Infants with regulatory behaviors or maternal psychiatric problems may have increased risk of FSS

Elsevier Health SciencesSep 27 2012

Functional somatic symptoms (FSS) are physical complaints, such as headaches, pain, fatigue, and dizziness, that cannot be explained medically. These symptoms affect 10-30% of children and adolescents and account for 2-4% of all pediatric doctor visits. A new study scheduled for publication in The Journal of Pediatrics finds that infants with regulatory problems (i.e., feeding, sleeping, and tactile reactivity) and/or maternal psychiatric problems may have an increased risk of FSS in later childhood.

It is believed that maternal anxiety and depression can influence the child's capacity to self-regulate, but infant problems can also exaggerate parental problems. Charlotte Ulrikka Rask, MD, PhD, Child and Adolescent Psychiatrist at Aarhus University Hospital in Denmark, states, "Parents of infants with regulatory problems could be taught to help their infants regulate their behavioral and physiological state, which potentially could reduce the risk of later development of impairing FSS."

Dr. Rask and colleagues from Aarhus University Hospital and Copenhagen University Hospital in Denmark prospectively assessed 1,327 5-7-year-old children who are part of the Copenhagen Child Cohort (6,090 children born around Copenhagen in 2000). Home health nurses assessed infants 4 times before they were 10 months of age. Maternal mental health was assessed by self-report 1-5 weeks after child birth, and researchers checked whether mothers had been diagnosed with a mental disorder during the infant's first year of life. Three overall factors were assessed: (1) infant regulatory factor; (2) maternal postnatal psychiatric illness; and (3) annual household income.

At 5-7 years of age, 23.2% of the children had FSS, with an increased prevalence in girls (27.6% versus 18.8%). Impairing, or severe, FSS was seen in 4.4% of the children. Limb pain, headaches, and stomach aches were the most frequent FSS reported. Thirteen mothers were diagnosed with depression, bipolar disorder, or anxiety during their infants' first year of life; the infants of these mothers were 7 times more likely to develop FSS at 5-7 years of age. Infants with 2 or more regulating issues had a nearly 3-fold increased risk of FSS at 5-7 years of age. There was no association between impairing FSS and household income early in life.

Because recent studies have suggested that eating and sleeping problems during early childhood may be risk factors for mood and anxiety disorders and FSS (e.g., recurrent abdominal pain) later in life, early intervention is important for both parents and infants. Dr. Rask suggests, "Interventions should include strategies to improve maternal mental health and parents' ability to handle the infant's regulatory problems, as well as strategies that focus on infants who have multiple regulatory problems."