The course of mental health problems in children presenting with abdominal pain in general practice

Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months' follow-up. Design. A prospective cohort study with one-year follow-up. Setting. 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects. 281 children aged 4-17 years. Main outcome measures. The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up. Results. A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3-44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2-46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7-51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months' follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple nonspecific somatic symptoms at follow-up. Conclusions. In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain

Samenvatting NHG-standaard 'Buikpijn bij kinderen': de 100e NHG-standaard

The Dutch College of General Practitioners (NHG) guideline 'Abdominal pain in children' was published in September 2012. The guideline distinguishes between children with acute abdominal pain (≤ 1 week) and chronic abdominal pain (> 1 week). Abdominal pain can be caused by an underlying somatic condition or can have a functional nature. The chance of finding a somatic cause is far higher in children with acute abdominal pain than in children with chronic abdominal pain. In children with acute pain the emphasis is on diagnosis, whereas in children with chronic pain it is on treatment. Additional investigations in children without indications for a somatic cause can be limited to urinary investigation. Most children with functional abdominal pain can be treated by their GP. This treatment consists of explanation and advice to the patient and his or her parents, with the aim of providing reassurance. In children with continued severe functional abdominal pain, consultation with or possible referral to the paediatrician is advised

Summary of the NHG guideline 'Abdominal pain in children', the 100th NHG guideline

The Dutch College of General Practitioners (NHG) guideline 'Abdominal pain in children' was published in September 2012. The guideline distinguishes between children with acute abdominal pain (≤ 1 week) and chronic abdominal pain (&gt; 1 week). Abdominal pain can be caused by an underlying somatic condition or can have a functional nature. The chance of finding a somatic cause is far higher in children with acute abdominal pain than in children with chronic abdominal pain. In children with acute pain the emphasis is on diagnosis, whereas in children with chronic pain it is on treatment. Additional investigations in children without indications for a somatic cause can be limited to urinary investigation. Most children with functional abdominal pain can be treated by their GP. This treatment consists of explanation and advice to the patient and his or her parents, with the aim of providing reassurance. In children with continued severe functional abdominal pain, consultation with or possible referral to the paediatrician is advised.</p

Prognosis of chronic or recurrent abdominal pain in children

Background: Chronic abdominal pain (CAP) or recurrent abdominal pain is common in childhood and is rarely associated with organic disease. With modern diagnostic technology, new organic abnormalities are found in children with CAP. Thus far a causal relation between these abnormalities and CAP has not been established. The additional prognostic value of extensive testing of children with CAP is a subject of debate. Objectives: To investigate how often abdominal pain persists in children with CAP and to investigate whether medical tests such as laboratory tests, imaging, and endoscopy have additional prognostic value to history taking and clinical examination. Materials and Methods: A systematic search was conducted in MEDLINE, EMBASE, and PsycINFO for prospective cohort studies published from 1960 until October 2005. The most common medical key words for CAP were used in our search strategy. The methodological quality of studies was determined. Clinical heterogeneity between studies was analyzed. The percentages of children with abdominal pain after follow-up were pooled. Results: The search yielded 2620 citations, of which 18 studies met the inclusion criteria. In total, 1331 children were followed up for 5 years (median, range 1-29 years). In total, 29.1% (95% CI 28.1-30.2) of patients with CAP had abdominal pain after follow-up. The prognosis of CAP diagnosed clinically was similar to that diagnosed after additional medical testing. Conclusions: CAP persisted in 29.1% (95% CI 28.1-30.2) of children. In the absence of alarming symptoms, additional diagnostic testing did not influence the prognosis of CAP

Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

PURPOSE Nonspecific abdominal pain (NSAP) is a common complaint in childhood. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents are hard to reassure. Little is known about NSAP in family practice, but the impression is that family physicians consider it to be a benign syndrome needing little more than reassurance. This discrepancy calls for a better understanding of NSAP in family practice