Kids' Belly Pain Linked to Mental Health Risk

August 12, 2013

News Review From Harvard Medical School -- Kids' Belly Pain Linked to Mental Health Risk

Children who have long-lasting stomach pain may have a higher risk of anxiety or depression as adults, a new study finds. The study included 332 school-age children. All had been having belly pain that lasted at least 3 months and had no clear medical cause. Doctors call this functional abdominal pain. They were compared with 147 children who did not have long-lasting belly pain. By the time they were young adults, 51% of the children with belly pain and 20% of the other group had developed an anxiety disorder at some point. About 40% developed depression, compared with 16% of the other group. These conditions occurred even though many no longer had stomach pain. Doctors say it's important for children with this type of pain to keep up their regular activities as much as possible. Avoiding them can increase anxiety and make the pain worse.  The journal Pediatrics published the study August 12. The New York Times, HealthDay News and Reuters Health News Service wrote about it.

By Henry H. Bernstein, D.O.
Harvard Medical School

What Is the Doctor's Reaction?

All children get a tummy ache every now and then. It often goes away quickly for most of them. Other children are not so lucky.

A child may complain about belly pain without any obvious reason for more than three months. This is functional abdominal pain (FAP). It means that even after testing, there is no clear medical cause found for the pain. But the pain is real for the child.

This type of pain is common. About 10% to 15% of school-aged children report it to their doctors. It's estimated that another 15% of children have the pain but do not report it.

Children with FAP sometimes have other belly problems, such as like nausea, diarrhea or constipation. They also are more likely than other children to have emotional troubles, such as:

• Anxiety
•  Depression

What happens when children with FAP grow up? Researchers wondered whether these same children are at higher risk of anxiety or depression when they get older. The journal Pediatrics just published the answer.

The researchers kept track of people for several years. They compared those who had FAP when they were children with those who never had FAP (control group). Everyone was interviewed later as a teenagers or young adult.

In the FAP group:

• Just over half (51%) reported having anxiety at some point in life (lifetime anxiety). Only 20% of the control group reported anxiety.
• About 40% reported that they had been depressed, compared with only 16% of the control group.

The FAP group was also more likely to have a current diagnosis of anxiety (30% vs. 12%). Current depression was about the same in both groups.

The researchers also discovered that feelings of anxiety usually began in childhood, before the belly pain started. On the other hand, feelings of depression usually started when these children were teenagers.

What seems to be the connection between mental health problems and functional abdominal pain? Stress or anxiety might make the organs in the belly more sensitive. As a result, children feel pain even though their organs seem to be working normally. It is also possible that these children might become depressed or anxious because of their pain.

What Changes Can I Make Now? 

Abdominal pain is no fun. It can lead children to stop doing their usual activities. They may go to the school nurse a lot and even miss school.

It is important that a child with FAP:

• Continues as normal a routine as possible
• Builds a good bond with his or her  doctor

It might take time for the doctor to decide which is the best treatment plan to make your child's pain go away.  The doctor also will try to help your child (and you) handle the pain.

You can take steps to manage the pain and help your child feel better.

Stay positive.

• Send the right message to your child by keeping a positive attitude.
• Comfort and support your child. Do not focus on the pain. This only reinforces it.
• Remember that your child does not have a serious problem. This condition is common. It is not dangerous. Your child should grow well and stay healthy.

Reduce stress.

• Stress can lead to belly pain. It can also make the pain worse.
• Breathing exercises may help relax your child. They also may help during times of pain.
• Behavioral therapy can help lower any stress or anxiety. In turn, this may let your child do more of her normal activities.

Make diet changes.

• Avoid foods your child thinks may cause pain, such as:
  
  • High-fat foods
  • Caffeine
  • Foods that increase gas (for example, beans, carrots, raisins, bananas, cabbage, cauliflower, broccoli, asparagus)      
• For some children, constipation may be part of the problem. For them, eating lots of fiber may relieve some of the pain.

Think about medicine.

• Medicine may be helpful for some children with FAP. Talk with a doctor to see if this is a good idea for your child.

What Can I Expect Looking to the Future? 

The body and mind can affect each other. So doctors are more often likely to screen FAP patients for mental health problems. Future studies also will look at which treatments for anxiety and depression help improve belly pain more for FAP patients.