness, and poor appetite. The principal physical finding was tenderness on deep palpation over various sections of the abdomen. Proctoscopic findings in 88 of 90 patients examined were rectal dilatation, hyperemic areas, pallor, lymphoid hyperplasia, pellet stools, edema, and friability. There were no other abnormal laboratory or x-ray findings. Various behavioral manifestations were observed in this group of children. Some of the children were able to delineate points of stress as precipitants of episodes of pain. During hospitalization there was total abatement of intestinal symptoms in 53% of the children and there was a decline in symptomatology in another 38%. It is proposed that the abdominal manifestations of this group of patients can be described as the irritable bowel syndrome in childhood.
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TL;DR: Recurrent abdominal pain and symptoms of IBS are commonly noted in a community-based adolescent population and frequently result in use of health care resources, and anxiety and depression scores were significantly higher for students with IBS-type symptoms compared with those without symptoms.
521 citations
TL;DR: Whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care is determined and treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions are examined.
Abstract: Objective. The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care. Methods. Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status. Results. RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety. Conclusions. Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.
448 citations
TL;DR: Investigation in pediatric patients with recurrent abdominal pain and comparison groups of patients with organic etiology for abdominal pain found chronicity of abdominal pain in RAP patients was not significantly associated with their level of somatization symptoms.
Abstract: Symptoms of somatization were investigated in pediatric patients with recurrent abdominal pain (RAP) and comparison groups of patients with organic etiology for abdominal pain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3- month followup. Higher somatization scores in mothers and fathers were associated with higher somatization scores in RAP patients, but not in organic or well patients. Contrary to the findings of Ernst, Routh, and Harper (1984), chronicity of abdominal pain in RAP patients was not significantly associated with their level of somatization symptoms. Psychometric information about the Children's Somatization Inventory is presented.
289 citations
TL;DR: Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting.
Abstract: Objective To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment. Method One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization. Results Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R -defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services. Conclusion Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.
270 citations