Somatic Symptoms in Adolescents With an Ill Parent.

OBJECTIVE: Parent chronic illness may increase somatic symptomology risk in children. The current study examines this association in relation to a variety of chronic illnesses and also considers possible related parental and adolescent background factors. METHODS: Secondary analyses used longitudinal data from the University of North Carolina National Longitudinal Study of Adolescent to Adult Health. Interviews were used to assess demographics, adolescent somatic symptoms, living situation, and parental illness and general physical health. Somatic symptoms in adolescents with no ill parents (n = 2302 adolescents; Mage = 15.3) were compared with adolescents with ill mothers (n = 2336; Mage = 15.3), ill fathers (n = 1304; Mage = 15.3), or two ill parents (n = 3768; Mage = 15.3) using Poisson regression models. We also examined the role of living status, adolescent sex, and parent general physical health on somatic symptom outcomes. RESULTS: Elevated somatic symptoms were observed in adolescents with ill mothers (mean ratio [MR] = 1.15, p = .015) and with both parents ill (MR = 1.10, p < .001). Among adolescents with ill parents, females had more symptoms than males (ill mother: MR = 1.12, p < .001; ill father: MR = 1.23, p < .001; and both parents ill: MR = 1.23, p < .001). Poorer maternal physical health also increased somatic symptom risk (MR = 1.12, p = .02). Longitudinally, adolescents with ill mothers (MR = 1.14, p < .001), ill fathers (MR = 1.13, p < .001), or both parents ill (MR = 1.16, p < .001) had increased somatic symptom risk. Wave I somatic symptoms also increased future risk: ill mother (MR = 1.19, p < .001), ill father (MR = 1.22, p < .001), or both parents ill (MR = 1.20, p < .001). CONCLUSIONS: The results highlight that having an ill parent is a risk factor for adolescent somatic symptoms. In addition, other factors such as adolescent sex play an additional role in adolescent somatic symptoms.

A Systematic Review of Somatic Symptoms in Children With a Chronically Ill Family Member.

OBJECTIVE: Somatization and functional somatic symptoms reflect conditions in which physical symptoms are not sufficiently explained by medical conditions. Literature suggests that these somatic symptoms may be related to illness exposure in the family. Children with a parent or sibling with a chronic illness may be particularly vulnerable to developing somatic symptoms. This study provides a systematic review of the literature on somatic symptoms in children with a chronically ill family member. METHODS: A systematic review (PROSPERO registry ID: CRD42018092344) was conducted using six databases (PubMed, EMBASE, PsychINFO, Scopus, CINAHL, and Cochrane) from articles published before April 5, 2018. All authors evaluated articles by title and abstract, and then by full-text review. Relevant data were extracted by the first author and reviewed by remaining authors. RESULTS: Twenty-seven unique studies met the criteria. Seventeen examined somatic symptoms in children with a chronically ill parent, and seven evaluated somatic symptoms in children with a chronically ill sibling. Three studies examined somatic symptoms in children with an unspecified ill relative. The strongest relationship between child somatization and familial illness was found with children with a chronically ill parent (13/17 studies). Evidence for somatic symptoms in children with an ill sibling was mixed (4/7 studies found a positive association). CONCLUSIONS: The literature on somatic symptoms in children suggests that parental illness is related to increased somatic symptoms in children. Research examining the effects of having a sibling with an illness on somatic symptoms is mixed. Several areas of future research are outlined to further clarify the relationship between familial chronic illness and somatic symptoms.

A review of functional neurological symptom disorder etiology and the integrated etiological summary model

Functional neurological symptom disorder (FNSD) is characterized by neurological symptoms that are unexplained by other traditional neurological or medical conditions. Both physicians and patients have limited understanding of FNSD, which is often explained as a physical manifestation of psychological distress. Recently, diagnostic criteria have shifted from requiring a preceding stressor to relying on positive symptoms. Given this shift, we have provided a review of the etiology of FNSD. Predisposing factors include trauma or psychiatric symptoms, somatic symptoms, illness exposure, symptom monitoring and neurobiological factors. Neurobiological research has indicated that patients with FNSD have a decreased sense of agency and abnormal attentional focus on the affected area, both of which are modulated by beliefs and expectations about illness. Sick role and secondary gain may reinforce and maintain FNSD. The integrated etiological summary model combines research from various fields and other recent etiological models to represent the current understanding of FNSD etiology. It discusses a potential causal mechanism and informs future research and treatment.

Quality of Life in Youth With Obstructive Sleep Apnea Syndrome (OSAS) Treated With Continuous Positive Airway Pressure (CPAP) Therapy.

