When a physical condition cannot be found to fully explain your child’s or teen’s physical symptoms, the symptoms might be described as:
- functional
- non-organic
- amplified
- medically unexplained
- psychosomatic
- psychogenic
- pseudo (for example, pseudoseizures)
- somatization (expressing distress through physical symptoms)
A doctor may also use these terms when a child or teen with an existing medical condition has symptoms that:
- are more severe, and have a greater impact on their daily life, than would be expected with the medical condition;
- cannot be entirely explained by the medical condition.
Functional disorders hinder your child’s or teen’s everyday routine. For example, they can make it difficult for your child or teen to dress, bathe, feed themselves, move around, go to school consistently or do activities with family and friends.
Common symptoms include headaches, nausea, recurring stomach pain and tiredness. These symptoms occur in up to 40 per cent of children and teens. They can be even more common in children with medical illnesses, where the exact cause is harder to figure out.
Searching for causes of symptoms
It can be quite hard to see your child or teen not doing well. When they have distressing symptoms that impair their everyday routine, it is natural to worry about possible causes and look for answers online or by talking with others. You might also seek professional help to understand and manage your child’s or teen’s symptoms.
Hearing that your child will have tests may lead you to expect a diagnosis, treatment and cure. Children and teens may also be encouraged by the idea of finding a physical cause for their symptoms.
However, when medical professionals evaluate physical symptoms, they tend to use a biomedical approach. This focuses only on physical symptoms or biological factors (rather than also considering any psychological or social factors in the child’s life) and using tests to search for an underlying physical cause.
There is a small chance that medical tests can produce a ‘false positive’ result (also known as a false alarm) by indicating a condition that is not actually present. Other times, there is a small possibility of ‘false negatives’ (results that fail to diagnose a medical condition). In these cases, some families may want more tests to find a physical cause to explain their child’s physical symptoms. This may lead to many doctor visits, trips to the emergency room, medical procedures and, sometimes, hospital admissions.
Adjusting to normal test results when symptoms persist
When doctors say that everything seems normal or that they cannot identify a medical conditon to explain your child’s or teen’s symptoms, you may feel more distressed and confused. For instance, you might, understandably:
- feel frustrated that the doctors do not appreciate the severity of your child’s symptoms;
- worry that your health-care team thinks the condition is in your child’s head or that your child is faking symptoms for attention;
- worry that the health-care team is missing something life-threatening and that the diagnosis, treatment and prognosis (outlook for the condition) are all unknown;
- feel hopeless, if your child’s team says that nothing more can be done for your child or teen;
- feel stressed because of your child’s symptoms or pre-existing medical condition or disability, similar symptoms in the family or the impact on the family.
Response to illness or injury
Often, children and teens who develop functional disorders may have had an illness or injury and then have a longer-than-expected recovery. The illness or injury may have caused them to be more aware of their body’s sensations, including pain.
When illness or injury affects children and teens, they may feel like they are no longer speeding along the fast lane of the highway but instead are stalling at the side of the road. They might feel overwhelmed about ‘starting the car’, never mind getting back to their previous fast pace. They might compare themselves to their friends and peers, which can make recovery more difficult.
Response to stress and uncomfortable emotions
Some children and teens may have experienced stressful situations such as time away from school, a drop in marks, a conflict with a friend or teacher, stress in the family, death of a loved one or a traumatic event.
Stressful situations affect children and teens in different ways. When children and teens find it hard to talk about what has been stressful, it can activate the fight, flight or freeze response and increase the chance of distress showing up through physical symptoms. In this way, physical symptoms can be the body’s way of talking when a child or teen cannot express what is troubling them.
Impact on child or teen
A child or teen may experience stress with physical symptoms if they cannot keep up with their peers and gain normal independence. When a child or teen thinks of themselves as being ill first, other parts of who they are fade into the background, and being sick can feel like a major part of their identity.
Family, friends and teachers may also perceive a child or teen with a functional disorder as sick, fragile and vulnerable. They may pay a lot of attention to the physical symptoms, and even come to expect them, and reduce their expectations of the child or teen. This may cause the child or teen to avoid challenging situations while also gaining relief from their symptoms.
Understandably, the child may find that this seems to help them feel better, but it may actually make symptoms last longer or get worse.
In addition, communication may break down between the child and their family. If there is any stigma with expressing emotions, the family may pay more attention to and offer sympathy for physical symptoms than for the child expressing difficult emotions.
When to see a doctor
It is important to see a family doctor or paediatrician if your child has significant physical symptoms that cause them to miss school or activities. Just as doctors try to find the cause of a fever, and not just treat the fever, they need to understand what causes distressing and impairing physical symptoms.
How to more effectively assess and manage functional disorders
It is important to see a family doctor or paediatrician if your child has significant physical symptoms that cause them to miss school or activities. Just as doctors try to find the cause of a fever, and not just treat the fever, they need to understand what causes distressing and impairing physical symptoms.
A detailed assessment using a biopsychosocial, or holistic, approach can help to explore the different factors that might contribute to your child’s physical symptoms and impaired routine and that trigger the return of symptoms or make them worse or better.
- Biological factors are the physical causes of symptoms, such an illness, a health condition or an injury.
- Psychological factors include any ways of thinking, stress and/or uncomfortable emotions.
- Social factors could be any stressors or other features in a child’s or teen’s environment, whether at home, at school or with friends.
A biopsychosocial approach can explore not only the symptoms, but also their context and their impact. These can all highlight opportunities for treatment.
Up to 40 per cent of children and teens with medical conditions have mental health conditions. For example, children and teens with depression often have fatigue and headaches and those with anxiety disorders often have headaches, muscle tension and nausea.
When a child or teen has distressing and impairing symptoms, they benefit from treatment that integrates professional support from medical, mental health and rehabilitation health-care professionals. With time, guidance from your child’s health-care team and
support at home:
- your child’s symptoms can be relieved
- their functioning (everyday tasks) can improve
- the causes of their symptoms can be identified and managed.
A holistic approach to understanding and managing physical symptoms gives the best opportunity for recovery.