{
  "abstract": "Paediatric gastroenterology often involves complex cases in which psychosocial factors significantly influence symptom expression, disease trajectory, and family functioning. Traditional models of care may inadvertently prioritise biological interventions, overlooking the psychosocial components that drive health-seeking behaviour, adherence, and wellbeing. The biopsychosocial (BPS) approach provides a framework for understanding and addressing the predisposing, precipitating, perpetuating, and protective factors contributing to illness. 1 2 This pilot clinic was established in a tertiary paediatric gastroenterology service to operationalise this model within routine practice and evaluate its impact on patient management, family dynamics, and team understanding.3Over a six-month pilot period, ten dedicated BPS clinics were conducted within a tertiary paediatric gastroenterology unit. Each clinic consisted of one morning session, typically comprising four new 60-minute assessments or, for follow-up clinics, 30-minute review appointments. Inclusion criteria focused on complexity—specifically, children whose presentations involved significant psychosocial difficulties, family distress, diagnostic uncertainty, or difficulties engaging with medical recommendations. The clinical model was explicitly person-centred, grounded in the classical BPS framework. Assessments systematically explored the four Ps (predisposing, precipitating, perpetuating, and protective factors). The consultation structure integrated elements of mental-health formulation, behavioural management, and trauma-informed care. All cases were referred by consultant gastroenterologists because of their recognised complexity.Overall, twelve children and their families were seen. Qualitative outcomes indicated improvements in clinical management, family engagement, and diagnostic clarity. Representative findings included: enhanced diagnostic accuracy—a young person initially thought to have refractory rumination syndrome was identified as having an underlying psychiatric disorder, leading to appropriate mental-health referral; improved family understanding and trust—a family convinced of undiagnosed Crohn’s disease accepted the absence of organic pathology following supportive psychoeducation; reduction in parental distress—targeted de-escalation and containment strategies alleviated anxiety in a parent with high health anxiety; improved emotional wellbeing—a child with inflammatory bowel disease (IBD) and low mood showed marked emotional improvement after coordinated psychological input through the BPS clinic; better symptom outcomes—a patient with dysmotility experienced improved physical outcomes once psychosocial stressors were identified and addressed; and enhanced treatment adherence—a child refusing nasogastric feeding accepted tube placement after a brief behavioural intervention using mindful-breathing techniques. Referring clinicians reported that the clinic clarified diagnostic uncertainty, improved adherence, and reduced repeated contacts and crisis presentations.This pilot demonstrates that embedding a structured biopsychosocial framework within paediatric gastroenterology practice is feasible and effective. The BPS clinic provided a psychologically informed space for exploring meaning, emotion, and context—elements often overshadowed by biological management. The observed outcomes suggest that incorporating psychosocial assessment and intervention alongside medical care can meaningfully improve engagement, treatment adherence, and family wellbeing. This experience highlights the importance of training paediatric teams in biopsychosocial formulation and the value of dedicated clinical time to address these dimensions of care.References Borrell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6): 576–82.Van Oudenhove L, Levy RL, Crowell MD, Drossman DA, Halpert AD, Keefer L, et al. Biopsychosocial aspects of functional gastrointestinal disorders: how central and environmental processes contribute to the development and expression of FGIDs. Gastroenterol. 2016;150(6):1355–67.Keefer L, Palsson OS, Pandolfino JE. Best practice update: incorporating psychogastroenterology into management of digestive disorders. Gastroenterol. 2018;154(5):1249–57.",
  "authors": [
    {
      "affiliations": [
        "Paediatric Gastroenterology Service, University Hospital of Wales, Cardiff, United Kingdom"
      ],
      "name": "Mohamad Hilal"
    },
    {
      "affiliations": [
        "Paediatric Gastroenterology Service, University Hospital of Wales, Cardiff, United Kingdom"
      ],
      "name": "Amar Wahid"
    },
    {
      "affiliations": [
        "Paediatric Gastroenterology Service, University Hospital of Wales, Cardiff, United Kingdom"
      ],
      "name": "Huda Atta"
    },
    {
      "affiliations": [
        "Paediatric Gastroenterology Service, University Hospital of Wales, Cardiff, United Kingdom"
      ],
      "name": "Joe Chan"
    }
  ],
  "title": "OC3 Integrating the biopsychosocial model in paediatric gastroenterology: a pilot clinic experience from a tertiary centre",
  "uid": "9e5cfed5-4df1-521b-ab2d-81386434f64a"
}