Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2006 Massachusetts Medical Society. All rights reserved.

Five-year outcomes of children with functional abdominal pain ▸

Children with the highest levels of depression, anxiety, and negative life events failed to improve over 5 years.

Recurrent abdominal pain affects 10% to 24% of children and is a major reason for referral to gastroenterologists. Although prospective studies indicate that many children continue to have symptoms for years after an initial evaluation, the relation between initial presentation and persistence of symptoms over time has not been examined. In this 5-year follow-up study, investigators assessed 132 children (age range, 6–18) who were referred to a pediatric gastroenterologist for abdominal pain with no evidence of organic disease. Baseline and follow-up measures included child and parental reports of severity of somatic symptoms, functional disability, anxiety and depression, life events, child’s feelings of self-worth, and characteristics of the pain.

Statistical modeling revealed three distinct trajectories for symptoms and impairment. Most patients (70%) were low-risk with low levels of symptoms and impairment at baseline and improvement within 2 months. The short-term risk group (16%) had the highest levels of pain frequency and intensity and impairment at baseline but also improved within 2 months. The long-term risk group (14%), which had the highest levels of depression and anxiety symptoms and negative life events, scored lowest in feelings of self-worth. These children did not improve over 5 years. Child, but not parental, …