September 19, 1997

Link between child stress, abdominal pain studied

Link between child stress, abdominal pain studied

Sometimes, it's the little things that matter most.

When it comes to stress, the relatively small hassles of daily life often get to us as much or more than the major events. The result may be a pounding headache or a pain in the gut.

A new study under way at Vanderbilt Children's Hospital is examining whether the annoyances of daily life have a similar impact on children.

Led by Lynn S. Walker, Ph.D., associate professor of Pediatrics, the study is specifically investigating whether daily hassles and children's reaction to them play a role in recurrent episodes of abdominal pain. The study also will have general implications about the relation of stress to children's physical and emotional well-being.

"We'd like to understand more about the processes that contribute to the development and the maintenance of recurrent abdominal pain so that we can develop interventions to help these children," Walker said.

"We hope to be able to address psychosocial issues in ways that may help reduce the pain or help these children cope better with it."

Children and adults often experience physical symptoms ‹ a headache, an upset stomach or other complaint ‹ that are not caused by any identifiable disease. The symptoms are real, but there's no organic disease.

In children, the most common of these is recurrent abdominal pain (RAP), defined as episodes of abdominal pain over a three-month period that are severe enough to interrupt a child's normal activities or to cause parents to seek medical advice. An organic cause is rarely found.

The condition is estimated to affect 10 percent of school-age children.

"We see a lot of children with RAP in our pediatric gastroenterology clinic and other pediatric clinics at Vanderbilt," Walker said.

"Because there are more than 100 different possible causes of abdominal pain, there's a possibility of quite a medical work-up. It's important that we understand more how psychosocial factors may also contribute to these episodes."

With the support of the National Institutes of Health, Walker and her colleagues at Vanderbilt are studying the psychosocial and emotional issues associated with RAP.

Their previous research found that children with RAP have more anxiety and depression than children without abdominal pain, though about equal to children with abdominal pain caused by a known medical ailment. It is not known whether the anxiety and depression is a cause of the pain or result of it, Walker said.

They also have found that children with RAP are more likely to have a family member with a chronic health complaint. The exact relationship is still unclear, but Walker said it could be that children in these families are more attuned to their symptoms. Perhaps they have learned that they can attract attention with physical complaints, she said, or their parents are more likely to seek medical advice.

"We've also done some studies following these children for as long as five years, trying to find out which of them continue to complain of RAP," Walker said. "We found that children who have more life stress and who have lower levels of social and academic competence are the ones who continue to complain a year later."

The current study, funded by a $376,000, three-year grant from the National Institute of Child Health and Human Development, will expand on this last finding.

Using a "daily diary methodology," researchers will interview about 250 children between the ages of 8 and 14. One group of the children will be recruited from the pediatric gastroenterology clinic, where they've been seen for RAP. The control group will be recruited in the community.

Researchers talk to the children over the telephone before bedtime on several consecutive days. The children will be asked to describe what happened during the day and will be asked about a standard list of hassles, such as being late for the school bus, getting grounded, not having someone to sit with at lunch, or being called on in class when they didn't know the answer.

"We'll be examining a number of issues, including whether children with RAP have more hassles than others and, even if they don't experience more hassles, whether they regard those that do occur as more serious," Walker said. "When something happens, they may think it's much worse than other children would think."

The study will also look at how the children cope with the problems they encounter during their day, and how they cope with physical symptoms such as a stomach ache.

"This will be one of the first studies to apply the daily diary methodology to an examination of children's health," Walker said. "It's not just the big things that influence our lives. We have so many different things that happen during the day, and we forget many of them, but they are likely to have an impact on the physical and emotional symptoms we experience from day to day.

"We believe that the daily diary methodology may be especially useful in understanding children with RAP because their episodes don't last every day for weeks. It's periodic. They have pain today, but not tomorrow, but again the next day or the next week. The diaries will help us understand the context in which their pain episodes occur. That context should giveus some clues about ways to intervene."