OBJECTIVE/BACKGROUND: Improvement is sought for youth with obstructive sleep apnea syndrome (OSAS) who have poor quality of life (QoL), which resolves somewhat following treatment. One mitigating factor in improved QoL following treatment may be adherence to the CPAP protocol, which presents a barrier to most youth. This study explored relations between CPAP adherence and QoL in youth with OSAS. PARTICIPANTS: We recruited 42 youth-caregiver dyads in which youth between the ages of 8 and 16 years were diagnosed with OSAS and required CPAP use as part of their treatment plan. METHODS: Following diagnosis of OSAS requiring treatment with CPAP therapy, caregivers completed baseline measures of OSAS-specific QoL. The OSAS-specific QoL domains assessed included sleep disturbance, physical symptoms, emotional distress, daytime function, and caregiver concern. Families received routine CPAP care for three months, after which caregivers again completed measures of OSAS-specific QoL. Adherence data were collected from smartcards within the CPAP machine after three months of treatment. RESULTS: Fifteen youth were adherent to CPAP therapy and 10 were not adherent. CPAP-adherent youth demonstrated significant changes in two domains of OSAS-specific QoL when compared to nonadherent youth: decreased sleep disturbance and decreased caregiver concern. CONCLUSIONS: CPAP adherence appears to be associated with positive changes in OSAS-specific QoL domains. It will be important for future research and clinical work to examine strategies for improving CPAP adherence in youth with OSAS.

A Systematic Review of Sleep, Hypertension, and Cardiovascular Risk in Children and Adolescents.

PURPOSE OF REVIEW: Many of the risk factors for heart disease have recently been shown to develop during childhood such as left ventricular hypertrophy and fibrous plaque lesions. As risk for cardiovascular disease in children and adolescents has risen, sleep duration has decreased, and inadequate sleep in children and adolescents has been found to be associated with cardiovascular disease risk. The aims of this manuscript are to provide an updated systematic review of the literature assessing sleep, hypertension, and cardiovascular risk and evaluate the strength of the evidence based on the available research. RECENT FINDINGS: A systematic review was conducted using six databases from January 1, 2015 through March 9, 2018. We sought studies which looked at the relationship between sleep duration, sleep timing, or sleep quality and outcome variables of hypertension, inflammation, obesity, glucose or insulin, and lipids in children and adolescents. We found 24 studies which met our criteria. Nine studies included hypertension as an outcome variable; fifteen included obesity; thirteen included glucose or insulin; eight included lipids; and three included measures of inflammation. The existing literature on sleep and cardiovascular disease in children and adolescents is limited and relatively weak. Only one RCT was identified, and the overwhelming majority of studies had a high risk of bias. The strongest evidence of an association with sleep is with obesity, hypertension, and insulin sensitivity. Further research using more standardized methods and objective measures is needed to determine if a causal relationship truly exists between sleep and cardiovascular risk.

Treatment of Pediatric Functional Neurological Symptom Disorder: A Review of the State of the Literature.

Functional Neurological Symptom Disorder (FNSD), or experiencing neurological symptoms incompatible with either a neurological condition or a medical condition, is a common condition presenting in children and adolescents. It is associated with impairment in quality of life for patients and their families and represents a significant burden to the healthcare system. There is currently limited research available regarding effective treatment of pediatric FNSD. Currently, only one RCT exists studying effective treatment of FNSD in children and adolescents, and it is limited to one sub-type of FNSD and only examined cognitive behavioral therapy compared to supportive therapy. Despite this, almost all published research supports good prognosis for pediatric FNSD with all studies reporting improvement either in FNSD symptoms or in the quality of life and functioning of patients with FNSD. The most support was found for the use of cognitive behavioral therapy either as a stand-alone treatment or in the context of interdisciplinary treatment. Future research should focus on increasing the rigor of research, including expanding RCTs to include additional sub-types of FNSD and comparing across various treatment modalities.

Body Mass Index Changes Associated with Smoking are Moderated by Race and Depression.

Smoking and obesity relate to several leading causes of death in the U.S. and are common within the criminal justice system. Previous studies demonstrate links between smoking, obesity, depression, and race but have not examined all four variables together. The current study evaluated these relationships after a smoking cessation intervention. Participants (N=500) were recruited from community corrections. The Center for Epidemiological Studies Depression Scale (CES-D) measured depression. Self-reported number of cigarettes and weight and height measurements assessed smoking status and body mass index (BMI) at baseline and 12-month follow-up. Depression was associated with increased BMI. Among Blacks without depression, there was a significant relationship between smoking and BMI, such that greater smoking reduction was associated with greater weight gain. This is the first study to assess the interaction between race, smoking, BMI and depression. These findings support tailoring smoking cessation and depression interventions for different races.

An Inpatient Child Passenger Safety program.

Background. Our institution implemented an Inpatient Child Passenger Safety (CPS) program for hospitalized children to improve knowledge and compliance with the Massachusetts CPS law, requiring children less than 8 years old or 57 inches tall to be secured in a car seat when in a motor vehicle. Methods. After the Inpatient CPS Program was piloted on 3 units in 2009, the program was expanded to all inpatient units in 2010. A computerized nursing assessment tool identifies children in need of a CPS consult for education and/or car seat. Results. With the expanded Inpatient CPS Program, 3650 children have been assessed, 598 consults initiated, and 325 families have received CPS education. Car seats were distributed to 419 children; specialty car seats were loaned to 134 families. Conclusions. With a multidisciplinary approach, we implemented an Inpatient CPS Program for hospitalized children providing CPS education and car seats to families in need.