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Family anxiety is strongly linked to unexplained illness

15 June 2006

Doctors treating schoolchildren for persistent stomach ache might need to ask about anxiety in the family.

Doctors treating schoolchildren for persistent stomach ache might need to ask about anxiety in the family.

A new study of Recurrent Abdominal Pain among six-year-old children suggests the problem could be connected to high levels of anxiety in their parents going back several years. If the researchers are right, it would help GPs understand one of the most common problems they have to deal with.

The findings are based on the experiences of 8,272 families taking part in the Children of the 90s project at the University of Bristol.

Oxford psychiatrist Dr Paul Ramchandani and his colleagues say that a large proportion of doctors' time is taken up dealing with illnesses where the exact cause is uncertain - of which recurrent abdominal pain is the most common among children.

Previous research has shown that many children with RAP come from homes where the parents appear to suffer higher rates of anxiety but until now no-one has been able to say which comes first - the anxiety or the tummy ache.

In the latest study, published by the American Academy of Child and Adolescent Psychiatry, mothers and fathers had been asked about their anxieties, depression and illness soon after the birth of their children. Six years later they were asked about their children's illnesses and temperaments.

Parents reported that 11.8 per cent had stomach ache at least five times in the year.

Researchers found that in families where parents had experienced most anxiety while the children were babies - it was about 50 per cent more likely that their children would complain of recurrent abdominal pain at the age of six. The risk was higher still if both parents had anxiety.

Dr Ramchandani says: "This is the first study to demonstrate that anxiety in both fathers and mothers predates the onset of Recurrent Abdominal Pain by several years.

The findings suggest a possible causal role for parental anxiety in RAP, and perhaps in other medically unexplained symptoms."

The report suggests a number of possible reasons. It could be that anxious parents react differently when their children appear to be ill - and their behaviour leads the child to complain of similar symptoms again. Or it could be that the children are simply copying their own parents’ behaviour when they fall ill. It is also possible that anxiety runs in the family, and they tend to worry more about illness.

Dr Ramchandani says the findings have implications both for treating patients with unexplained stomach ache - and for preventing RAP in the first place where parents are known to suffer from anxiety.

"Taken together with other research we would suggest that child psychiatrists, primary health care physicians, paediatricians, and others working with children with Recurrent Abdominal Pain should sensitively inquire about parental anxiety when a child presents with a medically-unexplained symptom.

"Given the enormous personal impact and health care cost associated with medicallyunexplained symptoms and the often-chronic nature of such symptoms, the potential for an early point of intervention is one to be grasped. These findings have implications for both prevention and early intervention at a family level."

Academic paper reference:

Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study. Paul G Ramchandani, Alan Stein, Matthew Hotopf, Nicola J Wiles, and the Alspac Study Team. Journal of the American Academy of Child and Adolescent Psychiatry. doi 10.1097/01.chi.0000215329.35928.e0


1. ALSPAC The Avon Longitudinal Study of Parents and Children (also known as Children of the 90s) is a unique ongoing research project based in the University of Bristol. It enrolled 14,000 mothers during pregnancy in 1991-2 and has followed most of the children and parents in minute detail ever since.

2. The ALSPAC study could not have been undertaken without the continuing financial support of the Medical Research Council, the Wellcome Trust, and the University of Bristol among many others.


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