Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain

Lindley, Keith; Glaser, Danya; Milla, Peter J.

doi:10.1136/adc.2003.032524

Cited by 81 publications

(86 citation statements)

References 22 publications

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“…The impression is that family physicians consider NSAP in children to be a benign disorder needing little more than reassurance of parent and child. This view, how-ever, contradicts the presence of psychological comorbidity, [5][6][7][8] other nonspecifi c somatic symptoms, 5,7,9 and the high prevalence of prolonged symptoms 11 found in children referred to secondary and tertiary care. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents of children with NSAP are found to be hard to reassure.…”

Section: Introductionmentioning

confidence: 78%

“…These fi ndings are remarkable, because in referred children it has been shown that NSAP has a chronic course, 10 and parents are found to be demanding and diffi cult to reassure. 11,12 Maybe the family physicians successfully managed early stages of NSAP. That is the family physician reassured the child and parents that there were no severe underlying disorders and taught families how to deal with the abdominal pain of the child.…”

mentioning

confidence: 99%

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Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

Gieteling¹,

Leeuwen²,

Wouden³

et al. 2011

The Annals of Family Medicine

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PURPOSE Nonspecifi c abdominal pain (NSAP) is a common complaint in childhood. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents are hard to reassure. Little is known about NSAP in family practice, but the impression is that family physicians consider it to be a benign syndrome needing little more than reassurance. This discrepancy calls for a better understanding of NSAP in family practice.METHODS Data were obtained from the Second Dutch National Survey of General Practice (2001). Using registration data of 91 family practices, we identifi ed children aged 4 to 17 years with NSAP. We calculated the incidence, and we studied factors associated with childhood NSAP, referrals, and prescriptions. RESULTSThe incidence of NSAP was 25.0 (95% confi dence interval [CI], 23.7-26.3) per 1,000 person years. Most children (92.7%) with newly diagnosed NSAP (N = 1,480) consulted their doctor for this condition once or twice. Factors independently associated with NSAP were female sex (odds ratio [OR] = 1.4; 95% CI, 1.3-1.5), nongastrointestinal-nonspecifi c somatic symptoms (OR = 1.3; 95% CI, 1.1-1.5), and health care use (OR = 1.04; 95% CI, 1.03-1.05). When NSAP was diagnosed at the fi rst visit, 3% of the patients were referred to specialist care, and 1% received additional testing. Family physicians prescribed medication in 21.3% of the visits for NSAP.CONCLUSIONS Childhood NSAP is a common problem in family practice. Most patients visit their doctor once or twice for this problem. Family physicians use little additional testing and make few referrals in their management of childhood NSAP. Despite the lack of evidence for effectiveness, family physicians commonly prescribe medication for NSAP. Ann Fam Med 2011;9:337-343. doi:10.1370/afm.1268. INTRODUCTIONA bdominal pain is a common complaint in children worldwide. 1 Although its effect on a child's well-being is considerable, and it leads to substantial school absenteeism, 2 childhood abdominal pain is usually not associated with organic disease. 3,4 In this study, we use the expression nonspecifi c abdominal pain (NSAP) for abdominal pain for which the physician does not suspect an organic pathologic cause. Most studies on NSAP are carried out in specialist care and include children with chronic or recurrent abdominal pain.Little is known about childhood NSAP in family practice. In population and school-based studies, the prevalence of NSAP ranges from 4% to 10%. 1 The occurrence of NSAP in family practice has hardly been studied, nor has family physicians' management. The impression is that family physicians consider NSAP in children to be a benign disorder needing little more than reassurance of parent and child. This view, how- 5,7,9 and the high prevalence of prolonged symptoms 11 found in children referred to secondary and tertiary care. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents of children with NSAP are found to be hard to reassure. 11,12 For...

