Depressive symptoms in children with recurrent abdominal pain and in their families

Our purpose was to evaluate depression in children with recurrent abdominal pain and in their families. A self-report measure, the Children's Depression Inventory, and a psychiatric structured interview, the Child Assessment Schedule, were administered to 25 children with recurrent abdominal pain (RAP) as well as to 67 behaviorally disordered (BD) and 42 healthy children. Parents of all three groups completed the Beck Depression Inventory. On both measures, scores for RAP children were not significantly different from those of healthy children and were significantly lower than those of BD children. In contrast, the mothers of both the RAP group and the BD group had significantly higher depression scores than the mothers of healthy children. There were no group differences for fathers. The data suggest that although depression is not prevalent in children with RAP, depressive characteristics in the family may play a role in the origin of their abdominal pain.     

Pain, disability, and symptoms among siblings of children with functional abdominal pain

OBJECTIVE: To examine reports of pain, disability, and somatic and psychological symptoms among siblings of children with functional abdominal pain (FAP) and siblings of "healthy" comparison children. METHODS: This survey study explored two groups of participants (FAP and healthy) consisting of (1) children with FAP and their siblings and parents and (2) healthy comparison children and their siblings, and parents. Participants included 13 FAP families and 10 healthy comparison families. Siblings and children were between 8 and 14 years of age. Measures included the Behavioral Assessment System for Children, Abdominal Pain Index, Children's Somatization Inventory, Functional Disability Inventory, and Family Inventory of Life Events. Cross-sectional data were analyzed using correlations and analysis of variance techniques. RESULTS: Siblings of children with FAP reported significantly greater mean levels of emotional/ behavioral symptoms than siblings of healthy comparison children. No significant between-group differences were identified in FAP and healthy comparison parents' reports of siblings' pain or emotional/behavioral symptoms. There were significantly more persons with pain problems living in the homes of FAP families. Among FAP families, a greater number of parent-reported family stressful life events was significantly associated with sibling functional disability and somatic symptoms. CONCLUSION: This investigation suggests that siblings of children with FAP experience more emotional/behavioral symptoms than peers and that their symptoms are not readily identified by parents. These findings highlight the importance of considering the psychological functioning of "unaffected" siblings and family stressors when children present with recurrent pain complaints.     

The impact of recurrent abdominal pain: predictors of outcome in a large population cohort

AIM: Recurrent abdominal pain is one of the commonest complaints of childhood, affecting approximately 10% of children at any one time. This study aims to describe the outcome of recurrent abdominal pain amongst 6-year-old children, and to identify risk factors (in both the children and their parents), which predict these outcomes. METHODS: 7128 6-year-old children in the Avon Longitudinal Study of Parents and Children (ALSPAC) were followed up for 1 year. The principle outcomes were abdominal pain, number of days missed from school in the preceding year and psychiatric diagnoses. RESULTS: Children with recurrent abdominal pain at age 6 years had higher rates of further abdominal pain [odds ratio 4.88 (95% CI: 4.01, 5.95)], school absence (10 or more days off school in a year) [OR 1.89 (1.53, 2.33)] and anxiety disorders [OR 2.36 (1.68, 3.32)] at age 7 years. Maternal anxiety was the most consistent predictor of subsequent adverse outcomes for these children. CONCLUSION: Children with recurrent abdominal pain are at significant and continuing risk of adverse functioning. It is important for clinicians to take a whole family perspective, and particularly to consider parental anxiety, when a child with recurrent abdominal pain presents to them.     

Impaired accommodation of the proximal stomach in children with recurrent abdominal pain

BACKGROUND: A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal. METHODS: After an overnight fast, 20 patients with recurrent abdominal pain (age, 7-14 years) and 23 healthy control subjects (age, 7-13 years), were scanned by a 5-MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup. RESULTS: Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P = 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects. CONCLUSION: The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.     

