Recurrent abdominal pain in children and adolescents - a survey among paediatricians

Angelika A Schlarb, Marco D Gulewitsch, Inga Bock Genannt Kasten, Paul Enck, Martin Hautzinger, Angelika A Schlarb, Marco D Gulewitsch, Inga Bock Genannt Kasten, Paul Enck, Martin Hautzinger

Abstract

Objective: Little is known about prevalence and usual treatment of childhood and adolescent recurrent abdominal pain (RAP) in outpatient paediatricians' practice. This study's primary objective was to acquire insights into the usual paediatricians' treatment and their estimation of prevalence, age and gender of RAP patients. Further objectives were to assess to which extent family members of patients report similar symptoms, how paediatricians rate the strain of parents of affected children and adolescents and how paediatricians estimate the demand for psychological support.

Methods: Provided by a medical register, 437 outpatient paediatricians received a questionnaire to assess their perception of several psychosomatic problems and disorders including recurrent abdominal pain.

Results: According to paediatricians' estimation, 15% of all visits are caused by patients with RAP. In 22% of these cases of RAP, at least one family member has similar problems. In about 15% of all RAP cases, parents ask for professional psychological support concerning their children's issues, whereas 40% of paediatricians wish for psychological support considering this group of patients.

Conclusions: Estimated frequencies and paediatricians' demands show the need for evidence-based psychological interventions in RAP to support usual medical treatment.

Keywords: RAP; functional abdominal pain; outpatient practice; paediatricians; recurrent abdominal pain; standard medical care.

