Recurrent Abdominal Pain in Primary and Tertiary Care: Differences and Similarities

This study sought to identify child and parent characteristics differentiating children with recurrent abdominal pain seen by a pediatrician (RAP-Peds) from those seen by a gastroenterologist (RAP-GI). Children (7–10 years) and mothers in three groups (RAP-GI, RAP-Peds, and Controls) completed mother and child reports of child's functional disability, internalizing symptoms, and somatic complaints, and mother report of her anxiety and somatization. Child report did not differentiate groups. RAP mothers were more likely than Control mothers to focus on somatic complaints in themselves and their children. Mother report of child disability was strongly related to tertiary care for child's recurrent abdominal pain.     

Going to the doctors: the views of mothers of children with recurrent abdominal pain

OBJECTIVES: to explore how mothers of children with recurrent abdominal pain view seeking medical help on behalf of their children. DESIGN: qualitative interview study. SETTING: paediatric clinics and schools. PARTICIPANTS: purposive sample of 28 mothers of children with recurrent abdominal pain. MAIN OUTCOME MEASURES: Beliefs concerning recurrent abdominal pain, the respective roles of doctors and mothers and the nature and quality of interactions with doctors. RESULTS: Mothers of children with recurrent abdominal pain reported shaping the way they discussed the child's problem with doctors according to their beliefs about their own roles and the beliefs they perceived doctors to hold about recurrent abdominal pain. Where they were seeking help in managing the pain, they often felt undermined and threatened and responded to this by stressing the physical aspects of the child's presentation. CONCLUSIONS: Doctors may need to acknowledge actively mothers' competence in order to establish a therapeutic alliance.     

An evaluation of efforts to educate mothers about child development in pediatric office practices.

The efforts expended by pediatricians in a variety of private practice settings to educate mothers of first-born children about child behavior and development were examined in relation to various outcome measures of mother and child functioning over a time period of one-and-a-half years. Mothers learned more about child development in group settings than in solo practice settings, but differences between medical groups with and without nurse practitioners were not significant. Mothers receiving care from pediatricians who made at least a moderate effort to teach, learned more about child development, described more use of positive contact with their children, and felt they were helped more in their childrearing efforts than did mothers receiving care from pediatricians who made little effort to teach. However, there were no significant differences in measures of the child's developmental status related to physician teaching input, and mothers exposed to higher levels of teaching input reported more behavioral problems with their children. The most important predictor of the child's developmental status at 18 months of age was the amount of positive contact between mother and child at one year. It is suggested that the effects of changing the frequency of well-child visits on the mothers' interaction patterns with their children and on their feelings of being supported by the physician be ascertained before making recommendations about the optimal number of such visits.     

Recurrent pain in children, socio-economic factors and accumulation in families

The aim of this study was to estimate the prevalence of parent-reported pain among children in the Nordic countries in 1996, and to describe the association between recurrent pain in children and parental socio-economic factors. We also wanted to estimate the association between parental pain and childhood pain and co-occurrence of different pain patterns in the same child. Data were obtained from a cross-sectional survey on children's health and well-being in the Nordic countries in 1996. About 10, 000 children aged 2–17 years of age were selected from population registries. Mean response rate was 68%. We selected the cases 7 years where the respondent was the child's biological mother or father, yielding a total of 6230 subjects. The adjusted analyses were performed using logistic regression in SPSS. The total prevalence of headache, abdominal pain and back pain among children 7–17 years of age was 14.9, 8.3 and 4.7%, respectively. The most common pain combination was headache and abdominal pain. Pain was most frequent among girls. The prevalence was slightly higher in low educated or low-income families compared to those of high status. Children living in low educated, low-income, worker families had approximately a 1.4-fold odds of having pain. There was a strong association between the different pain conditions, and between pain and other forms of distress in the same child. A site-specific association between parental and child pain was also shown, but we assume that this might have been mediated through subjective (information) bias.     

Malnutrition and dysfunctional mother-child feeding interactions: clinical assessment and research implications

