Use of health care services by children and diagnoses received during presumably stressful life transitions.

Transition periods in the lives of children are potentially stressful and might therefore be associated with adverse changes in children's physical or emotional health. The computerized medical records of 1,521 children continuously enrolled in a prepaid health plan for 6 years were analyzed to identify if such a trend was present. The overall rates of children's health care use steadily decline with increasing age until early adolescence, at which time girls' rates modestly increase and boys' continue to decline. However, the prevalence of diagnoses for which an emotional basis may be presumed increases markedly during two major transitional periods: (1) early elementary school and (2) early adolescence. During both periods, there are notable differences between boys and girls with regard to rates and temporal patterns. Girls do not demonstrate the same increased rates during elementary school years as do boys. The study provides evidence from population-based data that for some children early school years and adolescence are times of increased stress. Children who are once diagnosed as having an emotional problem, presumably related to stressful life transitions, tend to continue having similar difficulties.