The Relation Between Child Chronic Pain and Internalizing Symptoms: An Analysis of Sibling Relationships as Moderators and Child Social Engagement as a Mediator

Pediatric chronic pain is surprisingly common and impactful, prospectively predicting poorer mental and physical health outcomes. Internalizing symptoms represents one such outcome. It is the most common cluster of symptoms in children, it is related to poorer child functioning, and it has been linked to future functioning/psychopathology. The psychosocial mechanisms through which child pain may impact internalizing have yet to be fully elaborated, but withdrawal from social engagement with peers has been proposed as one possible mechanism. Additionally, sibling relationships may play a role in enhancing or diminishing a child’s social engagement while they are in pain. The current study aimed to examine whether child social engagement at age 8 mediates the relation between child chronic pain at age 8 and internalizing symptoms at age 9. Further, the study tested whether sibling warmth and sibling conflict act as moderators between child chronic pain and child social engagement. The physical and emotional health, quality of sibling relations, and extracurricular social engagement of 491 twin children from 247 families were assessed at age 8 and age 9 via surveys completed by the children’s primary caregivers. Findings showed that child pain at age 8 did not predict lower levels of social engagement, and social engagement did not predict child internalizing at age 9. Sibling warmth, but not conflict, significantly moderated the pain—social engagement relation. Together, these findings indicate that the relation between chronic pain and internalizing functions differently in children than in adults through a variety of cognitive, environmental, and social factors. More longitudinal research in this area will help establish changes in the relation between pain and internalizing from childhood into adulthood.