OBJECTIVES: To evaluate the effects of age and the presence of feeding pathologies on the relational modes during meals in a sample of mother-child pairs (n = 333), comparing groups of children in the first three years of life with normal development (ND-group, n = 211) and clinical groups of children who presented a diagnosis of feeding disorder and failure to thrive (FD-group, n = 122), and to show an association between specific symptomatic characteristics of the mother, of the child and the dysfunctional modes of their relationship during meals in a subgroup of mother-child pairs (n = 50), selected at random from the total clinical sample and paired with a control group chosen for this study. METHODS: All mother-child pairs in the sample were observed in twenty-minute video-recordings during a meal, using the procedure of the Feeding Scale in the Italian version. A subgroup of mothers, selected at random from the total clinical sample, and paired with a control group, were given two self-reporting instruments for the evaluation of their psychological symptom status: the Eating Attitude Test and the Symptom Checklist-90-Revised, as well as two instruments for the evaluation of the infant temperament and emotional/behavioral functioning: the Baby and Toddler Behavior Questionnaires (from 1 to 18 months) and the Child Behavior Checklist 1-1/2--5 (from 18 to 36 months). RESULTS: Analysis of variance showed that the FD-group present interactional dysfunctional patterns during feeding and raise higher scores in symptomatic characteristics both of the mother and of the child, compared to ND-group. A set of correlation analyses (Pearson coefficients) showed an association among specific symptomatic characteristics of the mothers (dysfunctional eating attitudes, anxiety, depression, hostility), of their children (in particular, anxiety/depression, somatic complaints and aggressive behavior) and of their dysfunctional relational modes during feeding (p < 0.05). CONCLUSIONS: Our study confirms that analysis of the individual characteristics of the child, of the mother and of their relationship during the development of feeding patterns in the first three years of the child's life is extremely important in the clinical assessment of early feeding disorders, in order to establish a valid diagnostic methodology and formulate strategies for targeted and effective intervention. Furthermore, the results emphasize the clinical utility of our research in early identification of infants and toddlers at risk for feeding problems.     

Mothers' Report of Stressful Experiences Related to Having a Child With a Physical Disability

In this study, we delineated the types of psychosocial stressors experienced by mothers of children with chronic physical conditions. One hundred nineteen mothers, each having a child between 2 and 18 years of age with a motor or sensory disability, were asked on three occasions to describe the most bothersome thing that had happened to them related to their child's disability. A content analysis was then performed on the 246 independent responses to this request. On this basis, four general domains of concern were delineated: medical and legal concerns, concerns for the child, concerns for the family, and concerns for the self. Each domain can be further divided into three to five more specific areas of concern. None of the demographic variables evaluated were found to associate with the type of concern reported. However, specifics of the child's condition were found to be related to the types of problems described. Mothers who reported problems in the area of concerns for the self also reported poorer physical health. However, neither maternal mental health nor maternal physical health were found to be related to other types of concern reported by the mother.     

A follow-up study of parent education in pediatric office practices: impact at age two and a half.

The relationship between physician efforts to educate mothers of first born children about child behavior and development, and various outcome measures of mother and child functioning has been extended from 18 months to a time period of two and a half years. As was found earlier, there was a modest relationship between physician effort and mother gain in knowledge about child development, her feeling of being supported by the practice in her child-rearing role, and the frequency of her participation in affectional and cognitively stimulating activities with her child. These relationships, however, did not significantly increase in strength over time. At the end of 30 months there were still no significant positive relationships between teaching input and the child's developmental status, and mothers receiving care form physicians who taught more continued to report more behavior problems with their child than mothers receiving care from physicians who taught less. A content analysis of a small sample of the visits of high and low scoring physicians indicated that neither focused their teaching efforts on ways that mothers could interact with their children in more affectionate and cognitively stimulating ways. It is suggested that more focused teaching in this area might lead to better child development outcomes.     

Study on the relationship between toddler temperament and development (first report)--the correlation among toddler temperament, maternal perception and rearing environment]

The purpose of this study is to clarify how a child's temperament and maternal perception influences the rearing environment. As the conceptual framework, we used A.J. Sameroff's transactional model and Miyake's conceptual model of mother and child. The following process was hypothesized: toddler temperament influences maternal perception, which in turn influences rearing environment under which children are developing. Questionnaires concerning toddler temperament, maternal perception and rearing environment were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and results from 306 mothers and children who answered the questionnaires were analyzed. The results were as follows: (1) Child temperament showed a tendency to accord with maternal perception of how easy it is to handle him/her. (2) Maternal perception was related to rearing environment. (3) Temperamental characteristics were related to rearing environment. (4) While the influence of child temperament and maternal perception on the rearing environment was not shown to be strong, the hypothesized process of this study was supported to a certain degree. From these results, it appears that it is important to pay attention to a child's temperament as a contributing factor in the health practice of mother and child.     

Understanding the medically unexplained: emotional and familial influences on children's somatic functioning

Background   Many youth experience impairing, unexplained somatic complaints. Psychosocial models of child somatization have primarily focused on parent somatic functioning. Although helpful in understanding child somatization, this narrow focus on parental factors leaves a large proportion of the variance unaccounted for when explaining children's general somatic functioning. The goal of this investigation is to extend current models of child somatization by collectively examining the influence of parent somatization and child emotional functioning.
Methods   Forty-two children (50% male; M age = 9.11) reported on their somatic symptoms, emotion awareness skills, and negative affect. Parents reported on their own somatic symptoms and their child's somatic symptoms and emotion regulation skills.
Results   Regression analyses indicated that poor awareness of emotional experiences and frequency of negative effect predicted child-reported somatic symptoms. Parental somatic symptoms and parent reports of children's emotion regulation difficulties predicted mother-reported child somatic symptoms. Only parental somatic symptoms significantly predicted father-reported child somatic symptoms.
Conclusions   These results suggest that models of child somatization should consider both family – (e.g. parent somatization) and child-level (e.g. emotional functioning) variables. The discrepancies between parent and child report of youth somatic symptoms underscore the importance of including multiple reporters on symptomatology in research and clinical settings. Suggestions for future research are provided.     