Figures

Table 1. Therapy options in RAP
Table 1. Therapy options in RAP

References

    1. Ellert U, Neuhauser H, Roth-Isigkeit A. Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. [Pain in children and adolescents in Germany: the prevalence and usage of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5-6):711–717. doi: 10.1007/s00103-007-0232-8. (Ger). Available from: .
    1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130(5):1527–1537. doi: 10.1053/j.gastro.2005.08.063. Available from: .
    1. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in western countries: a systematic review. Am J Gastroenterol. 2005;100(8):1868–1875. doi: 10.1111/j.1572-0241.2005.41893.x. Available from: .
    1. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child. 1958;33(168):165–170. doi: 10.1136/adc.33.168.165. Available from: .
    1. Walker LS, Lipani TA, Greene JW, Caines K, Stutts J, Polk DB, Caplan A, Rasquin-Weber A. Recurrent abdominal pain: symptom subtypes based on the Rome II Criteria for pediatric functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2004;38(2):187–191. doi: 10.1097/00005176-200402000-00016. Available from: .
    1. Helgeland H, Flagstad G, Grotta J, Vandvik PO, Kristensen H, Markestad T. Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr. 2009;49(3):309–315. doi: 10.1097/MPG.0b013e31818de3ab. Available from: .
    1. Starfield B, Hoekelman R, McCormick M. Who provides health care to children and adolescents in the United States? Pediatrics. 1984;74(6):991–997.
    1. Boyle JT. Recurrent abdominal pain: an update. Pediatr Rev. 1997;18(9):310–320.
    1. Ramchandani PG, Hotopf M, Sandhu B, Stein A. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. 2005;116(1):46–50. doi: 10.1542/peds.2004-1854. Available from: .
    1. Schwille IJ, Giel KE, Ellert U, Zipfel S, Enck P. A community-based survey of abdominal pain prevalence, characteristics, and health care use among children. Clin Gastroenterol Hepatol. 2009;7(10):1062–1068. doi: 10.1016/j.cgh.2009.07.002. Available from: .
    1. Barr RG, Feuerstein M. Recurrent abdominal pain syndrome: How appropriate are our basic clinical assumptions? In: McGrath PJ, Firestone P, editors. Pediatric and adolescent behavioral medicine. New York: Springer; 1983. pp. 13–27.
    1. Walker LS, Garber J, Greene JW. Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization. J Abnorm Child Psychol. 1991;19(4):379–394. doi: 10.1007/BF00919084. Available from: .
    1. Youssef NN, Murphy TG, Langseder AL, Rosh JR. Quality of life for children with functional abdominal pain: a comparison study of patients' and parents' perceptions. Pediatrics. 2006;117(1):54–59. doi: 10.1542/peds.2005-0114. Available from: .
    1. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr. 1996;129(2):220–226. doi: 10.1016/S0022-3476(96)70246-9. Available from: .
    1. Walker LS, Garber J, Greene JW. Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. J Abnorm Psychol. 1993;102(2):248–258. doi: 10.1037/0021-843X.102.2.248. Available from: .
    1. Campo JV, Bridge J, Ehmann M, Altman S, Lucas A, Birmaher B, Di Lorenzo C, Iyengar S, Brent DA. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004;113(4):817–824. doi: 10.1542/peds.113.4.817. Available from: .
    1. Dufton LM, Dunn MJ, Compas BE. Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders. J Pediatr Psychol. 2009;34(2):176–186. doi: 10.1093/jpepsy/jsn064. Available from: .
    1. Ramchandani PG, Fazel M, Stein A, Wiles N, Hotopf M. The impact of recurrent abdominal pain: predictors of outcome in a large population cohort. Acta Paediatr. 2007;96(5):697–701. doi: 10.1111/j.1651-2227.2007.00291.x. Available from: .
    1. Walker LS, Greene JW. Children with recurrent abdominal pain and their parents: more somatic complaints, anxiety, and depression than other patient families? J Pediatr Psychol. 1989;14(2):231–243. doi: 10.1093/jpepsy/14.2.231. Available from: .
    1. Youssef NN, Atienza K, Langseder AL, Strauss RS. Chronic abdominal pain and depressive symptoms: analysis of the national longitudinal study of adolescent health. Clin Gastroenterol Hepatol. 2008;6(3):329–332. doi: 10.1016/j.cgh.2007.12.019. Available from: .
    1. Walker LS, Guite JW, Duke M, Barnard JA, Greene JW. Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults. J Pediatr. 1998;132(6):1010–1015. doi: 10.1016/S0022-3476(98)70400-7. Available from: .
    1. Walker LS, Garber J, Van Slyke DA, Greene JW. Long-term health outcomes in patients with recurrent abdominal pain. J Pediatr Psychol. 1995;20(2):233–245. doi: 10.1093/jpepsy/20.2.233. Available from: .
    1. Campo JV, Di Lorenzo C, Chiapetta L. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it? Pediatrics. 2001;108(1):e1. doi: 10.1542/peds.108.1.e1. Available from: .
    1. Sanders MR, Rebgetz M, Morrison M, Bor W, Gordon A, Dadds M, Shepherd R. Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: an analysis of generalization, maintenance, and side effects. J Consult Clin Psychol. 1989;57(2):294–300. doi: 10.1037/0022-006X.57.2.294. Available from: .
    1. Robins PM, Smith SM, Glutting JJ, Bishop CT. A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain. J Pediatr Psychol. 2005;30(5):397–408. doi: 10.1093/jpepsy/jsi063. Available from: .
