When a child has distressing and impairing symptoms, they benefit from treatment that integrates support from medical, mental health and rehabilitation professionals. In this way, treatment for somatization is based on a biopsychosocial or holistic approach to understanding a child’s symptoms.
Once your child identifies and agrees upon their goals with you and their health-care team, treatment aims to address those goals to restore your child’s quality of life.
Principles of treatment
The principles of treatment for somatization include:
- Treating any co-occurring medical and mental health conditions, which may involve:
- getting regular follow-up from both medical and mental health providers to monitor symptoms, functioning and progress towards goals
- working with a psychologist or psychiatrist to identify any additional mental health diagnoses that may be appropriate.
- getting regular follow-up from both medical and mental health providers to monitor symptoms, functioning and progress towards goals
- Returning your child to a normal routine, which may involve:
- engaging in physical reconditioning (for example, by doing prescribed exercises)
- a gradual return to school
- encouraging balance and activity pacing
- focusing on your child's functioning, coping and ability
- supporting developmental expectations
- developing a plan to manage somatic symptoms (see below).
- engaging in physical reconditioning (for example, by doing prescribed exercises)
- Promoting awareness of and expressing emotions, which may include:
- better understanding how thoughts, feelings, physical sensations and behaviours may improve or worsen somatic symptoms
- engaging in relaxation techniques (e.g., deep breathing, mindfulness) to help cope with somatic symptoms
- learning how to support your child with somatic symptoms through education and developing effective communication and emotion regulation skills.
- better understanding how thoughts, feelings, physical sensations and behaviours may improve or worsen somatic symptoms
Developing a somatic symptom action plan
Children can work with their health-care team to develop a somatic symptom action plan to help them feel more in control of their symptoms and less distressed, which will help to support them in returning to wellness.
An action plan usually includes a list of:
- typical symptom triggers (such as stressors)
- early warning signs that symptoms are getting worse
- strategies, or techniques, to manage symptoms—for example, deep breathing or places to rest and recover
- supports that are available at school and elsewhere.
It is important to offer your child support to put this plan into action in their everyday life.
Risks of treatment
In biopsychosocial treatments for somatic symptoms, it's important to understand that symptoms may worsen before they improve. As the focus shifts from waiting for symptoms to stop to actively returning to everyday activities, your child will build healthier ways to manage their condition.
Preparing for treatment
Preparing for treatment requires both the caregiver and child to acknowledge that somatization might play a role in their physical symptoms and to remain open to the biopsychosocial approach. If this acceptance is difficult, it's important to discuss these concerns with your child’s health-care team to explore the best path forward.
Medical support
Children should see their primary health-care provider regularly to monitor symptoms, functioning and progress towards goals. New symptoms can arise and require review.
Rehabilitation support
Rehabilitation, including physiotherapy, occupational therapy or speech therapy, can be helpful to establish routine, improve functioning and return to regular activities gradually.
Treatment may include education, goal setting, activity pacing and planning (for example, by allowing for rest breaks) and adjustments to activities as needed (for example, by using assistive devices or other equipment).
Physiotherapy
Physiotherapists can help children improve their ability to walk and reduce the need for aids such as a wheelchair, walker or cane. They can also help children return to sports and increase their level of physical activities. In some cases, physiotherapists can also help prevent muscles from becoming weak or tight if a child has not been physically active for a while.
Physiotherapy is recommended early on, as children can improve their physical abilities even when they have distressing symptoms.
Occupational therapy
Occupational therapists work with children and families to identify and help children take part in meaningful activities in the areas of self-care (such as feeding or sleep), productivity (such as school) and leisure (such as drawing or reading).
Speech therapy
Speech-language pathologists (SLPs) assess, treat and prevent speech and language difficulties to develop, maintain or increase communicative functions. You can access SLP services in the community or through your local children’s treatment network.
Psychotherapy (talk therapy)
Talk therapy is an effective form of treatment for somatization and can benefit both the child and the family as a whole. There are a number of options for individual and family therapy, and your child’s mental health provider will recommend the approach that is proven to work best for the specific challenges your child is facing.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) involves better understanding the connections among thoughts, feelings, physical sensations and actions. CBT involves:
- learning about the mind and body connection: noticing when the body feels uncomfortable or different, and connecting physical symptoms with emotions
- understanding triggers: noticing the situation that gives rise to the physical symptoms
- exploring thoughts: identifying the underlying thoughts before, during and after the physical symptoms
- noticing behaviours: identifying the actions and behaviours before, during and after the physical symptoms
- building coping skills: finding new ways to handle uncomfortable feelings, calm the body, and shift away from unhelpful thoughts and beliefs.
Narrative therapy
Narrative therapy involves working with the child and family to create narratives, or stories, about themselves that are helpful to them by:
- collaborating with the child and family to identify areas of strength and times when physical symptoms are not present or are less impairing
- focusing on the child’s values, skills and abilities
- separating the problems and symptoms from the child (for example, by asking questions like “If the symptom were sitting beside you, what would it look like and how much space would it take up?”)
- reflecting on what life was like before the symptoms, how life has changed as a result and what the future may hold.
Supportive-expressive therapy
Supportive-expressive therapy involves creating an environment that supports the child or family and their goals and using different techniques to help the child or family express themselves. Techniques include:
- reviewing various stressors for a child
- reflecting the feelings and issues that may be contributing to physical symptoms
- helping the child talk about their feelings and thoughts
- connecting thoughts and feelings with physical symptoms
- developing coping strategies.
Mindfulness and acceptance-based therapies
These therapies involve helping your child pay attention to the present moment and accept their thoughts, feelings and physical experiences without judging them.
Mindfulness techniques teach people how to respond calmly to difficult experiences or physical sensations, rather than reacting automatically. These techniques can help people make choices that move them toward their goals and what is important to them instead of being controlled by physical symptoms. Mindfulness and acceptance techniques can involve both formal meditation and informal exercises that help your child become more aware and present during everyday activities such as eating and walking.
Group therapy
Education in a group setting allows children and caregivers to learn how physical symptoms can develop after a physical injury or illness or because of stressors. Hearing from other children about similar experiences provides support and education in a meaningful way.
Therapeutic groups allow children and caregivers to express their emotions, connect with one another and gain support through sharing. Experiences of somatization can be very isolating, so it is important and beneficial for children and caregivers to know that this is a common experience, there is support, they are not alone and there is hope for returning to wellness.
Behavioural approaches to treat somatization
A behavioural approach can help teach skills and provide resources for structure in your child's home and school environment. Behaviour therapy plans usually involve small systematic steps towards a successful end goal, especially if your child's behaviour has regressed (returned to a former or less mature state).
A behavioural analyst can conduct a functional behaviour assessment to guide behaviour therapy plans. A functional behaviour assessment involves:
- exploring how the intensity, duration, and frequency of your child’s symptoms change over time
- identifying factors that may trigger, worsen, or alleviate symptoms
- examining potential early warning signs of more distressing symptoms.
Parent coaching
Parent coaching can provide caregivers with strategies on how to respond to their child and how to make practical and long-lasting changes in the home, community and school.
Resources
The Kelty Mental Health Pediatric Somatization Family Handbook was designed to help you review treatment options for somatization: https://keltymentalhealth.ca/r/pediatric-somatization-family-handbook.
FND Hope provides supports for young people with functional neurological symptom disorder https://fndhope.org/living-fnd/youth-young-adult/.
Being with all of your experiences is a video that can be used to help manage unwanted thoughts, feelings and sensations: https://youtu.be/jaNAwy3XsfI.
