Abstract
Background: We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Methods: We retrospectively reviewed 100 consecutive patients from an outpatient pediatric neurology clinic. Patients were included if they were ≥5 years old and reported ≥4 symptoms that were unexplained for ≥3-months. Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. ACEs were scored for all patients. Results: Seventeen patients reported ≥4 medical symptoms. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority. Forty-two children reported ≥1 ACE, but children with ≥4 symptoms were more likely to report ACEs compared to other children (88% vs. 33%; p < 0.0001) and had a higher median total ACE score (3 vs. 1; p < 0.001). Conclusions: Children with multiple medical symptoms should be screened for potential exposure to ACEs. A clinical profile of symptoms across multiple functional domains suggests putative neurobiological mechanisms involving stress and nervous system dysregulation that require further study.
Highlights
Pediatricians frequently see patients with symptoms for which no organic disorder can be found, including chronic pain, dizziness, and constipation
Children with ≥4 unexplained medical symptoms are common, accounting for 17% of patients presenting to an outpatient child neurology clinic, and are associated with a higher prevalence of adverse childhood experiences
These symptoms are likely to be related to a nervous system that has adapted to chronic stress, whereby physiological dysregulation impairs the ability to control and effectively regulate all the functions of the nervous system: emotional processing, sleep-wake cycles, autonomic function, digestion, motor function, and sensory perception
Summary
Pediatricians frequently see patients with symptoms for which no organic disorder can be found, including chronic pain, dizziness, and constipation. Patients with these complaints often have co-morbid sleep problems, cognitive difficulties involving attention and memory, and psychiatric symptoms including depression, anxiety, and panic attacks. We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority
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