From the New York Times (Children with Chronic Stomach Pain)

The following article features a study by my good friend Lynn Walker, Director of the division of adolescent health at Monroe Carell Jr. Children’s Hospital at Vanderbilt and senior author of the study.

Risk of Adult Anxiety Seen in Children’s Stomachaches

By CATHERINE SAINT LOUIS

Christopher Berkey for The New York Times Donya Kazemi, 11, right, with her mother, Nasrin, and sister, Diana, 15, has functional abdominal pain. 

 

Children with chronic stomach pains are at high risk for anxiety disorders in adolescence and young adulthood, a new study has found, suggesting that parents may wish to have their children evaluated at some point for anxiety.

Researchers at Vanderbilt University tracked 332 children with recurring stomachaches that could not be traced to a physical cause — so-called functional abdominal pain — comparing them as they reached young adulthood with 147 children who had never had such stomachaches.

About half the teenagers and young adults who had had functional abdominal pain as children developed an anxiety disorder at some point, compared with 20 percent of the control group, the researchers found. The vulnerability to anxiety persisted into adulthood even if the pain had disappeared, although the risk was highest if the pain continued.

Forty percent of the children with functional abdominal pain went on to experience depression, compared with 16 percent of those who had never had these stomachaches.

The study was published on Monday in the journal Pediatrics.

“What this study shows is a strong connection between functional abdominal pain and anxiety persists into adulthood, and it drives home the point that this isn’t by chance,” said Dr. John V. Campo, chairman of the department of psychiatry at Ohio State University, who was not involved in the new study.

In 2001, Dr. Campo published a smaller study that found that 28 young adults who had suffered functional abdominal pain as children were far more likely to have an anxiety disorder than 28 similar adults who had experienced another childhood illness.

Chronic abdominal pain affects 8 percent to 25 percent of school-age children. The problem can lead to school absences and take a toll on families.

“Somebody might say, ‘Of course they have mental issues or they are emotionally distressed — it’s because of the pain,’ ” said Lynn S. Walker, senior author of the study and director of the division of adolescent health at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“But we found even if the pain went away, these adolescents and young adults still have anxiety,” Dr. Walker said. “So maybe we need to treat their anxiety.”

The state-of-the-art treatment for functional abdominal pain is rehabilitative, focused on getting patients to participate in daily activities despite their stomachaches. “There’s no question that there are triggers for the pain, but the problem is in the perception of the pain and adaptation to the pain,” said Dr. Samuel Nurko, director of a functional abdominal pain center at Children’s Hospital Boston.

Dr. Nurko compared the pain to a light on a dimmer switch, which psychological techniques can help children control. “You don’t take away the pain,” he said. “You ‘dim’ it to be able to cope better.”

The new study underscores the importance of screening children with the condition for anxiety or depression, the authors said. Anxious children tend to be good children who are concerned about doing their best, Dr. Walker said, and parents may be flummoxed by the suggestion that such a child could be grappling with a mental health issue.

The majority of the children enrolled in the study “had not seen a mental health professional, ever,” Dr. Walker said.

But Miranda van Tilburg, an associate professor of medicine at the University of North Carolina School of Medicine, cautioned parents against leaping to the conclusion that a child’s unexplained stomach pain is “all anxiety based, because we don’t know that.”

“The take-away message should be you should not be afraid, if your doctor talks to you about anxiety in your child, to seek help from a mental health professional, because it could help your child feel better,” Dr. van Tilburg said.

Such a referral is “not an admission that that’s what’s causing the pain,” she said. “It’s just an admission that anxiety is linked to the pain.”

Nasrin Kazemi, a part-time real estate agent in Brentwood, Tenn., has three children, all of whom had frequent stomachaches. “If I get a little more excited, or sad, or mad about something, my stomach will start hurting,” said Mrs. Kazemi’s youngest daughter, Donya, 11.
The anticipation of starting sixth grade this fall has set off new waves of stomach pain. “It’s probably not going to stop until I get used to sixth grade,” Donya said.

She became anxious two years ago after a ghastly fortnight of flu-induced vomiting, her mother said. Since then, Donya worries about attending birthday parties where she might catch another flu, and such concerns make her abdominal pain flare up.

At first, Mrs. Kazemi was reluctant to seek psychological help for Donya, but her daughter eventually saw Dr. Walker. Mrs. Kazemi is hopeful about the new research, even though it suggests that Donya may have a lifelong vulnerability to anxiety.

“Because she is learning to deal with her emotions and to not let them get the better of her, she’ll be better with dealing with negative things that happen later in life,” Mrs. Kazemi said.