PHYSICAL SYMPTOMS WITHOUT EVIDENCE OF SOMATIC AETIOLOGY

Key words: Psychosomatics, Development, Doctor-patient relationship, Children, Adolescence

Physical symptoms without evidence of somatic aetiology are common events in children and adolescents; sometimes they may be challenging for the paediatrician. The diagnosis usually comes when an organic pathology has been excluded and must be reinforced looking for the presence of some “key findings”. Moreover, like in other medical illnesses, in this context it is very important to consider the interplay of symptoms and child development. The relationship among school attendance, learning and psychiatric problems (particularly anxiety and depression) must be precociously delineated because the level of derived functional impairment influences the prognosis. The presence of more than one symptom, their persistence, the association with school and social impairment often constitute a severe situation for the child, the family and the paediatrician. A very long history of multiple medical opinions, diagnostic tests and hospitalization contribute to the child distress and limitations. In presence of physical symptoms without evidence of somatic aetiology, the relationship among child, the family and paediatrician has a central role in the communication of the diagnosis and can be the first therapeutic action.