Plasma oxytocin in children with recurrent abdominal pain

OBJECTIVE: The main objective of this work was to study plasma oxytocin concentration of children with psychosomatic recurrent abdominal pain and children with organic abdominal disease producing pain. Another objective was to study plasma oxytocin in children with psychosomatic recurrent pain over time and its relationship to other associated symptoms such as somatic pains and appetite. DESIGN: The concentration of oxytocin in plasma (fasting morning sample) was measured by radioimmunoassay in 48 children with abdominal pain, 32 of whom had psychosomatic recurrent abdominal pain according to previously defined criteria. Oxytocin levels were assessed in a separate group of 15 children with inflammatory bowel disease with abdominal pain and in a control group of 79 healthy school children. RESULTS: Plasma oxytocin concentration was significantly lower in children with recurrent abdominal pain of psychosomatic origin (P < 0.0001) and in the group of children with inflammatory bowel disease (P < 0.001) compared to controls. There was no difference between oxytocin levels of children with psychosomatic abdominal pain and those with inflammatory bowel disease. When repeated after one year, children with psychosomatic abdominal pain had an increase in mean plasma oxytocin level (P < 0.05). No relationship was found between specific symptoms and plasma oxytocin. CONCLUSIONS: Plasma oxytocin level is low in patients with abdominal pain of psychosomatic origin and inflammatory bowel disease. Measurement of plasma oxytocin may be of some help in the differential diagnosis of recurrent abdominal pain, but does not differentiate between psychosomatic abdominal pain and pain associated with inflammatory bowel disease.     

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.     

哮喘儿童及家长心理健康状况调查

目的 了解哮喘儿童及其家长的心理健康状况.方法 采用艾森克人格问卷(儿童)、Rutter's儿童行为量表(父母问卷)对36例6～14岁哮喘儿童进行个性、行为心理测试.采用90项症状自评量表(SCL-90)对其家长进行心理卫生状况调查.结果 哮喘儿童E、N值均高于正常对照组(P<0.05),行为问题发生率为33.3%,哮喘家长SCL-90各项因子分均高于对照组,以抑郁、焦虑、躯体诉述及恐怖因子得分最明显(P<0.05).结论 哮喘儿童及家长的心理问题均较健康对照人群高,应引起高度重视,积极进行心理干预.     

Screening for celiac disease in children with recurrent abdominal pain

BACKGROUND: The clinical presentation of celiac disease--a life-long gluten intolerance--may be characterized by chronic abdominal pain. The objective of this study was to determine if children with recurrent abdominal pain had a higher prevalence of antiendomysial antibodies (a serologic marker of celiac disease) compared with healthy children. METHODS: Children with recurrent abdominal pain and healthy control participants were recruited from the offices of community pediatricians. Serum samples were drawn and antiendomysial antibodies were measured in both groups. Demographic data included age, gender, height, and weight. RESULTS: A total of 200 children were recruited, of whom 173 (87%) had serum samples drawn. Of these, 92 were children with recurrent abdominal pain and 81 were control participants. Only 2 of the 173 samples (1.2%) were positive for antiendomysial antibody. The frequency of antiendomysial antibody positivity in children with recurrent abdominal pain was 1 in 92 (1%; 95% confidence interval, 0-6%) compared with 1 in 81 (1%; 95% confidence interval, 0-7%) in control participants. CONCLUSIONS: This community-based case-control study found no association between recurrent abdominal pain and the prevalence of antiendomysial antibody. Therefore, these data do not support screening for celiac disease in the child with classic recurrent abdominal pain in the primary care setting.     

Depression and anxiety in chronic hepatitis B: effect of hepatitis B virus infection on psychological state in childhood

We aimed to evaluate the effect of chronic hepatitis B virus infection on the psychological state of children. Children who were carriers of hepatitis B virus (n:20) and those with chronic hepatitis B virus infection (n:20) for at least one year formed study Groups 1 and 2, respectively. Healthy children with similar demographic characteristics (n:43) were enrolled as the control group. The "Children's Depression Inventory" and "State-Trait Anxiety Inventory for Children" were used for the assessment of the extent of depression and anxiety, respectively. Then, mean depression and anxiety scores of the study and control groups were compared. In addition, the children in each group were further evaluated for depression and anxiety with respect to gender and age as prepubertal and postpubertal. The mean depression and anxiety scores of study Groups 1 and 2 and of the control group were 8.35 +/- 5.6, 8.22 +/- 6.85, 9.12 +/- 5.2 (depression scores) and 32.7 +/- 6.85, 33.4 +/- 10 and 34 +/- 6.5 (anxiety scores), respectively. These three groups did not differ significantly from each other with respect to anxiety and depression scores (p>0.05). Athough there was no child with overt depression (with a depression score over 19) in study Group 2, two children in study Group 1 and one child in the control group were determined to be in overt depression. Children with chronic hepatitis B virus infection were not different with respect to depression and anxiety from children who were carriers of hepatitis B virus nor from the healthy controls.     

