Why should you care?
Chronic abdominal pain is a common problem that affects up to 20 percent of all school-aged children and teens. Despite how many youth struggle with abdominal pain, there is no clear agreement among medical professionals about how best to manage it.
A Multidisciplinary Approach
In the Abdominal Pain Program (APP) at Children's Mercy, we use a multidisciplinary approach that involves initial evaluation and follow-up by a team of professionals, including a pediatric gastroenterologist and pediatric psychologist and, occasionally, biofeedback therapists, dietitians, and other health professionals. Using this model, we take into account the many factors (biological, psychological, and social) that we believe can contribute to abdominal pain in children.
Who is impacted?
Everyone who experiences, lives with, and/or cares for a child with chronic abdominal pain is affected by it. We know that some kids suffer emotional and social difficulties as a result of their physical symptoms. These can complicate their treatment course and greatly affect their quality of life, as well as the quality of life of those who care for them. Without proper treatment, we know that abdominal pain and the related consequences don't get better on their own.
What does this all mean?
We ask children and their parents, when they first arrive in our clinic, to rate the child's current level of pain and how much the pain interferes with the child's ability to go to school, spend time with family and friends, do chores, etc. When the child returns for his or her first follow-up visit, families tell us whether they think their child is doing worse, the same, or better than at the time of their first appointment. The majority of patients come to their initial evaluation in the Abdominal Pain Clinic reporting moderate to severe pain intensity. They also report moderate to severe activity interference. In other words, their pain and other GI symptoms keep them from doing everyday activities (like attending school, spending time with family and friends, engaging in hobbies or sports) regularly or almost always. In a recent review of our clinic patients, we found that the typical child has experienced abdominal pain for about two years at the time of their initial evaluation, and has seen multiple providers to help improve his/her pain.
By the time children return for their first follow up visit (typically 2 to 8 weeks from the time of initial evaluation), about 30 percent report that their symptoms are nearly or completely gone and they are back to all of their normal daily activities. An additional 28 percent report that their pain is better, but is still interfering with their daily activities to some extent.
The first follow up visit is just the initial step in our comprehensive follow up program. Children who do not show improvement by the first follow up visit continue to be followed by our multidisciplinary team. Medication and other treatments are added or removed, as needed, and patients' progress is closely monitored. We are committed to helping all children find ways to live unimpaired by abdominal pain.The graphs pictured below show that the most improvement in pain and quality of life occurs in our patients during the first 6 months in the Abdominal Pain Program. The majority of patients have only 2-3 outpatient follow up visits during this time with additional follow up by phone. Patients who have resolution of pain and return to normal daily activities graduate from treatment and do not need to come back for further follow up. Only a small number of patients report still experiencing no improvement in pain one year later.
What do our patients and families say?
Outcomes are important, but so is the patient and family experience. In a recent survey, nearly 90% of the families seen for their initial evaluation visit in the APP reported that they were "very satisfied" with the visit.
Furthermore, over 90% of these same families
said that they intended to begin all of the
treatments (e.g., medications, biofeedback, and/or
individual therapy) recommended at their child's initial visit.
And, finally, when asked what specifically about the APP evaluation was helpful to them, roughly half highlighted their appreciation for the integrated medical and psychological perspectives. Specific comments included: "Knowing that they are looking at the whole picture, not just one-fourth of it" and "The mind-body connection - having both doctors meet with us together was very helpful." In sum, families said that having the medical and psychological teams working together resulted in a treatment plan in which all the components made sense and were tailored to their child's unique needs.