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Pediatric somatization in the emergency department: assessing missed opportunities for early management

  • Punit Virk (a1) (a2), Dzung X. Vo (a2) (a3), Jacob Ellis (a4) and Quynh Doan (a1) (a2) (a5)



Somatization is a common phenomenon that can severely complicate youths’ functioning and health. The burden of somatization on pediatric acute care settings is currently unclear; better understanding it may address challenges clinicians experience in effectively caring for somatizing patients. In this study, we estimate the prevalence of somatization in a pediatric emergency department (ED).


We conducted a retrospective cross-sectional study of visits for non-critical, non-mental health-related concerns (n = 150) to a quaternary-level pediatric ED between July 2016 and August 2017. Demographic and clinical visit details were collected through chart review and used by two reviewing clinicians to classify whether each visit had a “probable,” “unclear” (possible), or “unlikely” somatizing component.


Approximately 3.33% (n = 5) of youth displayed probable somatization, and an additional 13.33% (n = 20) possibly experienced a somatizing component but require additional psychosocial and visit documentation to be certain. Longer symptom duration and multiple negative diagnostic tests were associated with a higher likelihood of either probable or possible somatization.


A considerable proportion of non-mental health-related visits may involve a somatizing component, indicating the burden of mental health concerns on the ED may be underestimated. A higher index of suspicion for the possibility of somatization may support clinicians in managing somatizing patients.


La somatisation est un phénomène courant, qui peut grandement perturber la santé et le fonctionnement des jeunes. Toutefois, on ne connaît pas très bien, à l'heure actuelle, le fardeau de la somatisation dans les milieux de soins actifs en pédiatrie; si on en avait une meilleure idée, cela pourrait aider les cliniciens à surmonter les difficultés que pose le traitement efficace des patients touchés. L'étude visait donc à estimer la prévalence de la somatisation dans un service des urgences (SU) pédiatriques.


Il s'agit d'une étude transversale, rétrospective, portant sur des consultations pour des troubles ne nécessitant pas des soins de toute urgence et non en lien avec la santé mentale (n = 150), faites entre juillet 2016 et août 2017, dans un SU pédiatriques de soins quaternaires. Une collecte de données démographiques et de renseignements d'ordre clinique a été réalisée à l'aide d'un examen des dossiers médicaux, puis soumise au jugement de deux cliniciens afin qu'ils déterminent si, pour chacune des consultations, il y avait un élément «probable», «possible (incertain)» ou «peu probable» de somatisation.


Dans environ 3,33% des cas (n = 5), il y avait une somatisation probable et, dans 13,33% de cas additionnels (n = 20), il y avait une somatisation possible mais, pour s'en assurer, il faudrait consulter d'autres documents sur l'état psychosocial et les consultations ultérieures. La présence prolongée de symptômes et l'accumulation d'examens de diagnostic négatifs étaient associées à une probabilité accrue de somatisation probable ou possible.


Une proportion importante de consultations pour des troubles non en lien avec la santé mentale pourrait comporter un élément de somatisation, ce qui autorise à penser que le fardeau des troubles mentaux au SU pourrait être sous-estimé. Ainsi, une vigilance accrue devant de possibles signes de somatisation pourrait aider les cliniciens à traiter les personnes affectées.


Corresponding author

Correspondence to: Dr. Quynh Doan, Faculty of Medicine, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, CANV6T 1Z3; Email:


