ARTICLES
Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study

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ABSTRACT

Objective

To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6¾ years.

Method

A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6¾ years. Parental reports of child and parent functioning were gathered. Associations between parental and child functioning assessed at 6 to 8 months postpartum, and RAP measured at age 6¾ years were investigated.

Results

The prevalence of RAP in this sample was 11.8%. Both maternal anxiety (adjusted odds ratio = 1.53; 95% confidence interval 1.24-1.89) and paternal anxiety (adjusted odds ratio = 1.38; 95% confidence interval 1.12-1.71) in the first year of a child's life were associated with later childhood RAP. Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP.

Conclusions

This is the first evidence from a prospective study that anxiety in both mothers and fathers and child temperament features predate the occurrence of RAP in children. These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP, although some caution should be exercised in their interpretation because of possible reporting bias.

Section snippets

Participants

ALSPAC is a prospective, longitudinal study of children born to women residents of Avon, England, with an expected date of delivery between April 1, 1991, and December 31, 1992, and their parents. The background and detailed methods of the study have been previously described (Golding et al., 2001). Approximately 85% of eligible women took part. This resulted in 13,971 live births who survived the first year of life.

Measures

All of the data concerning the predictor variables were taken from

RESULTS

The questions on RAP at age 6¾ years were completed for 8,272 children. Of these, 7,906 (95.6%) had data from earlier mothers' questionnaires and 5,357 (64.8%) from fathers' questionnaires. Further details of sample attrition over time are given on the ALSPAC study Web site (see References). Mothers withdrawing from the study were more likely to have been anxious at 8 months (17.4% versus 14.7%) and score highly on somatic symptoms (16.1% versus 10.9%) than those remaining in the study. No

DISCUSSION

This is the first study to demonstrate prospectively that RAP at age 6 years is preceded in early life by anxiety in both mothers and fathers and by particular infant temperament characteristics. Both maternal anxiety and paternal anxiety were found to be associated with later RAP in children, as were maternal somatic symptoms. A dose-response relationship existed between parental anxiety early in a child's life and subsequent risk of RAP. We found weaker evidence of an association of RAP with

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    Dr. Ramchandani is funded by the Medical Research Council, U.K., through a special fellowship in Health Services and Health of Public Research. Prof. Stein is funded by the Wellcome Trust.

    The ALSPAC study is part of the World Health Organization-initiated European Longitudinal Study of Pregnancy & Childhood. This study could not have been undertaken without the financial support of the Wellcome Trust, the Medical Research Council, the University of Bristol, the Department of Health, and the Department of the Environment. The authors are extremely grateful to all of the mothers and fathers who took part and to the midwives for their cooperation and help in recruitment. The whole ALSPAC study team comprises interviewers, computer technicians, laboratory technicians, clerical workers, research scientists, volunteers, and managers who continue to make the study possible. The authors also thank Professor B. Sandhu, who developed the abdominal pain questions for the ALSPAC study, and Kate Northstone and Professor Jean Golding, in particular, for their help and support with this work.

    Disclosure: The other authors have no financial relationships to disclose.

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