Transient dystonia in non-handicapped low-birthweight infants and later neurodevelopment

The aim of the present study was to evaluate the long-term prognostic significance of transient increase in muscle tone during infancy (dystonia) in very low-birthweight (VLBW) infants without cerebral palsy. Motor (Peabody Developmental Motor Scales), cognitive (Wechsler Preschool and Primary Scale of Intelligence) and behavioural (Personality Inventory for Children, Yale Children's Inventory) development was assessed at 5 years of age. In a population-based sample of 50 VLBW children, transient dystonia was present in 14. In explorative analyses, transient dystonia was associated with low 1 min Apgar scores, neonatal bacterial infection, and lack of breast-milk in the neonatal period. Cognitive, neuromotor and behavioural development at 5 years of age was comparable in those with and without transient dystonia, although there was a statistically non-significant tendency towards more neuromotor problems in the dystonic children.     

Psycho-behavioral changes in children with type 1 diabetes mellitus

Background

Type 1 diabetes mellitus (T1DM) is the most common type of diabetes in children. This study aimed to investigate psycho-behavioral changes in Chinese children with T1DM and to provide some advices for nurses, parents and other persons.

Methods

Forty-five patients with T1DM (26 boys and 19 girls with a mean age of 10.40±3.01 years) were enrolled. According to the glycosylated hemoglobin levels recommended by the American Diabetes Association, the patients were subdivided into a well-controlled group and a poorly-controlled group. Fifty-three healthy children served as a control group. Psycho-behavioral changes were investigated by using Achenbach’s Child Behavior Check List.

Results

Compared with the control group, the patients with T1DM had significantly higher mean scores for withdrawal, anxiety/depression, attention problems, delinquent behavior, aggressive behavior, externalizing problems, and internalizing problems (P<0.017). Moreover, the mean scores for somatic complaints in the poorly-controlled subgroup were significantly higher than those in the well-controlled subgroup (t=3.582, P=0.001). Compared with the control group, the well-controlled subgroup had higher scores for withdrawal, anxiety/depression, and internalizing problems (P<0.017). But the poorly-controlled subgroup had higher scores for withdrawal, somatic complaint, anxiety/depression, delinquent behavior, aggressive behavior, externalizing and internalizing problems (P<0.017).

Conclusions

Children with T1DM may have some psycho-behavioral problems. Timely nursing interventions must be conducted to solve these problems.     

Recurrent abdominal pain in 200 children: somatic causes and diagnostic criteria

Aim: To establish to what extent somatic causes can be found in children referred to secondary care with recurrent abdominal pain. Methods: For 2 years, all consecutive patients (age 4–16 years) fulfilling Apley criteria, referred to secondary care, were included. After a diagnostic work‐up, stepwise therapeutic interventions were performed. A diagnosis was considered to be the cause of the pain when the patient became pain free following therapeutic intervention and remained so for at least 6 months. Results: Two hundred and twenty children (128 F, 92 M; mean age 8.8 years) were enrolled, of which 20 were lost to follow‐up. Spontaneous recovery was seen in 54 patients, (occult) constipation in 92 patients (of whom 18 also had a somatic cause), gastrointestinal infections in 40, food allergy in five, miscellaneous disorders in seven and uncertain diagnosis in 13. In five patients, stress most likely caused the pain. A total of 198 patients became pain free and remained so during follow‐up (mean 18, range 6–60 months). Conclusion: In 200 children with recurrent abdominal pain, somatic causes were found in 26%. Laxative therapy was successful in 46%, resulting in nearly all patients with functional abdominal pain to become pain free. Eventually, 99% became pain free using a therapeutic intervention protocol.     

