Patterns and seasonality in pediatric referrals for functional somatic symptoms, 2022, den Braber et al

Abstract

Functional somatic symptoms (FSS), or medically unexplained physical symptoms, are common in children and it has been suggested that the incidence is increasing. To determine the incidence and pattern of referrals for FSS to pediatricians, we performed a retrospective analysis including newly referred pediatric patients to our secondary pediatric practice in Zwolle, The Netherlands, ultimately diagnosed with FSS between 2013 and 2018. FSS was defined as functional abdominal pain, chronic fatigue, chronic musculoskeletal pain and chronic headache without an underlying medical diagnosis. In the 6-year period, 10.4% of elective referrals were related to FSS without a significant upward trend. We found clear seasonal variation with peaks in incidences in March (+31%) and November (+21%) and a nadir around August (−48%). In conclusion, FSS account for 1 in 10 non-acute pediatric referrals, without an increase in incidence in the past 6 years. The seasonal pattern is remarkable and warrants further analysis.

Paywall, https://jim.bmj.com/content/early/2022/06/30/jim-2021-002252

 

Maybe the children are away on holiday with their families?

 

Maybe the doctors are too and the clinics cancelled.

 

It has been suggested...
Some people are saying...
A little birdie told me that...
I heard a rumor that...

S C I E N C E

 

That and seasonal variation of parental behaviour.

 

Towards the Beginning and end of winter in the northern hemisphere for peaks .
These are times when my daughter has short glitches in sleep ( phase shift wobbles before reverting to her " normal")
It's also when weather patterns change here and there have shown to be links with humidity and pressure with RA ( I think but may have misremembered). My daughter is a human barometer and winter always sees a slide.

We may be more attuned to natural patterns than we think.

" Children" is pretty broad. Is there an age range association with this ?

It's the wee small hours and sleep deprivation may be affecting thoughts but I wonder if vit D plays into this.
The totally left field thought is genetic haplotype. Some things seem to be associated with Neanderthal genes - there has been suggestion of some sort of hibernation mode in carbohydrate metabolism, and some conditions seem to be more prevalent . @BeautifulDay

ETA link
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509894/

 

"nadir around August"

I mean I can think of many illness-related reasons why it would be a certain point into peak or long terms that people would end up falling over, but I can't help but ask whether the researchers have accommodated for PHYSICIANS summer holidays.

I know my dentists for example basically schedule around their August hols, from what I hear about FRance and their August schlep to the coast things close down there, and many other professions the people who play a part in someone seeing someone are often out of the area/country.

How could someone exclude that - or a comparison of other non-urgent dept referrals when noting a stat about 'August'?

One thing is that if it were anxiety-related school-skipping related then you'd think August-Sept in the UK as it begins at the start of Sept, so at least this research debunks all that nonsense firmly?

I'm massively frustrated at the closed abstract and not even being able to tell which way this one swings..