Children with Intestinal Failure are at Risk for Psychopathology and Trauma

Lotte E. Vlug, Jeroen S. Legerstee, Merit M. Tabbers, Aysenur Demirok, Merel W. Verloop, Lotte Bosman, Edmond H.H.M. Rings, René M.H. Wijnen, Marjolein Spoel, Barbara A.E. De Koning*, Petra Mazer, Elisabeth W.C. Aendekerk, Esther G. Neelis, Jessie M. Hulst

*Corresponding author for this work

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The objective of this study is to assess the psychopathology and medical traumatic stress in children with intestinal failure (IF) and identify associated risk factors. 


Two-center study, performed from September 2019 until April 2022 (partly during COVID-19 pandemic), including children (1.5-17 years) with IF, dependent on parenteral nutrition (PN) or weaned off PN, treated by a multidisciplinary IF-team. Psychopathology in children was evaluated with a semi-structured interview assessing psychiatric classifications and validated questionnaires assessing emotional (internalizing) and behavioral (externalizing) problems. Medical traumatic stress was assessed with a validated questionnaire. Problem scores were compared with normative data. Associations between clinical characteristics and outcomes were analyzed with linear regression analyses. 


Forty-one (of 111 eligible) children were included [median age 8.9 years (interquartile range, IQR 5.5-11.8), 54% female, 73% born preterm]. Median PN-duration was 17.3 months (IQR 6.9-54.0); 17 children (41%) were still PN-dependent. One third of the children met criteria for at least 1 psychiatric classification (compared with 14% in age-matched general population). Anxiety disorders and attention deficit hyperactivity disorder were most common. In school-aged children (n = 29, 6-17 years), significantly increased emotional problems were consistently reported by children (P = 0.011), parents (P < 0.001), and teachers (P = 0.004). In preschool children (n = 12, 1.5-5 years), no significant differences with normative data were found. Subclinical or clinical emotional problems were reported in 19 children (46%). Medical traumatic stress was present in 14%, and 22% of children had received psychological help for trauma before. Lower gastrointestinal related quality of life was associated with more emotional problems, but not PN-duration. 


Children with IF, particularly school-aged children, are at risk for psychological problems which is reflected by the high rate of received psychotherapy and the high rate of emotional problems and psychiatric classifications.

Original languageEnglish
Pages (from-to)E104-E113
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number6
Publication statusPublished - Dec 2023

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