Shraim Mujahed, Blagojevic-Bucknall Milisa, Mallen Christian D, Dunn Kate M
Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, USA.
BMC Fam Pract. 2014 Dec 5;15:195. doi: 10.1186/s12875-014-0195-4.
Non-specific physical symptoms (NSPS), such as headache and abdominal pain, are common reasons for children to consult primary care. NSPS represent a significant burden not only on society, but also on health care services, through frequent physician consultations and referrals to secondary care. Research evidence suggests a positive relationship between health and consulting behavior of parents and their children, but research on whether repeated physician consultations for NSPS in children is influenced by parental consultations for NSPS is lacking. The aim was to measure the frequency of repeated physician consultations for NSPS in children, and investigate whether this is influenced by maternal consultations for NSPS.
A cohort study of children registered with primary care practices contributing to the Consultation in Primary Care Archive database. Participants were child-mother pairs registered between January 2007 and December 2010. The cohort comprised all children (n = 1437) aged 2 to 16 years who consulted a physician for NSPS in 2009. Mothers' consultations for NSPS were measured between 2007 and 2008. Main outcome measures were repetition and frequency of consultations for NSPS in children (consultations for NSPS in both 2009 and 2010).
Overall, 27% of children had repeated consultations for NSPS. The three most common repeated consultations were for back pain, constipation and abdominal pain. Exposure to maternal consultation for NSPS was associated with 21% increase in consultation frequency for NSPS (adjusted incidence rate ratio 1.21; 95% CI 1.12, 1.31). After adjusting for child age and maternal age, maternal consultation for NSPS was associated with an increased risk of repeated consultations for NSPS in children (relative risk 1.41; 95% CI 1.16, 1.73). This association was also significant for specific NSPS groups including painful, gastrointestinal, and neurologic symptoms.
Repeated consultation for NSPS is common among children. It is important for primary care physicians and secondary care clinicians, managing children referred from primary care for NSPS, to be aware that consultation for NSPS in mothers is a risk factor for repeated consultations for NSPS among children. More research is needed to uncover exactly how parental health influences health and consulting behavior of children.
非特异性躯体症状（如头痛和腹痛）是儿童咨询初级保健的常见原因。非特异性躯体症状不仅给社会带来了沉重负担，还因频繁就医咨询及转诊至二级保健给医疗服务带来了巨大负担。研究证据表明，父母及其子女的健康状况与就医行为之间存在正相关关系，但关于儿童因非特异性躯体症状反复就医咨询是否受父母因非特异性躯体症状就医咨询的影响，目前尚缺乏相关研究。本研究旨在测量儿童因非特异性躯体症状反复就医咨询的频率，并调查这是否受母亲因非特异性躯体症状就医咨询的影响。
一项队列研究，研究对象为向初级保健存档数据库提供数据的初级保健机构登记的儿童。参与者为2007年1月至2010年12月期间登记的儿童-母亲对。该队列包括2009年因非特异性躯体症状咨询过医生的所有2至16岁儿童（n = 1437）。母亲因非特异性躯体症状的就医咨询情况在2007年至2008年期间进行测量。主要结局指标为儿童因非特异性躯体症状就医咨询的重复情况及频率（2009年和2010年因非特异性躯体症状的就医咨询）。
总体而言，27%的儿童因非特异性躯体症状进行了反复就医咨询。最常见的三种反复就医咨询情况是背痛、便秘和腹痛。母亲因非特异性躯体症状就医咨询与儿童因非特异性躯体症状就医咨询频率增加21%相关（调整后的发病率比为1.21；95%置信区间为1.12，1.31）。在调整儿童年龄和母亲年龄后，母亲因非特异性躯体症状就医咨询与儿童因非特异性躯体症状反复就医咨询的风险增加相关（相对风险为1.41；95%置信区间为1.16，1.73）。这种关联在包括疼痛、胃肠道和神经系统症状在内的特定非特异性躯体症状组中也很显著。
儿童因非特异性躯体症状反复就医咨询很常见。对于管理从初级保健转诊来的因非特异性躯体症状就诊的儿童的初级保健医生和二级保健临床医生而言，了解母亲因非特异性躯体症状就医咨询是儿童因非特异性躯体症状反复就医咨询的一个风险因素很重要。需要更多研究来确切揭示父母的健康状况如何影响儿童的健康及就医行为。
