Psychological factors key in tackling children’s unexplained pain

Educating parents is the key to tackling medically unexplained pain in children and adolescents, and parents are often “fixed in a cycle of demanding more tests”, a senior clinical psychologist at Crumlin Children’s Hospital has said.

It is estimated that one in five GP visits by children and adolescents involve complaints with a “psychological element”, including stomach pain and headaches with no diagnosable medical cause, as well as more severe and debilitating chronic conditions.

Vincent McDarby of Crumlin Children’s Hospital is a member of the Psychological Society of Ireland and heads up an international conference on chronic pain and medically unexplained symptoms in children taking place in Dublin today.

The severity of unexplained chronic conditions in children should not be underestimated just because there is an underlying psychological cause, Mr McDarby said. “In extreme cases, we’ve seen children go blind from pseudo-seizures,” he said. .

Pseudo-seizures appear to be medical in origin but do not show up on an ECG test. They are fairly common among children who have epilepsy and may be anxious about having seizures.

European studies have found that children may be more likely than adults to show physical symptoms when suffering from emotional distress or anxiety because of their immature verbal skills and lack of vocabulary for expressing their emotions.

Another study found that one in 100 children and adolescents met the criteria for somatic disorder, where children’s health is put at risk by complaints of a psychosomatic origin.

“They may be avoiding anxiety-provoking situations, for example trying to avoid school, or the child could be in a household where there’s a lot going on and they are not getting the attention that they need; either way, they are expressing distress and need to be listened to,” said Mr McDarby. “Just saying they’re making it up is not the answer.”

Affected children have often had an original medical issue, but the symptoms are prolonged beyond what could be expected after treatment.

Coping with medically unexplained symptoms can be stressful for children and their families and can affect a child’s school attendance, dependence on their parents and ability to attend extra-curricular activities.

The conference, run by the psychological society of Ireland, includes speeches from experts in pain management and paediatric psychology. It hopes to build what Mr McDarby describes as a “route-map” for parents and children whose symptoms are not explained by regular medical diagnostics.

This could often include more holistic form of treatment including psychological therapies.

Mr McDarby said there is still a stigma attached to labelling an illness as psychological in origin, and that it is important to reassure parents that their children’s symptoms are being taken seriously.

However, parents need to understand that their child’s treatment may require more than a simple medical approach.


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