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Section: Introductionmentioning

confidence: 78%

mentioning

confidence: 99%

Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

Gieteling¹,

Leeuwen²,

Wouden³

et al. 2011

The Annals of Family Medicine

View full text Add to dashboard Cite

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“…Therefore, parents might contribute to a maladaptive role by showing positive consequences to it. Other studies highlight the importance of parental acceptance of a biopsychosocial model for the explanation of the child's symptoms which was associated with long-term symptom recovery [9,37]. A three-session cognitive-behavioral intervention study by Levy and coauthors [35] aimed mainly at modifying the families' response on illness behavior of the child and could demonstrate a long-lasting reduction of parentreported AP in a large sample.…”

Section: Discussionmentioning

confidence: 99%

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

et al. 2013

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Functional abdominal pain and irritable bowel syndrome are two prevalent disorders in childhood which are associated with recurrent or chronic abdominal pain, disabilities in daily functioning, and reduced quality of life. This study aimed to evaluate a brief hypnotherapeuticbehavioral intervention program in a prospective randomized controlled design. Thirty-eight children, 6 to 12 years of age, and their parents were randomly assigned to a standardized hypnotherapeutic-behavioral treatment (n=20) or to a waiting list condition (n=18). Both groups were reassessed 3 months after beginning. Primary outcome variables were child-completed pain measures and pain-related disability. Secondary outcome variables were parent-completed measures of their children's pain and pain-related disability. Health-related quality of life from both perspectives also served as a secondary outcome. In the treatment group, 11 of 20 children (55.0 %) showed clinical remission (>80 % improvement), whereas only one child (5.6 %) in the waiting list condition was classified as responder. Children in the treatment group reported a significantly greater reduction of pain scores and pain-related disability than children of the waiting list condition. Parental ratings also showed a greater reduction of children's abdominal pain and pain-related disability. Health-related quality of life did not increase significantly. Conclusions: Hypnotherapeutic and behavioral interventions are effective in treating children with long-standing AP. Treatment success of this brief program should be further evaluated against active interventions with a longer follow-up.

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“…[6][7][8][9] According to their symptoms, these children may undergo many investigations and treatment approaches, which can influence their well-being and constitute a large cost burden on society. [10][11][12][13] Still, research on consultation patterns for pediatric FSS remains scarce. The prevailing research data indicate that even though many parents cope with their child' s symptoms without resorting to medical care, [14][15][16] children' s use of general practitioner services has increased in particular in North European countries.…”

Section: Discussionmentioning

confidence: 99%

Functional Somatic Symptoms and Consultation Patterns in 5- to 7-Year-Olds

et al. 2013

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OBJECTIVE: To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. METHODS: We assessed 1327 children from the Copenhagen Child Cohort 2000 for FSS at ages 5 to 7 years. Register data on past health care use in general practice were compared between children with and those without parent-reported medical consultation for FSS at the age of 5 to 7 years: respective consulters (n = 96) and nonconsulters (n = 211) and children without FSS (n = 1019). Degree of parental worries about the child’s symptoms and parent-reported symptom characteristics and associated impacts were compared between consulters and nonconsulters. RESULTS: Among 308 children with FSS, 31.1% were consulters. Being a consulter was significantly associated with multisymptomatic presentation, parental worries about the symptoms, symptom impact, and a higher past health care use in general practice. Multiple logistic regression analysis controlled for gender, comorbid physical disease, and symptom severity revealed that the number of face-to-face contacts in general practice during the child’s first 4 years of life predicted being an consulter for FSS at 5 to 7 years (odds ratio 1.03, 95% confidence interval 1.00–1.06; odds ratio interpreted per unit change in number of contacts). CONCLUSIONS: This study adds to our understanding of health care use for FSS in childhood by highlighting the influence of parents’ early consultation patterns with their child and the influence of parental perceptions of their child’s health and FSS-related impact on pediatric health care use for FSS. Management of health care use in children with FSS should address these aspects.

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Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain

Cited by 81 publications

References 22 publications

Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

Functional Somatic Symptoms and Consultation Patterns in 5- to 7-Year-Olds

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