title: Repeated primary care consultations for non-specific physical symptoms in children in UK: a cohort study.
abstract: BACKGROUND
  Non-specific physical symptoms (NSPS), such as headache and abdominal pain, are common reasons for children to consult primary care. NSPS represent a significant burden not only on society, but also on health care services, through frequent physician consultations and referrals to secondary care. Research evidence suggests a positive relationship between health and consulting behavior of parents and their children, but research on whether repeated physician consultations for NSPS in children is influenced by parental consultations for NSPS is lacking. The aim was to measure the frequency of repeated physician consultations for NSPS in children, and investigate whether this is influenced by maternal consultations for NSPS.
  
  
  METHODS
  A cohort study of children registered with primary care practices contributing to the Consultation in Primary Care Archive database. Participants were child-mother pairs registered between January 2007 and December 2010. The cohort comprised all children (n = 1437) aged 2 to 16 years who consulted a physician for NSPS in 2009. Mothers' consultations for NSPS were measured between 2007 and 2008. Main outcome measures were repetition and frequency of consultations for NSPS in children (consultations for NSPS in both 2009 and 2010).
  
  
  RESULTS
  Overall, 27% of children had repeated consultations for NSPS. The three most common repeated consultations were for back pain, constipation and abdominal pain. Exposure to maternal consultation for NSPS was associated with 21% increase in consultation frequency for NSPS (adjusted incidence rate ratio 1.21; 95% CI 1.12, 1.31). After adjusting for child age and maternal age, maternal consultation for NSPS was associated with an increased risk of repeated consultations for NSPS in children (relative risk 1.41; 95% CI 1.16, 1.73). This association was also significant for specific NSPS groups including painful, gastrointestinal, and neurologic symptoms.
  
  
  CONCLUSIONS
  Repeated consultation for NSPS is common among children. It is important for primary care physicians and secondary care clinicians, managing children referred from primary care for NSPS, to be aware that consultation for NSPS in mothers is a risk factor for repeated consultations for NSPS among children. More research is needed to uncover exactly how parental health influences health and consulting behavior of children.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. mujahed.shraim@gmail.com.|Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, USA. mujahed.shraim@gmail.com.|Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA. mujahed.shraim@gmail.com.
authors.forename: Mujahed
authors.initials: M
authors.lastname: Shraim
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. m.bucknall@keele.ac.uk.
authors.forename: Milisa
authors.initials: M
authors.lastname: Blagojevic-Bucknall
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. c.d.mallen@keele.ac.uk.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, UK. k.m.dunn@keele.ac.uk.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Dunn
mesh_terms: D015746:Abdominal Pain; D000293:Adolescent; D000328:Adult; D001416:Back Pain; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003248:Constipation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006113:United Kingdom; D055815:Young Adult