Introduction

When somebody is experiencing physical symptoms with no physical signs of disease those symptoms are known as somatic symptoms. This then becomes a disorder when its negative impacts become significant, affecting the individual’s ability to carry out daily routine tasks.¹ Somatic Symptom disorder (SSD) can affect both adults and children, however, in this article we will be looking specifically at the diagnosis and management of somatic symptom disorder in children.

Diagnosis

The most common symptoms of this mental health disorder are fatigue, nausea, pain and feeling faint.² The pain is usually a headache or abdominal pain but can be in any other parts of the body and can change location or be in multiple locations of the body at once. The pain which starts off as a recurring event gets more and more frequent until it becomes a daily occurrence, and common painkillers have no impact on reducing the pain. Symptoms go on for months and even years without effective treatment and the child is often fatigued.¹

Family members are understandably concerned when they see the child in pain and in distress therefore would take them to the doctors and in some cases use emergency services depending on how urgent they believe the situation is. They would however be lower priority having to wait for longer to see the doctor than other A and E patients causing further distress.¹

Once they are taken to a doctor, the doctor will look at patient history to check for any known chronic disease or psychiatric illness such as depression or anxiety. They will also ask questions about the child’s attendance at school as children with SSD may be missing school more frequently as a result of the symptoms or be a victim of bullying, which could contribute to the worsening of symptoms of SSD . Aside from this, having a history of abuse and violence, having high familial and social expectations and a high level of conflict within the family also play a role in SSD. Females are more likely to be affected than males.¹

Once the doctor has ruled out any physical causes, they will then be able to diagnose the child which in some mild cases can itself be sufficient to ease the symptoms as they no longer have the fear of some unknown disease.¹

The diagnostic and statistical manual of mental disorders criteria is targeted mainly towards adults and therefore may not be the best way to go about diagnosing a child, however this is still being researched by scientists.³

Management

SSD has many negative impacts including children being absent from school, accessing healthcare services more regularly and socioeconomic costs. Once diagnosed, it is therefore important for the child that the SSD is managed in an effective manner. However, patients, families and even healthcare professionals often find treatment unsatisfactory. This is because SSD has both biological and environmental aspects that need to be considered when treating patients and there is no actual physical cause to treat making it challenging to manage. Still, finding what factors could be contributing to SSD first is an important step in effectively managing the condition.²

Taking a personalised approach to management is important with the goal of helping patients (the children) to learn strategies that they can use to cope with the pain rather than cure and enable them to return to school and take part in sports and social activities.²

There are many different approaches for management looking at different factors including a psychological approach, neurobiological approach and a social approach.³ 

• Psychological

The psychological approach is based on the view that the symptoms are a result of poor mental health and pain, a type of defence mechanism where the body is signalling distress. This type of approach is usually for those children already suffering from a psychiatric condition such as anxiety and depression.³ In these cases, pharmacological treatment is usually recommended. Cognitive behavioural therapy may also be recommended to the child.² The idea behind this is that by treating the existing psychiatric condition it will alleviate some of the symptoms of SSD.

• Neurobiological

The neurobiological approach is usually considered for children that have chronic pain from another condition. The idea is that due to their chronic pain they may have lower overall pain threshold so may feel more sensitive to pain than others as a result. For this cause, the child would be treated for their chronic pain³. Physiotherapy is often the route used for pain management here,² however the efficacy of this treatment method in the  long term needs to be researched further as most studies looking at its positive impacts focus on short term effects. Furthermore, research has shown that to get the most out of physiotherapy, other healthcare professionals such as paediatricians, psychologists and occupational therapists would have to be involved. It is not as simple as just seeing the physiotherapists; the approach must be multidisciplinary.⁴

• Social

The social approach looks at familial interactions and structure. Involving the family system in treating the child is important as families have a crucial role in the development of the child. Sometimes family interactions can be the main contributing factor. For example, being overprotective, lacking conflict resolution and rigidity, being overly strict on children. Enmeshment is another example where there is a lack of boundaries and over dependency on each other as a family which can negatively impact the child. Therefore, familial relationships and interactions are important for management of somatic symptoms. Additionally, the way that parents and other family members react when the child is in pain also influences their symptoms as being too panicked could cause the child to feel worse.³

In the study, a majority of the parents were highly educated which could be either because they expect from their child and may be putting pressure on them causing somatic symptoms OR they are more open to these types of treatment options because of their education. Training parents on how to help their child at home and also possibly social competence training could help the patient.³

School is another social aspect, so finding out if the child is a victim of bullying or any other issues are present there may also help.

Summary

To summarise, paediatric Somatic Symptom Disorder has many negative impacts on both the child and their family, and it is important that their symptoms are managed effectively to improve their quality of life. Managing the condition does not aim to cure but rather help the children cope better. Understanding the factors that exacerbate the condition in individual cases, taking a personalised approach is the best route for managing SSD in children.