Functional somatic symptoms in 5-7 year old children: assessment, prevalence and co-occurrence

Medically unexplained or functional somatic symptoms (FSS) in children constitute a major clinical problem. However, research data on FSS in young children are few, and epidemiological studies are hampered by lack of good standardised measures. The present thesis consists of two studies: In study one, we developed two measures to assess FSS in young children. The first measure is a parent interview, the Soma Assessment Interview (SAI), to assess the 1-year prevalence and associated impairment caused by FSS. The interview can be performed by lay interviewers and subsequently rated clinically by physicians. A preliminary validation showed a good agreement on FSS recognition between two clinical raters (kappa = 0.86), a good concurrent validity with independent measures of physical complaints and a good discrimination on the prevalence of FSS between a community sample and clinical samples. The second measure is a systematic medical record review of FSS in paediatric patients: the Medical Record Review for Functional Somatic Symptoms in Children (MRFC). Our findings suggest that the MRFC allows identification of subgroups of paediatric patients with multisymptomatic FSS and long-term and/or impairing FSS and it may prove useful for case finding in clinical and epidemiological research. In study two, we investigated the parent-reported FSS and their impairment in a population-based sample of Danish 5-7-year-old children. We used the SAI as the main measure. Data from 1,327 children from The Copenhagen Child Cohort 2000 were analysed. Impairing symptoms were defined as FSS causing substantial discomfort, impairment of everyday life, absence from daycare or school and/or health care seeking. We found that FSS are common in this age group with a 1-year prevalence of 23.2%. Different pain complaints, i.e. limb pain, abdominal pain and headache, were the most prevalent types of FSS. A subgroup of children with impairing FSS (4.4%) was identified. These children were more likely to present multisymptomatic FSS than children with non-impairing FSS. Health anxiety symptoms (HAS) and their associations with different physical health variables, including FSS, were investigated in the same population of 5-7-year-old children. In total, 2.4% presented prominent HAS, and the level of HAS was correlated with general poor health, chronic physical disease and physical complaints including FSS. In children with FSS, we found significant associations between the level of HAS and the impact of the childrens´ FSS in terms of number of doctor's visits and missed school and/or daycare due to FSS as well as the degree of parental worries about the childrens´ FSS. Furthermore, HAS were significantly associated with emotional symptoms. The findings suggest an early onset of somatisation and point to the need for clinical and preventive intervention in a substantial proportion of children. The findings also suggest a close link between HAS, FSS and emotional symptoms. Medically unexplained or functional somatic symptoms (FSS) in children constitute a major clinical problem. However, research data on FSS in young children are few, and epidemiological studies are hampered by lack of good standardised measures.