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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1368-1372

Importance of Parental Conceptual Model of Illness in Severe Recurrent Abdominal Pain

Ellen Crushell, MB*, Marion Rowland, MB*,{ddagger}, Mairin Doherty, MD{ddagger},§, Siobhan Gormally, MD||, Sinead Harty, MB*, Billy Bourke, MD*,{ddagger} and Brendan Drumm, MD*,{ddagger}

* Department of Paediatrics, Conway Institute for Biomolecular and Biomedical Research, University College, Dublin, Ireland
{ddagger} The Children’s Medical and Research Foundation, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
§ The Department of Liaison Child Psychiatry, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland
|| Department of Pediatrics, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland

Objectives. Recurrent abdominal pain (RAP) affects up to 15% of children. A biopsychosocial approach to the treatment of children with RAP has been proposed as an alternative to the traditional medical model. The aim of this study was to examine whether the parental conceptual model of illness is a factor in the long-term outcome of children with severe RAP.

Methods. The study was undertaken in 2 parts: 1) a review of the medical and psychiatric records (including Child Behavior Checklist [CBCL]) of all children with RAP of sufficient severity to necessitate hospitalization during a 5-year period and 2) a structured telephone interview to collect information on ongoing abdominal pain, other somatic symptoms, school attendance, and the parents’ opinion as to the cause of the child’s pain.

Results. Twenty-eight of 30 children who were identified were available for follow-up. Twenty-three (82%) were tertiary referrals from other pediatric services, and 20 had pain for >6 months. On admission 7 (25%) of 28 had a depressive disorder, and 8 (29%) had an anxiety/depressive disorder. Twenty-one of 28 parents completed the CBCL, and on analysis of the CBCL, 11 (52%) children had scores in the clinical range (>65). At follow-up (mean: 3.56 years; standard deviation: 1.59), 14 (50%) of 28 continued to complain of pain. These children also complained of multiple other somatic complaints and had repeated school absences. Only 1 (7%) of 14 parents of children with ongoing pain believed that there was a psychological cause for their child’s pain, whereas 11 (78%) of 14 parents of the children who had recovered believed that the cause was attributable to psychological factors (odds ratio: 47.67; 95% confidence interval: 3.56–1511.6).

Conclusions. The acceptance by parents of a biopsychosocial model of illness is important for the resolution of recurrent abdominal pain in children.

Key Words: recurrent abdominal pain • children • biopsychosocial model

Abbreviations: RAP, recurrent abdominal pain • IBS, irritable bowel syndrome • CBCL, Child Behavior Checklist • SD, standard deviation • OR, odds ratio • CI, confidence interval

Received for publication Sep 6, 2002; Accepted Feb 19, 2003.


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