Abstract
Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interview task in which children answered questions about a Teddy bear’s pain. Responses were analyzed quantitatively and qualitatively. Results indicate that the majority of young children with FAP are optimistic about pain outcomes. Children generated many types of coping strategies for Teddy’s pain and adjusted their calibration of Teddy’s pain tolerance dependent on the activity being performed. Early warning signs also emerged: a subset of children were pessimistic about Teddy’s pain, and several children identified coping strategies that, while developmentally appropriate, could lead to excessive help seeking if not intervened upon (e.g., physician consultation and shot). The Teddy Bear Interview allows children to externalize their pain, making it a useful tool to access cognitive pain constructs in younger children. Thus, these findings highlight the importance of early intervention for childhood FAP.
Highlights
Functional abdominal pain (FAP) is one of the most common physical complaints of childhood [1]
There were no significant differences in sex, age, race, and ethnicity between the sample used for the Teddy Bear Interview and the larger participant cohort
Findings suggest that children were optimistic about Teddy’s prognosis and were able to generate creative coping strategies for pain
Summary
Functional abdominal pain (FAP) is one of the most common physical complaints of childhood [1]. According to the Rome IV Criteria, FAP can be defined as when abdominal pain occurs 4 or more times a month, for at least 2 months, in either an episodic or continuous fashion, and cannot be ascribed to another medical condition [2]. A meta-analysis pooling prevalence rates across 58 studies, summarizing data from 196,472 children aged 4 to 18 years, found that 13.5% of youth (1.6% to 41.2% across studies) suffer from FAP disorders worldwide [1]. Prevalence rates were similar when data were collapsed for children below and above 12 years of age, suggesting that FAP is common across early development. Based on the data summaries in this meta-analysis, approximately 1 in 10 children experience FAP
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