Is There a Relationship Between a Mother's Mental State and Consulting the Doctor by the Family? A Study in a Military General Practice

A total of 174 families of service personnel with children between3 and 6 years of age were studied over a 6 month period. Allcontacts with the general practitioner, both in and out of hourstogether with the local casualty department were recorded. Mothersof the children were posted a specialty designed questionnaireto measure how seriously they perceived various childhood symptomsto be and a copy of the general health questionnaire, 28 questionversion (GHQ 28). The perceived severity questionnaire had beenpiloted previously in a neighbouring practice. The overall responserate was 77%. Analyses of the data showed that the factors mostsignificantly associated with a child's consultation frequencywere the psychological state of the mother, the mother's ownconsultation frequency and the number of children in the family;the last being an inverse relationship. No evidence was foundto suggest that the perception of the severity of illness variedwith the psychological state of the mother. In addition, thechildhood consultation rate was not influenced by the mother'sperception of the severity of childhood illness as measuredby the perceived severity questionnaire. Other factors suchas the age of the mother or child, within the age range studied,were not found to be significantly related to the child's frequencyof consulting. A mother's own consultation frequency was highlycorrelated with her GHQ 28 score, but more specifically withthe subsections that scored for depression and somatic symptoms.From the study, doctors who see children should seriously considerthe main reasons for a child's consultation. In particular,as mothers often make the decision as to whether their childshould see the doctor, the main patient may be the parent notthe child. Mothers who present themselves frequently may alsohave a high level of psychological distress.     

Patterns of relating between mothers and preschool-aged children using the Marschak Interaction Method Rating System

This study assesses the relationship of patterns of relating between mothers and their preschool-aged children. Thirty-one families were used, and the mother and child participated in the Marschak Interaction Method Rating System (MIM-RS). Mothers also completed the Demographic Data Questionnaire. Correlations based upon the MIM-RS for mothers and their preschool-aged children produced significant results. Mother's ability to structure, challenge, engage, nurture and facilitate their child's regulatory processes positively related/influenced their preschool-age child's ability to demonstrate exploratory behaviors, reciprocity with their parent and to demonstrate regulatory behaviors. A parent who was not able to structure, challenge, engage, nurture and facilitate their child's regulatory processes produced a child who was not capable of exploring their environment, regulating their own self-regulatory processes or staying within a comfortable and communicative stance with their parent.     

Catastrophizing and Parental Response to Child Symptom Complaints

This study investigated whether catastrophic thinking about pain by children with functional abdominal pain or by their parents is associated with health outcomes in the child. Participants were 132 parent–child dyads. Child catastrophizing predicted child depression, anxiety, and functional disability. Parents' catastrophizing cognitions about their own pain predicted self-reported protective responses to their children's abdominal pain (responding in ways that encourage illness behavior). Protectiveness, in turn, predicted child functional disability. All findings held despite controlling for child age, gender, and symptom severity. These results suggest that catastrophic cognitions play an important role in how children and parents cope and respond to functional abdominal pain, and may have implications for assessment and treatment in the clinical setting.     

Predictors of parental adjustment to children's epilepsy in rural India

BACKGROUND: Negative societal attitudes towards disability affect the adjustment of parents when their child is diagnosed with epilepsy. Recent studies have suggested that parental and child outcomes, including adjustment, can be influenced by non-directed social support to mothers of children with disability. The objective of our study was to test the hypothesis that maternal satisfaction with social support, measured at the beginning of treatment, would predict parental adjustment to the child's epilepsy after 1 year of treatment. METHODS: We enrolled 46 mothers of children aged 6-18 years with epilepsy in the study. We measured social support using the modified Dunst family support scale, and parental adjustment using a locally validated instrument (S-PAM). Correlation was tested using a multiple linear regression model, allowing for confounding variables. RESULTS: Parental adjustment at outcome was positively independently correlated with satisfaction with social support at baseline,and negatively with severity of the child's epilepsy. The regression model explained 34% of the total variance. CONCLUSIONS: Taken together with evidence from previous studies, this finding supports the idea that helping parents to find more satisfaction within their (new or existing) social networks will promote adjustment to their child's disability.     

