Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence.

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases.

AIMS: Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. METHODS: A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. RESULTS: The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. CONCLUSIONS: Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.