Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
Institute for Community Health, Saarpfalz Kreis, Homburg, Germany.
Neurourol Urodyn. 2019 Nov;38(8):2280-2287. doi: 10.1002/nau.24134. Epub 2019 Aug 8.
Headaches in preschool children are associated with behavioral and gastrointestinal symptoms. As the co-occurrence with incontinence is not known in young children, the aim of the study was to examine associations of headache, psychological symptoms and nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in a population-based sample of preschool children.
All preschool children of a defined geographical area were examined at school-entry. Parents completed a 22-item questionnaire, including 14 headache, 4 incontinence, and 25 items of the Strength and Difficulties Questionnaire (SDQ). Five hundred eighty-five children (50.4% males) with a mean age of 5.8 years were included.
In total, 27.2% of all children had headaches. 15.7% had secondary and 11.3% primary headaches. Five children had migraine and five tension-type headaches, while all others were unclassifiable. 9.4% of children had incontinence (7.7% NE; 2.4% DUI, 1.2% FI) and 4.0% constipation. The rates of incontinence did not differ between children with primary and those without headache for NE (12.9% vs 7.5%), DUI (3.1% vs 2.7%) or FI (3.0% vs 1.0%), but for constipation (12.1% vs 2.6%). Incontinent children had significantly more behavioral and externalizing symptoms, children with headache more internalizing problems. Primary headache was a significant predictor for internalizing, while constipation and FI were predictors for externalizing symptoms.
This population-based study showed that headache is associated with constipation, but not with incontinence in preschool children. Headache and incontinence are common risk factors for specific psychological symptoms and should be assessed in clinical practice.
学龄前儿童的头痛与行为和胃肠道症状有关。由于幼儿同时发生遗尿和失禁的情况尚不清楚，因此本研究的目的是在学龄前儿童的人群中检查头痛、心理症状与夜间遗尿（NE）、日间尿失禁（DUI）和粪便失禁（FI）的相关性。
在学校入学时对特定地理区域内的所有学龄前儿童进行检查。父母完成了一份包含 14 个头痛、4 个遗尿和 25 个 Strength and Difficulties Questionnaire（SDQ）项目的 22 项问卷。共纳入 585 名儿童（50.4%为男性），平均年龄为 5.8 岁。
所有儿童中有 27.2%患有头痛。15.7%为继发性头痛，11.3%为原发性头痛。有 5 名儿童患有偏头痛，5 名患有紧张型头痛，而其余的则无法分类。9.4%的儿童有遗尿（7.7%为 NE；2.4%为 DUI，1.2%为 FI）和 4.0%的便秘。原发性头痛组和无头痛组的遗尿率无差异（NE 为 12.9%和 7.5%，DUI 为 3.1%和 2.7%，FI 为 3.0%和 1.0%），但便秘率有差异（12.1%和 2.6%）。遗尿儿童的行为和外化症状明显更多，头痛儿童的内化问题更多。原发性头痛是内化问题的显著预测因素，而便秘和 FI 是外化症状的预测因素。
本基于人群的研究表明，头痛与学龄前儿童的便秘有关，但与遗尿无关。头痛和遗尿是特定心理症状的常见危险因素，应在临床实践中进行评估。