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1.Lipowski, ZJ.Somatization: the concept and its clinical application. Am J Psychiatry 1988;145(11):1358–68.
2.Campo, JV, Fritsch, SL.Somatization in children and adolescents. J Am Acad Child Adolesc Psychiatry 1994;33(9):1223–35.
3.Bujoreanu, S, Randall, E, Thomson, K, Ibeziako, P.Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hosp Pediatr 2014;4(5):283–90.
4.Steinhausen, H-C, Winkler Metzke, C.Continuity of functional-somatic symptoms from late childhood to young adulthood in a community sample. J Child Psychol Psychiatry 2007;48(5):508–13.
5.Kelty Mental Health Resource Center. Somatization and the Mind-Body Connection. [cited November 5, 2019]. Available at: (accessed December 7, 2019).
6.Beck, JE.A developmental perspective on functional somatic symptoms. J Pediatr Psychol 2008;33(5):547–62.
7.LeResche, L, Mancl, LA, Drangsholt, MT, Saunders, K, von Korff, M.Relationship of pain and symptoms to pubertal development in adolescents. Pain 2005;118(1):201–9.
8.Lieb, R, Pfister, H, Mastaler, M, Wittchen, H.Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand 2008;101(3):194208.
9.Karvonen, JT, Veijola, J, Jokelainen, J, Läksy, K, Järvelin, M-R, Joukamaa, M.Somatization disorder in young adult population. Gen Hosp Psychiatry 2004;26(1):912.
10.Offord, DR, Boyle, MH, Fleming, JE, Blum, H, Grant, N.Ontatio Child Health Study. Summary of selected results. Can J Psychiatry 1989;34:483–91.
11.Garralda, ME.A selective review of child psychiatric syndromes with a somatic presentation. Br J Psychiatry 2018/01/02. 1992;161(6):759–73.
12.Ramsawh, HJ, Chavira, DA, Kanegaye, JT, Ancoli-Israel, S, Madati, PJ, Stein, MB.Screening for adolescent anxiety disorders in a pediatric emergency department. Pediatr Emerg Care 2012;28(10):1041–7.
13.Alsma, J, Wouw, JV, Jellema, K, et al. Medically unexplained physical symptoms in patients visiting the emergency department: an international multicentre retrospective study. Eur J Emerg Med 2019;26(4):249–54.
14.Cozzi, G, Minute, M, Skabar, A, et al. Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain. Acta Paediatr Int J Paediatr 2017;106(4):586–93.
15.Stephenson, DT, Price, JR.Medically unexplained physical symptoms in emergency medicine. Emerg Med J 2006 Aug;23(8):595600.
16.Zijlema, WL, Stolk, RP, Löwe, B, Rief, W, White, PD, Rosmalen, JGM.How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires. J Psychosom Res 2013;74:459–68.
17.The American Academy of Child and Adolescent Psychiatry. Physical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders. 2017 [cited October 6, 2019]. Available at: (accessed December 7, 2019).
18.Newlove, T, Stanford, E, Chapman, A, Dhariwal, A. Pediatric Somatization: Professional Handbook [Internet]. Vancouver, BC; 2016. Available at: (accessed December 7, 2019).
19.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, Barta, DC, Steiner, J.Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27(3):305–8.
20.Statistics Canada. Census Profile, 2016 Census. Available at: Updated on : June 18, 2019 (accessed December 11, 2019).
21.McFadden, D.Conditional logit analysis of qualitative choice behavior. In: Frontiers in Econometrics (ed. Zarembka, P). New York: Academic Press; 1973:105–42.
22.Johnston, R, Jones, K, Manley, D.Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour. Qual Quant 2018;52(4):1957–76.
23.Santillanes, G, Lam, CN, Axeen, S, Menchine, MD.45 trends in emergency department mental health visits from 2009–2015. Ann Emerg Med 2018;72(4):S21.
24.Hatcher, S, Arroll, B.Assessment and management of medically unexplained symptoms. BMJ 2008;336(7653):1124–8.
25.Murray, AM, Toussaint, A, Althaus, A, Löwe, B.The challenge of diagnosing non-specific, functional, and somatoform disorders: a systematic review of barriers to diagnosis in primary care. J Psychosom Res 2016;80:110.
26.Stone, L.Making sense of medically unexplained symptoms in general practice: a grounded theory study. Ment Health Fam Med 2013;10(2):101–11.
27.Croicu, C, Chwastiak, L, Katon, W.Approach to the patient with multiple somatic symptoms. Med Clin North Am 2014;98(5):1079–95.
28.Malas, N, Ortiz-Aguayo, R, Giles, L, Ibeziako, P.Pediatric somatic symptom disorders. Curr Psychiatry Rep 2017;19(2):11.
29.Dimsdale, JE, Creed, F, Escobar, J, et al. Somatic symptom disorder: an important change in DSM. J Psychosom Res 2013;75(3):223–8.
30.Ibeziako, P, Brahmbhatt, K, Chapman, A, et al. Developing a clinical pathway for somatic symptom and related disorders in pediatric hospital settings. Hosp Pediatr 2019;9(3):147–55.
31.Gill, C, Arnold, B, Nugent, S, et al. Reliability of HEARTSMAP as a tool for evaluating psychosocial assessment documentation practices in emergency departments for pediatric mental health complaints. Acad Emerg Med 2018;25(12):1375–84.


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Pediatric somatization in the emergency department: assessing missed opportunities for early management

  • Punit Virk (a1) (a2), Dzung X. Vo (a2) (a3), Jacob Ellis (a4) and Quynh Doan (a1) (a2) (a5)


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