Somatization in Children

Questions and Answers

To address family and social network factors contributing to symptoms

To diagnose comorbid psychiatric problems

To prescribe psychopharmacologic interventions

To explain the link between physical, psychological, and social factors (correct)

To develop a treatment plan

To identify underlying medical conditions

To link physical, psychological, and social factors (correct)

To assign blame to family members or teachers

Medication management

Muscular relaxation (correct)

Cognitive-behavioral therapy

Surgery

To gradually shift the burden of responsibility to the parent/patient Signup and view all the answers

A stressful event at school Signup and view all the answers

To address any factors contributing to symptoms or interfering with symptom resolution Signup and view all the answers

It decreases the pain threshold Signup and view all the answers

How tense muscles lead to pain Signup and view all the answers

It decreases pain Signup and view all the answers

To address comorbid psychiatric problems Signup and view all the answers

Study Notes

Parents often report symptoms suggestive of somatization in children as young as 5-7 years old.
Somatization-related disorders in young children are primarily manifested through parental concerns, beliefs, and behaviors.

Typical presentations in children include:
- Recurrent episodes of severe abdominal pain, headaches, or vomiting
- Accompanied by lethargy, pale appearance, and unwellness
- May look like tension headaches, but sometimes coexist with migraine attacks
Additional complaints of other less prominent physical symptoms, mood changes, and marked impairment with reduction in social contact and school absence are common.

Chalder Fatigue Scale (CFS): measures physical and mental fatigue in patients
Functional Disability Inventory (FDI): assesses physical impairment and functioning
Munich-Composite International Diagnostic Interview (M-CIDI): diagnoses somatoform and dissociative disorders
Schedules for Clinical Assessment in Neuropsychiatry (SCAN): diagnoses somatoform and dissociative disorders
The Child and Adolescent Psychiatric Assessment (CAPA): assesses symptom diagnosis based on information on onset date, duration, frequency, and impact
The Preschool Age Psychiatric Assessment (PAPA): assesses symptom diagnosis in preschool children
The Soma Assessment Interview (SAI): assesses functional somatic symptoms and impairment

Necessary investigations to exclude organic disease and discuss with parents tactfully
Modify harmful aspects in the child's environment (e.g., excessive academic and emotional demands)
Share information about population frequency of FSS, risk factors, and management strategies to "normalize" the problem and "empower" families
Specialized mental health treatment, including family CBT and pharmacological treatment, may be necessary
Reframe complaints in a biopsychosocial model, linking physical, psychological, and social factors
Help the child and family learn new coping techniques and address contributing factors in the family or school