Preparation for Admission (ED Team)

Regardless of the reason for admission, evidence has shown children with somatization do better when there is consensus within the medical team about the diagnosis. Creating this consensus may involve discussions with the PCP and judicious consultations with sub-specialists. When admitting a child to the inpatient floor from the emergency room, it is important to find the right balance between introducing a somatic/functional diagnosis and exploring alternative medical explanations with consultations or testing. It is helpful to set clear expectations and goals for the admission to support a shift from a medical/diagnostic focus towards a commitment to accepting a Somatic Symptom diagnosis with the goal of improved functioning.

Consider using wording like “Your child is being admitted to the general pediatrics team for real and serious symptoms which have limited their function. We are considering a diagnosis of somatic symptoms, in which the body responds in inappropriate ways to non-life threatening symptoms”. The caregiver may be focused on identifying an organic diagnosis using additional medical testing or procedures, but once serious medical illness has been addressed, additional testing is not helpful for somatic symptoms and the focus should continue to shift toward education and management of somatic symptoms.

Providers can support families in “walking two paths” of their medical diagnostic journey and their somatic/functional journey as they make this shift. Pan-consulting and extensive medical testing may perpetuate a theme of overmedicalization. Delays in providing a somatic diagnosis to the child and/or caregiver may result in overmedicalization and iatrogenic harm to the child, as well as delays in treatment. Children who are diagnosed and treated quickly for somatization have a much better prognosis and chance for recovery.