Impact of the Covid-19 Pandemic on Abdominal Pain, Emotional Distress, Quality of Life, Sleep, and Disability in Children with Functional Abdominal Pain Disorders

ABSTRACT

Purpose: The COVID-19 pandemic has the potential to influence the well-being of families and children with Functional Abdominal Pain Disorders (FAPDs). Given the known relationship between stress and abdominal pain in children with FAPDs, we hypothesized pandemic-related changes (e.g., reductions in family finances, social interactions) could affect health outcomes. Our aim was to examine the potential impact of the pandemic on abdominal pain, quality of life, psychological and physiological symptoms, and functional disability in children with FAPDs. Method(s) Ninety-one parents of children ages 7-12 who met the Rome IV criteria for a FAPD completed baseline questionnaires as part of an ongoing randomized controlled intervention trial on their child's Quality of life (PedsQL), Pain Behavior and Response (PBQ, PBCL, PRI), Pain Catastrophizing (PCS), Psychological Symptoms (SCL-90), Functional Disability (FDI), and sleep habits (CSHQ). Heart rate was also measured. Participants were categorized into two groups, based on the date of entry into the original study, as before or during the COVID-19 pandemic, allowing us to take advantage of a naturally occurring opportunity to assess potential impacts of the pandemic. Result(s) Sixty-one participants were consented before, and 30 participants were consented during the COVID-19 pandemic. Parents in the latter group reported their children to have more days of abdominal pain, higher pain frequency, pain behavior, disability, helplessness, and depression, and significantly lower quality of life, compared to the before COVID group (Table 1). Finally, child sleep anxiety and overall sleep difficulty were significantly higher during COVID. Children also had a significantly higher mean heart rate during the COVID-19 pandemic. Conclusion(s) Our findings suggest that the COVID-19 pandemic has impacted children with FAPDs in multiple domains. Of concern, parents of children with FAPDs reported greater child pain frequency, disability, and pain behaviors during the pandemic than before the pandemic. Parents also reported significant increased child emotional distress during the COVID-19 pandemic and impacts on quality of life during COVID-19;in fact, most scores on the PedsQL were lower than those previously reported for children receiving cancer treatment. Child sleep anxiety and overall disordered sleep also worsened during the pandemic. Additionally, physiological changes (mean heart rate) were observed during the pandemic (Figure 1). Possible explanations for these findings could include increases in child and family stress, and greater parental awareness of child symptoms due to increased time at home together, or parents' own increased stress levels. Clinicians and researchers should be aware of the potential impact of COVID-19 pandemic on these areas to inform research as well as treatment of children with FAPDs.