Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study

BMJ 1998;316:1196-1200 ( 18 April )

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Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study

Matthew Hotopf, Medical Research Council clinical training fellow, ^a Siobhán Carr, lecturer in paediatrics, ^b Richard Mayou, professor of psychiatry, ^c Michael Wadsworth, director, ^d Simon Wessely, professor of epidemiological and liaison psychiatry. ^a

^a Department of Psychological Medicine, King's College School of Medicine and Dentistry and Institute of Psychiatry, London SE5 8AZ, ^b Department of Paediatrics, Royal Free Hospital, London NW3 2QG, ^c University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, ^d MRC National Survey of Health and Development, Department of Epidemiology and Public Health, University College and Middlesex School of Medicine, University College London, London WC1E 6BT

Correspondence to: Dr Hotopf m.hotopf{at}iop.bpmf.ac.uk

Objective: To test the hypotheses that children with abdominal pain have anxious parents and come from families withhigh rates of physical illness and that they grow up to sufferfrom high rates of medically unexplained symptoms and psychiatricdisorders.
Design: Population based birth cohort study.
Setting: General population.
Subjects: Participants in the Medical Research Council (MRC) national survey of health and development, a populationbased birth cohort study established in 1946.
Main outcome measures: Abdominal pain present throughout childhood in the absence of defined organic disease, and measuresof physical symptoms and psychiatric disorder at age 36 years.
Results: There were high rates of complaints about physical health among the parents of children with persistent abdominalpain, and the mothers had higher neuroticism scores. Childrenwith persistent abdominal pain were more likely to suffer frompsychiatric disorders in adulthood (odds ratio 2.72 (95% confidenceinterval 1.65 to 4.49)) but were not especially prone to physicalsymptoms once psychiatric disorder was controlled for (odds ratio1.39 (0.83 to 2.36)).
Conclusions: Persistent abdominal pain is associated with poor health and emotional disorder in the parents. Childrenwith abdominal pain do not necessarily continue to experiencephysical symptoms into adulthood but are at increased risk ofadult psychiatric disorders.

Key messages

Persistent abdominal pain in childhood is more common in families with high rates of reported physical illness and psychological symptoms
The outcome for persistent abdominal pain is good in terms of mortality
Children with persistent abdominal pain are not at greatly increased risk of developing physical symptoms in adulthood
Abdominal pain in childhood is associated with considerably increased risk of psychiatric disorders in adulthood

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