Understanding Pediatric Chest Pain and Other Symptoms

The current investigation will address some similar factors considered in prior research,
but will considerably extend our understanding of how psychological, familial, and
environmental factors influence noncardiac chest pain. In this investigation, a number of
variables that have not been considered in prior research in this area will be included.
Among these child variables are: the children's pain coping strategies, the children's
somatization behaviors aside from chest pain, the children's externalizing symptoms (e.g.,
symptoms of ADHD, oppositional defiant disorder), school related problems, social
competencies, parental perceptions of the child's vulnerability, functional disability (the
degree to which chest pain interferes with normal daily functioning), and the child's health
care utilization. Also, a more sensitive quantification of the children's frequency and
intensity of chest pain will be collected, as well as information on situations in which the
pain occurs. Parent report of child functioning and child self-report will be used to assess
children's behavior. The parental factors to be assessed include the parents' own physical
conditions and health care utilization, as well as the parents' psychological functioning.
The amount of changes and stress the family as a whole has experienced in different domains
will also be assessed as well. Measures of these constructs, as well as children's anxiety
and depression (similar to Lipsitz et al. reviewed above) will be collected at the time of
the original appointment.

With the exception of the chest pain measure, quantification of these variables will be
collected for both chest pain and innocent murmur patients between the ages of 8 and 18
years of age at the time of their initial appointment. Further, approximately one month
following the medical assessment by the cardiologists, the parents and children will be
asked to complete a measure of their satisfaction with the medical care they were provided,
their health care utilization subsequent to the diagnostic cardiology appointment, their
various somatic symptoms, and their functional disability at the one month follow-up
assessment. Also, the chest pain patients will be asked to complete the chest pain inventory
in conjunction with their parent.

Between-group analyses will address how these multiple variables differ for the chest pain
group and patients presenting for an evaluation for heart murmurs. This will be true at both
the time of the patients' appointment and at follow-up. Further, within-group correlational
analyses will be conducted primarily for with the chest pain group. The goal of these within
group analyses will be to address how the various child, parent, and familial factors
correlate with the children's chest pain symptoms, healthcare utilization, other somatic
symptoms, and functional disability. In addition, for the chest pain group, the patients'
and their families' functioning at the time of the initial appointment will be used to
predict chest pain and other somatic symptom maintenance, health care utilization following
the initial appointment, and satisfaction with their medical care at follow-up. Each of
these questions will advance the literature in this area.

We should also point out why the innocent murmur group was chosen as a comparison sample for
the chest pain patients. As noted above, pain is a subjective experience that is first noted
by the patient and then communicated to others. It is then reacted to in various ways by
those in the child's environment. In contrast, a child with a heart murmur is not the one
who first notices the symptom and then communicates it. Instead, the patient with a murmur
is told that they have the symptom by a pediatrician, family practice physician, or other
health care provider. This tendency to notice and interpret pain in a particular manner is
an essential component in the history of the children and their families who report to
cardiology clinics for an evaluation of the etiology of chest pain. Such noticing and
interpretation is fundamentally a psychological process.

Comparison: adolescents who present in a cardiac specialty clinic with noncardiac chest pain
versus those who present with innocent murmurs.