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Strong Self-Image Helps Kids With Bowel Disease

They can be prone to social and emotional problems

(HealthDay is the new name for HealthScoutNews.)

FRIDAY, Aug. 8, 2003 (HealthDayNews) -- Children with inflammatory bowel disease also struggle with emotional and social problems, a new study says.

But strong family relationships and high self-esteem can counteract some of those problems, the researchers add.

Children with inflammatory bowel disease (IBD) are three times as likely as healthy children to have behavioral or emotional problems, says Laura Mackner, an Ohio State researcher who presented her findings Aug. 8 at the annual meeting of the American Psychological Association in Toronto.

They're also more likely to struggle with social problems, such as teasing by peers.

IBD is an umbrella term for conditions in which the small or large intestine are inflamed, and may lead to diarrhea, rectal bleeding, sharp abdominal pain or cramping and other symptoms, according to the American College of Gastroenterology.

One type of IBD is called ulcerative colitis, which begins in the rectum and spreads upward. Another is Crohn's disease, which can start anywhere in the digestive tract. The causes of IBD aren't known, but diet has been ruled out, according to the college. Treatments include medication to ease the inflammation, a special diet and sometimes surgery.

Mackner evaluated 50 children, aged 11 to 17, who had been diagnosed with mild IBD one to 14 years earlier. She also compared the children with IBD with a control group of 27 healthy youngsters.

The common behavioral and emotional problems included feeling anxious or depressed. Social problems, reported by 17 percent of parents of IBD children, included being withdrawn and being teased.

Then Mackner looked at the problems in light of the child's self-esteem and the strength of the family relationship. "Those with stronger family relationships and higher self-esteem were less likely to have problems," she says.

But strong family bonds and high self-esteem didn't seem to offset the impact that IBD flare-ups had on a child's social functioning, Mackner found.

While several other studies have revealed that children with IBD can have social and emotional difficulties, Mackner says her research went a little further, evaluating which factors lead to emotional adjustment.

The findings are no surprise to Dr. Mika Hiramatsu, an Oakland, Calif., pediatrician and president of the Northern California chapter of the American Academy of Pediatrics. "Kids with any kind of chronic medical problem have more psychosocial stress," she says.

"School peers, especially during adolescence, can be quite unforgiving about anything that deviates from the mean," she adds.

While some children with IBD can hide their condition from others, if they need a special diet or take medication during school hours, classmates are likely to find out.Mackner says pediatricians often refer IBD patients to gastroenterologists and that some GI clinics have staff psychologists who can evaluate a youngster's emotional well-being. When no psychologist is available, a parent might consider asking the pediatrician or GI specialist for a referral if a child's school and social performance seem to suffer.

Besides talking to a therapist, the young IBD patient could benefit by talking to another patient, Hiramatsu says. She often asks youngsters with chronic conditions, or their parents, to talk to newly diagnosed children or their parents.

"Probably the most helpful thing for a child with a chronic medical problem is to find someone else with the same problem," Hiramatsu says.

More information

To learn more about inflammatory bowel disease, visit the American Academy of Family Physicians. For tips on dealing with gastrointestinal problems, see the American College of Gastroenterology.

SOURCES: Laura Mackner, Ph.D., assistant professor, pediatrics, Ohio State University, Columbus; Mika Hiramatsu, M.D., pediatrician, Oakland, Calif., and president, Northern California chapter, American Academy of Pediatrics; Aug. 8, 2003, presentation, American Psychological Association's annual meeting, Toronto
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