Children and adolescents are under greater stresses than ever.  Threats of terrorism, violence in schools and community, drugs, sexual issues, HIV, and the Internet are possible causes.  These stresses may impair sleep and appetite, cause mood swings, create anxiety and withdrawal, modify immune responses, and cause physical symptoms.  The most common physical complaints in children are headaches, stomachaches, musculoskeletal pains, dizziness, and fatigue. If physical complaints are secondary to emotional problems that go unaddressed, these children may be at higher risk for substance abuse, recurrent physical symptoms, academic and behavioral difficulties, and suicide. 

Health care providers faced with stressed youth with physical complaints need to examine these youth and elicit detailed histories of the symptoms  (e.g., timing: do symptoms occur on school and weekend nights?).  History can be revealing, for example, non-specific abdominal pain and centralized abdominal pain are less often related to pathology than is localized pain.  Problems with sleep, appetite, and energy levels are not specific indicators for a psychiatric illness, but hopelessness, diminished self-worth, and suicidal ideation are indicators (e.g., of depression).  Stress can exacerbate a genuine medical syndrome, so signs that point to stress must not be concluded to be caused by stress alone. 

Treatment for chronic pain syndromes must focus on getting children to adapt and rehabilitate, not convalesce.  Do not regard symptoms as a disability.  The child must learn to function normally despite the chronic symptoms.  Relaxation exercises and self-hypnosis are worthwhile to try.  If medications are prescribed, a plan of when they can be removed or reduced should begin concomitantly.  Parents require education on how to decipher when a child needs to seek medical advice or be kept from school, so that parents can keep their child to a normal schedule despite symptoms.  Rather than force children into stressful situations, expose them to stress in a gradual way, teach them coping mechanisms, and encourage stress-reducing activities.  Parents need to be taught to modify family lifestyles (e.g., sleep, diet, exercise, ‘down-time’).  Not least, mental health consultation is important. 

(Slater JA.  Pediatric Annals 2003; 32(6):402-407.)                              -- H.T.