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Functional abdominal pain (FAP) is one of the most common medical complaints children present to their pediatricians. Despite the prevalence of FAP as well as its early onset, treatments for young children are particularly rare. Young children are just beginning to learn about the complex messages that their body communicates. Yet, pain can contribute to a fear of the body and an attempt to avoid these important signals. This chapter describes the background and rationale for a new approach to pain for young children, one that conceptualizes the sensitivity to pain and other experiences of the body as a superpower rather than a vulnerability - “sensory superpowers!” We train children to be Feeling and Body Investigators (FBI), individuals who have awe-inspiring curiosity and responsivity towards the many wise communications from their bodies and who respond to these messages with dexterity and skill. The end result is children who are not only fearless about pain, but also who are adept at emotion awareness and regulation. They are Feeling and Body Investigators!
This chapter is where the action starts! We provide a step-by-step guide for clinicians to lead the introductory session for FBI including sample dialogues and examples of how to integrate the therapeutic materials provided (e.g. parent/child workbooks, worksheets, and coloring pages). Therapists are given accessible language to present the case formulation of visceral hypersensitivity as a collection of sensory superpowers that enable children to experience the world and their bodies through a lens of curiosity and excitement rather than fear. Children and parents begin their training as body detectives, Feeling and Body Investigators that harness these superpowers. Children create a “Body Map” a tracing of the child’s body that summarizes the many wisdoms of the body. Children are introduced to their first body characters. Examples include Henry Heartbeat, Samantha Sweat, and Gassy Gus. Children perform their first Body Investigation, a Henry Heartbeat exploration in which they compare strategies to raise and lower their heartbeat. A resulting body wisdom might be: my heart is smart- it knows to beat faster or slower depending on what I need. Body Brainstorms worksheets facilitate generalization of new learning to the outside world. Families are given home-based practices and worksheets to reinforce what they learn.
This playful and practical handbook presents one of the first clinically tested treatment protocols for Functional Abdominal Pain (FAP) in young children. Created and tested by Dr. Nancy Zucker with support from the National Institutes of Health, this intervention teaches children to become “FBI agents” (Feeling and Body Investigators) – detectives who investigate and learn to manage their symptoms. Kids develop a newfound trust in their bodies by using strategies that transform fear and confusion into curiosity and humor. This clinical manual provides a detailed step-by-step guide to treatment, including session plans, worksheets and activities, and is supplemented by diagrams, excerpts from case dialogues, references and cartoons. Downloadable full color materials are available online to print and use in individual or group sessions. Offering an effective and fun approach firmly rooted in science, this manual guides clinicians in implementing FBI in their own practices, enabling more children to access this novel treatment.
The management of patients in primary care is often complicated by the presence of multiple chronic conditions and psychosocial issues that increase the complexity of the encounter and have important impacts on care. There is a paucity of literature on this subject in the pediatric population.
Objectives
The aim of this study was to quantify the burden of chronic conditions in pediatric primary care.
Methods
The problem lists of 3995 randomly selected patients from a community pediatric clinic and an academic hospital-based pediatric clinic in the same metropolitan area were analyzed for the presence and number of any chronic condition.
Results
In total, 53% of patients suffered from at least one chronic problem, 25% had two or more chronic conditions and 5.1% had four or more conditions. Compared with the community clinic, the academic clinic had significantly more children with catastrophic complex conditions (P<0.001). A regression analysis showed a significant positive correlation between the number of chronic medical conditions and mental health diagnoses.
Conclusions
The burden of chronic disease in the pediatric primary care setting may be significantly higher than has been previously suggested. To ensure optimal quality of care, health planners should take into account the high burden of chronic illness, psychosocial issues and multimorbidity among patients in the pediatric primary care setting, as well as the higher complexity profile of patients attending academic clinics.
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