Background Conclusions of current state of the art report that 50% of all children and adolescents outpatient visits to a paediatrician are determined by a physical/somatic complaint. After medical evaluation, a third of these complaints have no apparent organic cause, thereby becoming a medically unexplained symptom. Somatic complaints have become a topic of research in child and adolescent psychiatric literature, as these are often correlated with anxiety disorders in this age category.
Separation anxiety disorder, panic disorder or scholar phobia (scholar refusal) for which physical symptoms are a part of the DSM diagnostic criteria are associated with increased somatic complaints. The term school phobia was first used in 1941 to identify children who fail to attend school because attendance causes emotional distress and anxiety, but since the early 2000’s the term school refusal is preferred.
Children who refuse to attend school usually try to win a parent’s permission to stay home, although some simply refuse to leave the house. In recent studies, the most commonly endorsed somatic symptoms in children and adolescent sample of school refusers were gastrointestinal items: nausea, vomiting, diarrhoea and stomach pains. Another physical symptoms are common and include dizziness, headaches, shaking or trembling, fast heart rate, chest pains, and back, joint pains. These symptoms usually improve once the child is allowed to stay home. Behavioural symptoms include temper tantrums, crying, angry outbursts, and threats to hurt themselves.
Usually, for parents, somatic symptoms outweigh the concerns, fears, and child’s refusal to attend the tests or going to school, so parents repeatedly address the family doctor or paediatrician.
Conclusions This paper aims to emphasise the importance of completing medical history and laboratory investigations with data that may suggest a psychogenic cause of somatic complaints. After excluding organic causes, it is important for paediatric patients to be oriented to mental health services for early intervention.
This is important to delineate because the longer is the period of missing school the harder it is the educational reintegration. The long term consequences are unfavourable for the child including loss of peer relationships and academic difficulties.
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