Functional disability in paediatric patients with recurrent abdominal pain

Background Recurrent abdominal pain (RAP) is common in childhood, affecting approximately 12% of children and adolescents. Children with RAP tend to experience impairments in functioning, such as increased school absences, anxiety and depression. Methods The current study investigated the potential influences on the relation between functional disability and RAP in 100 school‐aged children. A series of hierarchical regression analyses were conducted to test two models: main effects and moderation of the relation between abdominal pain symptoms, child anxiety, child depression, maternal emotional distress, maternal encouragement of child illness behaviour and functional disability. Results The results indicated support for abdominal pain symptoms and child depression in predicting functional disability. The results also indicated that child anxiety and child depression each moderated the relation between pain symptoms and functional disability. Conclusions Implications of the findings are discussed in terms of potential influences on the development of functional disability in youth.     

The death of a young son in violent circumstance: understanding the experience of the mother

This study was aimed at understanding the life of a mother who lost their child in violent circumstances. The methodological proceedings were supported on phenomenology. The study population was constituted by five mothers who had lost its young children for homicide. These homicides occurred different times ranging from 50 days to 10 years. I used as instrument of collection of data open interview the phenomenological method guided by a orienting question. The analysis phenomenology in their discourses showed the comprehension of essential meanings which were systematized in categories: the child's mummification in the memory; the two ways followed by the publicity concerning the death; fondness to spirituality to endure the pain from the child's death; maternal complicity and impunity. The results of this study can contribute to elaboration of intervention proposals close to the mothers in the sense of helping them in the reorganization of their lives after son's death.     

Stress and Coping Among Mothers of Infants With a Sickle Cell Condition

Thirty-one mothers of infants with sickle cell anemia (n = 14) or sickle cell trait (n = 17) were interviewed to investigate the psychological stress they experienced and the coping strategies they used when first learning their child's diagnosis and when presently caring for their child. All children were diagnosed with sickle cell conditions through newborn screening. Mothers of children with sickle cell disease most often reported the expectation of pain for their child as a stressor, whereas mothers of children with sickle cell trait most often reported uncertainty of the diagnosis as a stressor. Although sickle cell trait is not a life-threatening condition, mothers of these infants reported a great deal of stress in regard to the health of their children and to their own ability to manage such stress. Mothers in both groups reported using Positive Reappraisal, Seeking Social Support, Self-Control, and Planful Problem Solving most frequently to cope with present stressors. The results also have implications for the use of newborn screening.     

Child care and social support modify the association between maternal depressive symptoms and early childhood behaviour problems: a US national study

OBJECTIVE: To investigate the presence and patterns of modification effects of the sex of the child, social support, and childcare on the relation between maternal depressive symptoms and child behaviour problems at two developmental stages. DESIGN: Analyses are based on prospective longitudinal data from the study of early child care. PARTICIPANTS: A total of 1216 families were drawn from 10 locations across the USA. Mothers were age 18 or older at the time of the study child's birth and had completed outcome measures for at least one follow up time point (24 months, 36 months). MAIN OUTCOME MEASURES: Child internalising and externalising behaviour problems assessed at the child's age of 24 months and 36 months, as reported by the mother. RESULTS: Results from generalised estimating equation analyses showed that the association between child externalising behaviour problems and maternal depressive symptoms varied according to the social support received by the mother (p<0.05). Overall, social support mitigated the relation, but protective effects diminished at increasing levels of depressive symptoms. Associations between child internalising behaviour problems and maternal depressive symptoms varied according to whether or not the child received care from caregivers other than the mother (p<0.05). CONCLUSIONS: Health providers who are working with mothers with depressive symptoms may want to examine social support that is available to mothers, especially if mothers are not severely depressed. Furthermore, recommendations to begin, continue, or perhaps increase provision of childcare from other caregivers can provide respite for mothers and opportunities for children to engage in protective interactions with others.     

Mothers remember birthweights of adolescent children: the Muscatine Ponderosity Family Study

The mothers of 127 adolescents living in Muscatine, Iowa were asked at the time of a clinic examination to recall their child's birthweight in pounds and ounces. For comparison, the hospital-recorded birthweight was obtained for each child. On the average, mothers underreported their child's birthweight by 1.3 oz. Sixty of 127 (47%) mother-reported birthweights were the same as those from hospital delivery records; 12% of the mothers overreported the birthweight by at least 5 oz and 17% underreported by at least that amount. The age of the mother and number of biological children were related to the ability to recall the birthweight exactly. The mean age of the children, and thus the average length of the mother's recall, was 16.1 years. Neither the length of recall, nor the mother's education, her current body size, or the current body size of the child were related to recall ability. However, mothers who overreported their child's birthweight were significantly shorter and lighter and their children tended to be taller and heavier, when compared to the mothers who underreported and their children. When the degree of agreement found in our study between reported and recorded birthweight exists, the effect of using reported rather than recorded birthweights in an epidemiological investigation is sufficiently small to allow inferences to be made regarding the relationship between birthweight and body size at mid-adolescence.