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The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?

Gerasimos Kolaitis1, Jan van der Ende2, Foivos Zaravinos-Tsakos3

  • 1Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece. gkolaitis@med.uoa.gr.

European Child & Adolescent Psychiatry
|June 17, 2021
PubMed

Insights

Internalizing problems in preschoolers predict future chronic pain, but chronic pain does not predict internalizing problems. This suggests a unidirectional link where emotional difficulties may lead to physical symptoms in early childhood.

Area of Science:

  • Child Psychology
  • Developmental Pediatrics
  • Behavioral Health

Background:

  • Concurrent associations between chronic pain and internalizing problems are known.
  • The directionality of this relationship in early childhood is not well understood.

Purpose of the Study:

  • To investigate the bidirectional relationship between chronic pain and internalizing problems in preschoolers.
  • To examine the persistence of chronic pain over time in this age group.

Main Methods:

  • Prospective, population-based cohort study (Generation R) with 3,996 children.
  • Maternal and paternal reports of child's pain and internalizing problems at ages 3 and 6 years.
  • Inclusion of data on family functioning, discipline, and parental psychopathology.

Main Results:

  • Internalizing problems at age 3 predicted chronic pain at age 6 (maternal OR 1.05, paternal OR 1.03).
  • Chronic pain at age 3 did not predict internalizing problems at age 6.
  • Prevalence of chronic pain was 2.7% at age 3 and 8.0% at age 6.

Conclusions:

  • The relationship between chronic pain and internalizing problems in early childhood is largely unidirectional.
  • Internalizing problems appear to increase the risk for developing chronic pain.
  • Comprehensive assessment of psychiatric issues is crucial for understanding chronic pain manifestation.

Keywords:
BidirectionalityChildrenChronic painGeneral populationInternalizing problems

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