A Randomized Trial Testing a Body-Focused Exposure Treatment of Functional Abdominal Pain in Children

Functional abdominal pain (FAP) in young children is common, persistent, and associated with significant impairment and risk of later anxiety disorders. Current treatments often emphasize distraction from pain, which may preclude long-term fear reduction. We tested a novel exposure-based intervention that encourages children to focus on potentially uncomfortable bodily sensations with playful curiosity (Feeling and Body Investigators; FBI) compared with developmentally modified components of current best practices emphasizing distraction (Caregivers in Action; CIA).

In a randomized clinical trial, 107 parent-child dyads (children ages 5-9 with FAP) were assigned to either the FBI or CIA condition, each consisting of 10 weekly sessions. Primary outcomes were child and parent-reported pain intensity, frequency, duration, and interference. Secondary outcomes were negative affect and pain-related distress. Mixed-model and nonparametric analyses evaluated within-group and between-group changes.

Both interventions resulted in significant reductions in pain intensity, frequency, duration, and interference, as well as improvements in negative affect and distress (all P < 0.01). However, neither approach was shown to be superior. Both treatments were rated highly acceptable by parents and children, with over 90% of parents reporting that the treatment helped them manage their child's symptoms.

Both the FBI and CIA interventions reduced pain and improved emotional functioning in young children with FAP. Although the 2 approaches differed in their focus on attention to pain and use of exposure strategies, they were not significantly different. These findings provide pediatricians and mental health providers with evidence-based options for treating young children with FAP.