Children who are seldom really ill, but seldom really well, are repeatedly brought to their paediatricians’ attention for a variety of reasons, and may undergo a series of changing diagnoses and treatments. [1]
Epidemiological studies show that the prevalence of mental health and behavioural disorders is increasing in childhood and adolescence, and that these conditions frequently hide behind physical symptoms. [2] There is also evidence to suggest that parental anxiety, catastrophising, and overprotection impact on the development and outcome of these conditions. [3,4,5]
In these days of low natality, older parents, and only children, and with the availability of a wide range of sophisticated diagnostic tests and the constant fear of legal arguments, some paediatricians may become reluctant in making decisions without performing blood or other tests, without relying on specialist consults, or without prescribing medication for symptoms which are relatively minor and most likely self limiting. Because of this, repeated medical evaluation and diagnostic testing is often prominent in these children’s histories. [6]
Some physicians’ and parents’ behaviours may foster and perpetuate a certain perception of sickness, which can contribute to the loss of physical and mental growth opportunities in children.
To protect children and support families paediatricians need confidence to remain a continuous positive referral for these families, highlighting children’s and families’ strengths, and paying particular attention to family characteristics that could influence symptom presentation and exacerbation, such as family perception of illness, mechanisms for coping with stress, or any relevant family medical history. [7]
Scheduling frequent visits, sharing hypotheses, and involving community colleagues can reassure parents, limit reinforcement of familial anxieties, and discourage “doctor shopping” and excessive medicalisation. [7]
Dedicating time to offering explanations plays a pivotal role in reassuring parents and is constructive when deciding upon a shared way forward.
Giorgio Cozzi is a paediatrician at the Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
Conflict of interest: None declared
Egidio Barbi is a professor of Paediatrics at the University of Trieste, Italy
Conflict of interest: None declared
References:
- Apley J. Emotional and Behavioural Disorders-II. Br Med J 1965;2:213-5.
- Chun TH, Mace SE, Katz ER. Evaluation and management of children with acute mental health or behavioral problems. Part II: recognition of clinically challenging mental health related conditions presenting with medical or uncertain symptoms. Pediatrics 2016;138.
- Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol 2014;69:142-52.
- Lynch-Jordan AM, Kashikar-Zuck S, Szabova A, et al. The interplay of parent and adolescent catastrophizing and its impact on adolescents’ pain, functioning, and pain behavior. Clin J Pain 2013;29:681-8.
- Janssens KA, Oldehinkel AJ, Rosmalen JG. Parental overprotection predicts the development of functional somatic symptoms in young adolescents. J Pediatr 2009;154:918-23.
- Cozzi G, Minute M, Skabar A, et al. Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain. Acta Paediatr 2017;106:586-593.
- Malas N, Ortiz-Aguayo R, Giles L, et al. Pediatric Somatic Symptom Disorders. Curr Psychiatry Rep 2017;19:11.