Motilin in children with recurrent abdominal pain: a controlled study

Fjord Christensen M. Motilin in children with recurrent abdominal pain: a controlled study. Aeta Pædiatr 1994;83:542–4. Stockholm. ISSN 0803–5253
The aim of this study was to compare serum motilin levels in children with and without recurrent abdominal pain, based on the assumption that recurrent abdominal pain in children is a gut motility disorder. In this controlled study, 19 children between 6 and 15 years or age with recurrent non-organic abdominal pain and 20 control children between 6 and 15 years of age without abdominal pain or other functional somatic complaints were evaluated. No slatistical significant difference was found in serum motilin levels between children with and without abdominal pain. Median difference between the groups was II pmol/1 (95% confidence limits of median difference -9 to +33). This investigation could not support the assumption that motilin might be a pathogenic factor in children with recurrent abdominal pain. It is suggested, however, that future research should compare serum motilin levels during and between attacks of pain.     

Psychological adjustment and coping in a population of children with recurrent syncope

The authors examined the association of psychological adjustment, styles of coping, and disease severity for children with recurrent syncope. Participants were 44 children and adolescents with a history of recurrent syncope and 40 healthy comparison control children. Dependent variables were measures of internalizing adjustment (e.g., anxiety, depression, withdrawal) reported by children and their parents and styles of coping reported by children. Parents reported higher frequencies of the internalizing of behavioral symptoms (i.e., anxiety, withdrawal) for children with recurrent syncope compared with their healthy counterparts. Children's self-reports did not reveal significant differences between the syncope and comparison groups in psychological adjustment and styles of coping. The authors conclude from these findings that adjustment difficulties, including symptoms of anxiety and social withdrawal, may occur with recurrent syncope. Implications for clinical practice and future research are discussed.     

Psychiatric, somatic, and gastrointestinal disorders, and Helicobacter pylori infection in children with recurrent abdominal pain.

AIMS: To examine the utility of the Rome II criteria in children with recurrent abdominal pain (RAP) and compare them to those who met Apley's criteria and those who met neither criteria. METHODS: Prospective study in general paediatric clinics in Komagane, Japan. Children with abdominal pain were classified into those who met Rome II criteria, those who met Apley's criteria, and those who met neither. RESULTS: A total of 182 children with RAP participated; 45 children met Rome II criteria, 55 met Apley's criteria, and 82 met neither. Children who met Rome II criteria had a significantly higher prevalence of psychiatric and somatic disorders compared to the group met neither (36% v 6%, 22% v 10%, respectively). The overall prevalence of H pylori was 7%; prevalence increased with age from 3% at age < or = 10 to 10% for children >10 years. Children who met Rome II criteria had a significantly higher prevalence of H pylori infection than the reference group (18% v 4%). In a logistic regression model, all the study variables were included in the model specifying first the Rome II criteria group as the independent variable; psychiatric disorders, H pylori infection, and older age group were independent risk factors. CONCLUSIONS: More than half the children suffering from recurrent abdominal pain met neither Apley's nor Rome II criteria. Children who meet Rome II criteria should be evaluated for psychiatric disorders and should be tested for H pylori infection. Despite the overall trend for a fall in the prevalence of H pylori infection among children in Japan, there are subpopulations of sick children where the prevalence of the infection is relatively high.     

The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain

The aim of the study was to assess and compare the IgG seroprevalence of H. pylori in children with recurrent abdominal pain with healthy children and to investigate the related symptoms. IgG antibodies against low-molecular weight H. pylori antigens were assessed in 438 children with recurrent abdominal pain and in 91 healthy controls. Sera with an ELISA unit-value above the cut-off level were confirmed by Western immunoblot. Only seropositive children with recurrent abdominal pain were examined by an oesophago-gastro-duodenoscopy. Symptomatology was recorded according to the localization of the abdominal pain, presence of pyrosis, nocturnal pain, relation of pain to meals and bowel irregularities. The seroprevalence was 21% (95% CI: 17-25%) in the children with recurrent abdominal pain and 10% (95% CI: 5–18%) in the healthy controls ( p = 0:30). In seropositive children with RAP H. pylori was found in 46/66 by culture and histology. The presence of H. pylori was significantly associated with active or inactive chronic gastritis. The presence of H. pylori was associated with both parents being born in a country with a high prevalence and a low social class. Helicobacter pylori-positive children had more often pain related to meals than the H. pylori- negative children. No differences among the two groups were seen according to the levels of haemoglobin, leucocytes, thrombocytes, weight and height. In conclusion, the seroprevalence of H. pylori is comparable in children with recurrent abdominal pain and healthy children. No specific symptomatology was seen in H. pylori- positive children with RAP.     

