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When an SSD is being considered, a pediatrician and a mental health clinician should evaluate the child or adolescent from physical, psychological, social and developmental angles, both separately and in relation to each other. Having an SSD does not exclude the possibility of a physical illness, and vice versa. Both can and often coexist in the same child, so evaluation from multiple perspectives is key.
In evaluating for SSDs, clinicians will consider whether a child’s symptoms are more frequent and intense than the passing somatic symptoms we all experience, whether the child is having excessive and persistent thoughts and anxiety about existing physical symptoms, and whether the symptoms interfere with daily life, including school, home life and/or peer relationships
Medical evaluation is based on symptoms and guided by any previous tests the child or adolescent may have had. Many youth with SSDs have been subjected to a variety of medical tests already, so any medical work-up is balanced with the need to avoid unnecessary and potentially harmful tests and procedures.
Generally, in children and adolescents with SSDs, the physical examination will find that the symptoms change in different contexts, may not be consistent with any medical findings or may be more severe than what would be expected from the medical findings.
If an SSD is suspected, a psychiatric consultation can help the child’s care team understand what may be contributing to the child’s distress and which treatments are likely to be most effective. Through careful interviews with the child and family, the team will seek to get a picture of:
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”