This chapter summarizes current understanding and practice, emphasising particularly the role of the family and of the paediatric and child and adolescent mental health service multidisciplinary teams. As with all disorders of childhood, psychiatric or otherwise, developmental considerations are absolutely central, and all symptoms must be assessed in the developmental context of the child, with a sound understanding of normal developmental stages. Medically unexplained symptoms in children can be seen to occur as a result of multiple factors, biological, familial and historical. In many children who present with medically unexplained symptoms there are familial factors contributing to the development or maintenance of symptoms in either well-organized or disorganized families. As there are an increasing number of randomized controlled trials attesting to the efficacy of psychological therapies, medically unexplained symptoms in children need to be identified, assessed and managed appropriately to improve both short- and long-term outcomes.