The relationship between abdominal pain and emotional wellbeing in children and adolescents in the Raine Study

Abstract

Abdominal pain is a common reason for medical visits. We examined the prevalence, gastrointestinal, and emotional significance of abdominal pain in a population-based cohort serially followed up from birth to 17 years. Children and adolescents from Generation 2 of the Raine Study participated in comprehensive cross-sectional assessments at ages 2, 5, 8, 10, 14 and 17 years. At 17 years, medical history, general health, gastrointestinal symptoms, medications, health practitioner attendance, and self-rated unhappiness were recorded. Longitudinal data regarding abdominal pain or unhappiness, from serial questionnaires, were analysed to identify factors associated with abdominal pain and adverse emotional health at age 17 years. Females experienced more abdominal pain than males at all ages (p < 0.05). Seventeen-year-old adolescents with abdominal pain reported a higher prevalence of depression, anxiety, being bullied at school, and poorer health status than those without abdominal pain (p < 0.05 for all). Abdominal pain and unhappiness during childhood and mid-adolescence were prospectively associated with recurrent abdominal pain, anxiety, depression and unhappiness during late adolescence (p < 0.05 for all). In conclusion, abdominal pain in children and adolescents associates with depression, anxiety, being bullied, unhappiness and reduced overall health-rating during adolescence. Awareness of these factors may guide management decisions.Abdominal pain is one of the most common reasons for primary care, hospital outpatients or emergency department visits, hospitalisations, referrals to gastroenterologists and for imaging tests 1-7 . In 2016/2017, abdominal and pelvic pain was the most common principal diagnosis for emergency department presentations and hospitalisations in Australia, accounting for 4.3% of principal diagnoses 8 . Likewise, in the USA in 2014/2015, abdominal pain was the most frequent reason for gastrointestinal-related ambulatory medical visits to primary care and emergency departments, with an expenditure of US$10.2 billion 2 . In Australia, abdominal pain accounted for 2.1 per 100 patient primary care visits, and the aetiology was not confirmed in one third of males and half of females 9 . Only one third of patients were prescribed medications, primarily paracetamol or hyoscine butylbromide for the pain, while counselling was the most common non-pharmacological treatment. This suggests a suspected diagnosis of a functional abdominal pain disorder 10 . Rome IV diagnostic criteria for functional gastrointestinal disorders describe four main categories of functional abdominal pain disorders in children and adolescents. These comprise functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain -not otherwise specified, which can coexist with each other and with other medical conditions associating with gastrointestinal symptoms in the same individual 11 .

Parental Opinion about the Low FODMAP Diet in Dietary Treatment of Children with Functional Abdominal Pain

“…One of the concerns raised about FAP is that the stress caused by the disease may significantly affect not only on children, but also parents [1][2][3]. Therefore, in our study, special attention was paid to the parental perception of the child's symptoms during dietary intervention.…”

“…Functional abdominal pain disorders (FAPDs) such as functional abdominal pain (FAP), irritable bowel syndrome (IBS), functional dyspepsia (FD), and abdominal migraine (AM) are common health problems in childhood and adolescence [1,2]. Etiology and pathophysiology of FAPDs are still unclear and there is no effective treatment method [3].…”

“…Without effective treatment recurrent symptoms of the FAP may have a significant impact not only on children's quality of life, but also parents and the entire family [1][2][3]. Numerous medical visits and intensification of a child's gastrointestinal symptoms may generate stress and absences of parents at work.…”

“…Numerous medical visits and intensification of a child's gastrointestinal symptoms may generate stress and absences of parents at work. In addition, research suggests that the emotional bond between parents and children can often affect the parental assessment of symptoms and thus increase anxiety in both parties [1,10]. The parental perception of the disease may also influence a child's illness experience [10][11][12].…”

Schmerzmedizinische Versorgung chronisch schmerzkranker Kinder und Jugendlicher in Deutschland

“…B. hinsichtlich des Schulbesuchs [26,29,33], des Schlafs [25,31], der sozialen Kontakte in der Peergroup oder des Ausübens vonHobbys [33,34]. Sie sind häufig mit anderen somatischen Beschwerden und in bis zu 60 % der Fälle mit psychischen Auffälligkeiten, insbesondere mit internalisierenden Störungen wie Angst, Depression oder posttraumatischer Belastungsstörung assoziiert [2,10,21,24,36,37,39].…”