Somatic Symptoms in Children: The 5 Ws Explained

Has your child been diagnosed with a conversion disorder, functional gastrointestinal or neurological disorder, chronic pain, or syncope?

All of these diagnoses have something in common: somatic symptoms. Somatic symptoms are caused by disruptions in how the brain and the body communicate, rather than a disease or injury.

Somatic Symptoms Can Be Frustrating and Scary

These types of symptoms can be frustrating and scary for parents and children. Often they’ve had many medical appointments, diagnostic tests, and missed days of school before symptoms are correctly diagnosed and treated.

The treatment for somatic symptoms may not be what families expect. Instead of receiving a medication or procedure, children are often referred to a psychologist for cognitive behavioral therapy (CBT). This is a well-established and scientifically supported intervention for somatic symptoms.

To help families understand somatic symptoms and how CBT principles can help, I’ve outlined the 5 Ws below:

5 Ws of Somatic Symptoms

 

WHAT are somatic symptoms 

Somatic symptoms are real physical symptoms. However, unlike symptoms that are helpful and protective, such as feeling pain when you put your hand on a hot stove, somatic symptoms are unhelpful because they aren’t alerting you to any current danger, like feeling pain in your hand when you’re not touching anything hot.

Here’s a way to think about how somatic symptoms are an unhelpful signal. Imagine a fire alarm that keeps going off even though the fire is out. The “alarm,” or the symptom a child experiences, is real, but there isn’t a “fire,” or active injury or disease. Just because there is not something medically wrong does not mean the symptoms are “all in a child’s head.” The symptom is real, just not harmful or dangerous. Somatic symptoms can occur by themselves, or along with another medical or mental health condition.

WHERE do they occur

Somatic symptoms can be experienced in every body system. Neurological symptoms include weakness, tremors, or sensory changes. Cardiac symptoms can be dizziness or passing out. Gastrointestinal symptoms can involve stomachaches or nausea. Pain symptoms include chronic headaches or musculoskeletal pain. 

WHEN do they occur

Somatic symptoms often start after an illness, injury, or stressor that triggers the “alarm.” Symptoms can continue long after the child’s infection or injury has healed or the stressor has passed. They can happen occasionally, or they can happen frequently, lasting for a few months or a few years.

Somatic symptoms may be more noticeable at times when a child is under physical or emotional stress. For example, you might have noticed your child’s symptoms are worse at school or when your child is tired. This does not mean your child is purposefully making his or her symptoms worse to get out of school. Instead, when the body is activated by stressors (worrying about performance on a test), somatic symptoms are worse.

WHY do they happen

Somatic symptoms happen as a result of how the brain interprets stressors and communicates this information to the body. The autonomic nervous system plays a big role in how the brain communicates with the body. It functions like the engine in a car by regulating the body’s speed.

It happens when a person is activated by a stressor, or in a state of “fight-or-flight.” These symptoms become more intense and noticeable as the body speeds up and tries to protect itself from danger. As a person relaxes, the body moves into “rest-and-digest.” In this state, symptoms become less intense and noticeable as the body slows down and recovers.

Any type of physical, emotional, or social stressor (exercise, worry, negative interactions) can activate the autonomic nervous system. This can then increase symptoms. The body’s response to that stressor becomes a learned pattern over time. And then it can start to happen even when the stressor isn’t present.

This is how just thinking about something stressful can cause symptoms. This pattern typically leads children to avoid situations in which they feel symptoms. And this avoidance cycle only makes the symptoms stronger. In this way, we can see that somatic symptoms are not caused by anxiety alone. However, anxiety makes them worse because of the activating effect it has on the body.

WHO experiences them

Everyone experiences physical symptoms, but not all physical symptoms are somatic symptoms. Think of the last time your stomach felt queasy. You probably did not need treatment, as it went away and did not keep you from doing your daily activities. But, for some children, that same queasy sensation might come and go for months, which over time can keep them from their regular activities. That’s when it’s considered to be a somatic symptom. Somatic symptoms are diagnosed more often in teenagers, and in more girls than boys. 

 

WHEN to seek help and HOW to treat them

Now that you have a better understanding of your child’s symptoms, let’s talk about what you can do to help. Treatment varies depending on the severity, presence of other conditions, and how long the symptoms have been going on.

If your child has symptoms and has not been seen by a medical provider, it is important to start with a medical evaluation. If your child already has a somatic symptom diagnosis, here are some ways that you can help.

With symptoms that are infrequent and cause minor impairment, parents can validate their child’s symptoms and emotions, and empower them to actively cope. Getting your child’s mind off the symptoms is the goal. So encourage her to do a favorite activity, take some time to relax, or try to help her focus on what she can do instead of what she can’t.

Hitting the Brakes on Somatic Symptoms

These strategies will help them “hit the brakes” on their autonomic nervous system to reduce their symptom experience. You can say something like, “I know your stomach hurts on the way to school, so let’s play a game or listen to music on the way there.” For children who have started to avoid certain events, help them take small steps to break the cycle of activation and symptoms.

If your child is experiencing frequent symptoms and a lot of impairment, such as missing school, social, or family activities, you may be referred to or seek a referral to a psychologist who practices CBT. Your child will learn more about why symptoms are happening, how to cope with physical, emotional, and social stressors that might make symptoms worse. Additionally, he’ll learn specific skills to prevent or manage symptoms when they happen.

Overall, it’s important to know that somatic symptoms are real and are affected by everything we think, feel, and do. With the right support and encouragement, children can overcome somatic symptoms to do everything they want to do in their lives!

To learn more about Behavioral Medicine and Clinical Psychology at Cincinnati Children’s, please visit our website or call 513-636-4336.

 

Nicole Zahka, PhD

About the Author: Nicole Zahka, PhD

Nicole E. Zahka, PhD, is a pediatric psychologist at Cincinnati Children’s. Her practice includes children and adolescents with chronic medical conditions and anxiety disorders, with a specialty in assessment and treatment of conversion and functional movement disorders, as well as syncope and eosinophilic gastrointestinal disorders. She is also the co-author of "Treating Somatic Symptoms in Children and Adolescents"

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