Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 Apr;90(4):335–337. doi: 10.1136/adc.2003.032524

Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain

K Lindley 1, D Glaser 1, P Milla 1
PMCID: PMC1720365  PMID: 15781917

Abstract

Aims: To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child.

Methods: Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset.

Results: Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families.

Conclusions: Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.

Full Text

The Full Text of this article is available as a PDF (60.3 KB).

Figure 1.

Figure 1

Open in a new tab

 Biopsychosocial model of functional gastrointestinal disease in which genetics, environment (physical and psychosocial), and the nervous system (central and enteric) interact to cause symptoms.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. APLEY J., NAISH N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child. 1958 Apr;33(168):165–170. doi: 10.1136/adc.33.168.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alfvén G. One hundred cases of recurrent abdominal pain in children: diagnostic procedures and criteria for a psychosomatic diagnosis. Acta Paediatr. 2003;92(1):43–49. doi: 10.1111/j.1651-2227.2003.tb00467.x. [DOI] [PubMed] [Google Scholar]
  3. Bennett E. J., Piesse C., Palmer K., Badcock C. A., Tennant C. C., Kellow J. E. Functional gastrointestinal disorders: psychological, social, and somatic features. Gut. 1998 Mar;42(3):414–420. doi: 10.1136/gut.42.3.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Creed F., Craig T., Farmer R. Functional abdominal pain, psychiatric illness, and life events. Gut. 1988 Feb;29(2):235–242. doi: 10.1136/gut.29.2.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Creed Francis, Fernandes Lakshmi, Guthrie Elspeth, Palmer Stephen, Ratcliffe Joy, Read Nicholas, Rigby Christine, Thompson David, Tomenson Barbara, North of England IBS Research Group The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003 Feb;124(2):303–317. doi: 10.1053/gast.2003.50055. [DOI] [PubMed] [Google Scholar]
  6. Dalton C. B., Drossman D. A. Diagnosis and treatment of irritable bowel syndrome. Drugs Today (Barc) 1998 Jul;34(7):585–592. doi: 10.1358/dot.1998.34.7.484111. [DOI] [PubMed] [Google Scholar]
  7. Dalton Christine B., Drossman Douglas A., Hathaway Joseph M., Bangdiwala Shrikant I. Perceptions of physicians and patients with organic and functional gastrointestinal diagnoses. Clin Gastroenterol Hepatol. 2004 Feb;2(2):121–126. doi: 10.1016/s1542-3565(03)00319-7. [DOI] [PubMed] [Google Scholar]
  8. Drossman D. A., Creed F. H., Olden K. W., Svedlund J., Toner B. B., Whitehead W. E. Psychosocial aspects of the functional gastrointestinal disorders. Gut. 1999 Sep;45 (Suppl 2):II25–II30. doi: 10.1136/gut.45.2008.ii25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Drossman D. A. The functional gastrointestinal disorders and the Rome II process. Gut. 1999 Sep;45 (Suppl 2):II1–II5. doi: 10.1136/gut.45.2008.ii1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gulhati A., Minty B. Parental health attitudes, illnesses and supports and the referral of children to medical specialists. Child Care Health Dev. 1998 Jul;24(4):295–313. doi: 10.1111/j.1365-2214.1998.tb00949.x. [DOI] [PubMed] [Google Scholar]
  11. Gwee K-A, Collins S. M., Read N. W., Rajnakova A., Deng Y., Graham J. C., McKendrick M. W., Moochhala S. M. Increased rectal mucosal expression of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome. Gut. 2003 Apr;52(4):523–526. doi: 10.1136/gut.52.4.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hey E., Fleming P., Sibert J. Learning from the sad, sorry saga at Stoke. Arch Dis Child. 2002 Jan;86(1):1–3. doi: 10.1136/adc.86.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jones J., Boorman J., Cann P., Forbes A., Gomborone J., Heaton K., Hungin P., Kumar D., Libby G., Spiller R. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut. 2000 Nov;47 (Suppl 2):ii1–i19. doi: 10.1136/gut.47.suppl_2.ii1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Liakopoulou-Kairis M., Alifieraki T., Protagora D., Korpa T., Kondyli K., Dimosthenous E., Christopoulos G., Kovanis T. Recurrent abdominal pain and headache--psychopathology, life events and family functioning. Eur Child Adolesc Psychiatry. 2002 Jun;11(3):115–122. doi: 10.1007/s00787-002-0276-0. [DOI] [PubMed] [Google Scholar]
  15. Milla P. J. Irritable bowel syndrome in childhood. Gastroenterology. 2001 Jan;120(1):287–290. doi: 10.1053/gast.2001.21601. [DOI] [PubMed] [Google Scholar]
  16. Rasquin-Weber A., Hyman P. E., Cucchiara S., Fleisher D. R., Hyams J. S., Milla P. J., Staiano A. Childhood functional gastrointestinal disorders. Gut. 1999 Sep;45 (Suppl 2):II60–II68. doi: 10.1136/gut.45.2008.ii60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ringel Yehuda, Drossman Douglas A. Irritable bowel syndrome: classification and conceptualization. J Clin Gastroenterol. 2002 Jul;35(1 Suppl):S7–10. doi: 10.1097/00004836-200207001-00003. [DOI] [PubMed] [Google Scholar]
  18. Trimble K. C., Farouk R., Pryde A., Douglas S., Heading R. C. Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity. Dig Dis Sci. 1995 Aug;40(8):1607–1613. doi: 10.1007/BF02212678. [DOI] [PubMed] [Google Scholar]
  19. Van Ginkel R., Voskuijl W. P., Benninga M. A., Taminiau J. A., Boeckxstaens G. E. Alterations in rectal sensitivity and motility in childhood irritable bowel syndrome. Gastroenterology. 2001 Jan;120(1):31–38. doi: 10.1053/gast.2001.20898. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES