Somatising in children and adolescents. 2. Management and outcomes

How to recognize and manage psychosomatic pain in the pediatric emergency department

Aim

Children and adolescents affected by somatization and somatic symptom disorder commonly refer to emergency services. Due to the absence of specific guidelines for the emergency setting and to a possible lack of knowledge, these patients are at risk of being unrecognized and mismanaged. This study aims at proposing a clinical practice to approach and manage these patients and their families in the emergency setting.

Methods

This manuscript derived from the work of a research group of italian pediatric emergency physicians and anesthesiologists, with an expertise in pain management, members of the PIPER group. The research group reviewed the literature about psychosomatic pain and somatic symptom disorder and developed a clinical practice specific for the pediatric emergency setting.

Results

The manuscript provides information about the main clinical features shared by patients with psychosomatic pain and about current diagnostic criteria and appropriate management in the emergency setting. Furthermore, it highlights the possible pitfalls in which the emergency physician may run into dealing with these patients.

Conclusion

This clinical practice should be seen as a starting point toward a better understanding of patients with psychosomatic pain and a standardization of care in the pediatric emergency setting.

Somatising in children and adolescents. 1. Clinical presentations and aetiological factors

Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.

Clinical features of functional somatic symptoms in children and referral patterns to child and adolescent mental health services

AIM

Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them.

METHODS

The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not.

RESULTS

Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response.

CONCLUSION

Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS.

The association between parenting behavior and somatization in adolescents explained by physiological responses in adolescents

INTRODUCTION

This study adds to the knowledge on somatization in adolescents by exploring its relation with parenting behavior and the mediating/moderating role of physiological responses in adolescents to parenting behavior.

METHOD

Eighteen adolescents with high and 18 adolescents with low somatization scores and their mothers completed a discussion task, from which observed parenting behavior scores were derived. Skin conductance in adolescents was measured before and during the discussion.

RESULTS

For adolescents with high levels of physiological responses, unadaptive parenting was related to a higher chance of high somatization scores. For low physiologically responsive adolescents, the relation between parenting behavior and somatization was not significant.

CONCLUSION

Parenting behavior is not univocally related to somatization in adolescents, but the association depends on physiological responses in adolescents.

Medically unexplained symptoms in children and adolescents

A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.