Combined infant regulatory problems and early maternal psychiatric illness predict risk of functional somatic symptoms in later childhood
- Correspondence to: Professor M Elena Garralda
Imperial College London, Academic Unit of Child Psychiatry, St Mary's Campus, Norfolk Place, London W2 1PG, UK;
Commentary on Rask CU, Ørnbøl E, Olsen EM, et al. Infant behaviors are predictive of functional somatic symptoms at ages 5–7 years: results from the Copenhagen Child Cohort CCC2000. J Pediatr 2013;162:335–42.
Implications for practice and research
Counselling mothers to help settle babies with high levels of feeding/sleeping/tactile reactivity may help prevent the development of functional somatic symptoms (FSS) in children.
Further research is required to identify additional risk factors for FSS and the evaluation of preventative interventions.
FSS in children are physical symptoms that cannot be ascribed to a medical disease. FSS affect approximately 10% of children and adolescents: when frequent and causing impairment they can lead to unproductive and costly medical assessments.1 FSS are often associated with anxiety disorders, and can predict adult physical and psychiatric morbidity.2 FSS manifest in preschool children3; understanding early precursors offers the potential for prevention.
The study aimed to investigate early predictors of FSS in children.
The study is part of the Copenhagen Child Cohort CCC2000 prospective review of 6090 children followed up since birth. Health nurses collected information during four routine home visits in the child's first year of life. This included details and observations about the child's development and reactivity (eg,whether the child was hypersensitive to sensory and tactile stimuli, needing assistance to settle back to sleep once awake, and problems associated with the introduction of new ways of feeding). Information was also collected about maternal psychiatric and socioeconomic status. The presence of FSS was measured using the validated Soma Assessment Interview tool when the children were 5–7 years of age. FSS were defined as somatic symptoms that caused substantial distress, impairment and medical help seeking.
Of 2912 eligible children, FSS information was available for 1327 children. The overall prevalence of FSS (mainly limb pains, headaches, stomach aches) was 23%; symptoms were impairing (eg, causing distress, restrictions to social activities, accessing health services and absence from school or day care) in 4% of these children (n=58). Impairing FSS were significantly and independently associated with the child having more than one regulatory problem in infancy (15% compared with 6% of children not reported as having regulatory problems in infancy) and with mothers having a psychiatric illness causing a referral to psychiatric services 1 year post partum (5% compared with 0.8% of mothers not having a psychiatric referral). FSS were not associated with developmental delay or nurses reports of maternal mental health problems in the weeks around birth.
This study is important because it is one of the few to examine the early developmental precursors of impairing FSS in children. As the authors highlight, the study is based on a small sample with comparative socioeconomic advantage, which may limit its generalisability. Nevertheless, the main results confirm those from a previous study in a different country.4 The fact that the assessment of child regulatory problems was based on information obtained from routine nursing postnatal follow-up suggests that screening and preventive strategies could be applied as part of routine work, with minimal additional health resources. Moreover since regulatory problems in young children are also associated with mood and anxiety disorders later in life, early screening may offer an additional benefit in relation to preventative mental health problems. It is worth noting that regulatory problems in the child were only present in a minority of children with subsequent FSS. Other factors alone or in combination are likely to contribute to the development of FSS. Maternal psychiatric problems, although also predictive, were reported in even fewer (5%) children who developed FSS. The preventative effects of screening and counselling for child reactivity on future child FSS should be established empirically. However, intervening has plausibility and could be based on easily identifiable information and incorporated into postnatal nursing work.