Abdominal pain in childhood with no determined physical cause predicts much higher rates of anxiety and depression in adolescence and early adult years, according to a study published online today in Pediatrics.
It’s been estimated that anywhere from 8 to 25 percent of school-aged children experience recurring abdominal pain. Many of these patients have no evidence of a physical cause of the pain, and therefore have medically unexplained or “functional” abdominal pain.
This large, well run study followed over 300 patients with abdominal pain and a matched control group of about 150 patients from childhood into adulthood. The researchers from Vanderbilt University found of the adults who had abdominal pain as children, 51 percent had an anxiety disorder during their lifetime (and 30 percent had a current diagnosis), compared with 20 percent of adults in a control group who had an anxiety disorder in their lifetime. Forty percent of adults who had abdominal pain as children had depression during their lifetime, compared to 16 percent of adults in the control group.
What is more important is what this study tells us as parents on perhaps how to help young children manage their pain and anxiety early in life to make things easier as they grow up.
Anxiety has three components, the physical experience of increased breathing and heart rate, sometimes sweating, a distinct feeling of not being at ease, the cognitive-thinking component that tells us something bad is about to happen, and the emotional component of feeling anxious. Anxiety is being highly negatively emotionally aroused, and not being able to control it.
When children are very young and experience these negative feelings, they do not yet have the ability to label and identify them. Their physical negative feelings can be expressed as a tummy ache or a headache, and often evaluation and treatment goes down the road of looking for physical causes which often are not to be found.
A true biopsychosocial approach – taking into account biological, psychological, and social aspects – would also look at the child’s worry and anxiety, and help them cope. When individuals cannot identify the emotions bothering them, and lack the capacity to manage them, it often results in physical symptoms being amplified. The pain is real and hard to manage.
That children who have these early severe abdominal pains grow up to be adults with anxiety is not surprising. It is a different expression of the same intense emotions that they have trouble managing.
What helps is explicitly teaching children to identify emotions (good materials can be found from Center on the Social and Emotional Foundations for Early Learning at Vanderbilt University), and what to do when they experience intense feelings. That is the preventative that will help many children from developing out of control feelings. For those who have a much harder time managing their negative feelings early, those who do experience significant abdominal pain, cognitive therapy treatment can help greatly to mitigate the pain and prevent further problems down the road.
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