    1. Sanders MR, Shepherd RW, Cleghorn G, Woolford H. The treatment of recurrent abdominal pain in children: a controlled comparison of cognitive-behavioral family intervention and standard pediatric care. J Consult Clin Psychol. 1994;62(2):306–314. doi: 10.1037/0022-006X.62.2.306. Available from: .
    1. Edwards MC, Mullins LL, Johnson J, Bernardy N. Survey of paediatricians' management practices for recurrent abdominal pain. J Pediatr Psychol. 1994;19(2):241–253. doi: 10.1093/jpepsy/19.2.241. Available from: .
    1. McGrath PJ, Feldman W. Clinical approach to recurrent abdominal pain in children. J Dev Behav Pediatr. 1986;7(1):56–63. doi: 10.1097/00004703-198602000-00010. Available from: .
    1. Dorn LD, Campo JC, Thato SP, Dahl RE, Lewin D, Chandra R, Di Lorenzo C. Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2003;42(1):66–75. doi: 10.1097/00004583-200301000-00012. Available from: .
    1. Wasserman AL, Whitington PF, Rivara FP. Psychogenic basis for abdominal pain in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1988;27(2):179–184. doi: 10.1097/00004583-198803000-00008. Available from: .
    1. Hildebrand H, Finkel Y, Grahnquist L, Lindholm J, Ekbom A, Askling J. Changing pattern of paediatric inflammatory disease in northern Stockholm 1990-2001. Gut. 2003;52(10):1432–1434. doi: 10.1136/gut.52.10.1432. Available from: .
    1. Alven G. The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study. Acta Paediatr. 1993;82(5):484–487. doi: 10.1111/j.1651-2227.1993.tb12728.x. Available from: .
    1. Grøholt EK, Stigum H, Nordhagen R, Köhler L. Recurrent pain in children, socio-economic factors and accumulation in families. Eur J Epidemiol. 2003;18(10):965–975. doi: 10.1023/A:1025889912964. Available from: .
    1. Petersen S, Bergström E, Brulin C. High prevalence of tiredness and pain in young schoolchildren. Scand J Public Health. 2003;31(5):367–374. doi: 10.1080/14034940210165064. Available from: .
    1. Perquin CW, Hazebroek-Kampschreur AAJM, Hunfeld JAM, van Suijlekom-Smit LWA, Passchier J, van der Wouden JC. Chronic pain among children and adolescents: Physician consultation and medication use. Clin J Pain. 2000;16(3):229–235. doi: 10.1097/00002508-200009000-00008. Available from: .
    1. Renz-Polster H, Krautzig S, Braun J. Basislernbuch Innere Medizin. München: Elsevier; 2004.
    1. Heyman M, Kirschner B, Gold B, Ferry G, Baldassano R, Cohen S, Winter HS, Fain P, King C, Smith T, El-Serag HB. Children with early-onset inflammatory bowel disease (IBD): Analysis of a pediatric IBD consortium registry. J Pediatr. 2005;146(1):35–40. doi: 10.1016/j.jpeds.2004.08.043. Available from: .
    1. Mühlig S, Petermann F. Idiopathischer Bauchschmerz im Kindesalter: Ergebnisse, Defizite und Perspektiven empirischer Forschung. [Idiopathic abdominal pain in children: results, deficits and perspectives of empirical research]. Schmerz. 1997;11(3):148–157. doi: 10.1007/s004829700017. (Ger). Available from: .
    1. Harbeck C, Peterson L. Elephants dancing in my head: A developmental approach to children's concepts of specific pains. Child Dev. 1992;63(1):138–149. doi: 10.2307/1130908. Available from: .
    1. Payne B, Norfleet M. Chronic pain and the family: a review. Pain. 1986;26(1):1–22.
    1. Routh DK, Ernst AR. Somatization disorder in relatives of children and adolescents with functional abdominal pain. J Pediatr Psychol. 1984;9(4):427–438. doi: 10.1093/jpepsy/9.4.427. Available from: .
    1. Violin A, Giurgea D. Familial models for chronic pain. Pain. 1984;18:199–203.
    1. Walker LS, Claar RL, Garber J. Social consequences of children's pain: When do they encourage symptom maintenance? J Pediatr Psychol. 2002;27(8):689–698. doi: 10.1093/jpepsy/27.8.689. Available from: .
    1. Osborne RB, Hatcher JW, Richtsmeier AJ. The role of social modeling in unexplained pediatric pain. J Pediatr Psychol. 1989;14(1):43–61. doi: 10.1093/jpepsy/14.1.43. Available from: .
    1. Loonen HJ, Grootenhuis MA, Last BF, de Haan RJ, Bouquet J, Derkx BH. Measuring quality of life in children with inflammatory bowel disease: the impact-II (NL) Qual Life Res. 2002;11(1):47–56. doi: 10.1023/A:1014455702807. Available from: .
    1. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111(1):e1–e11. doi: 10.1542/peds.111.1.e1. Available from: .
    1. Scharff L. Recurrent abdominal pain in children: a review of psychological factors and treatment. Clin Psychol Rev. 1997;17(2):145–166. doi: 10.1016/S0272-7358(96)00001-3. Available from: .
    1. Dell'Api M, Rennick JE, Rosmus C. Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children. J Child Health Care. 2007;11(4):269–286. doi: 10.1177/1367493507082756. Available from: .
    1. Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev. 2008;(1):CD003019. doi: 10.1002/14651858.CD003019.pub2. Available from: .
    1. Huertas-Ceballos A, Macarthur C, Logan S. Pharmacological interventions for recurrent abdominal pain (RAP) in childhood. Cochrane Database Syst Rev. 2002;(1):CD003017. doi: 10.1002/14651858.CD003017. Available from: .
    1. Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C. Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev. 2008;(1):CD003014. doi: 10.1002/14651858.CD003014.pub2. Available from: .

Source: PubMed

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