Symptomatic mitral valve prolapse in children and adolescents: catecholamines, anxiety, and biofeedback

It has been proposed that symptomatic mitral valve prolapse may be associated with a hyperadrenergic state and/or increased anxiety. To test this hypothesis, Spielberger State-Trait Anxiety (STAI) scores and 24-hour urinary catecholamine collections were gathered from 11 children and adolescents without mitral valve prolapse, 6 with asymptomatic mitral valve prolapse, and 14 who had chest pain (some with additional symptoms of shortness of breath, palpitations, and fatigue). STAI scores and catecholamine excretion values were not significantly different between groups. Ten symptomatic patients were randomly assigned to either eight sessions of skin temperature biofeedback with daily home practice of relaxation-mental imagery techniques or an attention-placebo condition. Change in 24-hour urinary catecholamine excretion values and STAI scores from baseline to end of treatment did not differ significantly between treatment and placebo conditions. Although not evident at the end of treatment, a significant decrease in chest pain was found in the biofeedback group at 6-month follow-up evaluation. In summary, results of this study did not show evidence of increased sympathetic tone or levels of anxiety in symptomatic pediatric patients with mitral valve prolapse. A behavioral treatment program using biofeedback and relaxation-mental imagery techniques was associated with decreased chest pain at 6-month follow-up.     

Organic abnormalities in recurrent abdominal pain in children

Using an investigation protocol, the aim of this study was to determine the frequency of organic abnormalities in children with recurrent abdominal pain, as new diagnostic approaches may reveal a higher prevalence of organic disease in this group than has been found in most studies. Included in the study were 44 children (mean age 8.3 y; 2-15) with more than three bouts of abdominal pain severe enough to affect the daily activities of the child and lasting more than 3 mo. The investigation covered a detailed medical story, a physical examination, blood, urine and stool samples. The somatic investigation was completed by abdominal X-ray and ultrasound, lactose-breath-hydrogen test and 24-h pH monitoring in the lower oesophagus. A Child Behaviour Checklist was completed to assess psychosocial aspects of the illness. The blood, urine and stool samples were normal, and abdominal ultrasound did not give any results related to the symptoms. Constipation was diagnosed in 7 patients (16%); 9 patients (21%) had gastro-oesophageal reflux and oesophagitis was found in another 3 children. One child had nodular antral gastritis with colonization by Helicobacter pylori, and three children had pathological lactose-breath-hydrogen tests. Twenty-four children (55%) did not have any signs of organic disease. The total score for the CBCL was in the normal range in 89%. Conclusion: Our observations indicate a higher proportion of organic abnormalities in recurrent abdominal pain than has been found in most previously reported studies, though a multicausal approach seems important.     

The role of Helicobacter pylori in abdominal pain in children]

Helicobacter pylori (H. pylori) colonizes the human stomach, especially during childhood. H. pylori gastritis, in the absence of duodenal ulcer, does not appear to be associated with specific symptoms. After eradication of H. pylori infection, abdominal pain is improved only in children with duodenal ulcer. Children with H. pylori gastritis cannot be distinguished from uninfected children on the basis of initial symptoms. However, although not demonstrated, a relationship between H. pylori and recurrent abdominal pain might exist since some studies showed that H. pylori-infected children present more frequent pain related to meals or ulcer-like symptoms. These discrepancies could be explained by the fact that H. pylori is probably not a frequent cause of recurrent abdominal pain. The use of refined clinical characteristics of abdominal pain could be of help identifying a subgroup of patients with abdominal pain in whom H. pylori infection needs to be sought and treated. Recent pediatric consensus conferences recommend testing for H. pylori infection by endoscopy only those patients presenting symptoms suggestive of an organic origin.