My doctor thinks some of my child’s problems are psychological – what the ****** do they know?
You know how it is – you’re getting pretty frustrated now.
Your child is suffering (it seems like all the time) from headaches, funny pains with no obvious cause or solution,stomach aches, diarrhoea – or any of a number of other similar symptoms. You’ve been to see your own GP several times and they’ve been very sympathetic and suggested some initial treatments but they never really helped. Eventually you pushed to get a Paediatric referral and went to the General clinic.
The Paediatrician (like your GP) was lovely and did some investigations (including the bloods which you might have pushed a little bit to get done). They suggested some more treatments like those your GP already tried, and while you had great hopes for each, they seemed to help a bit, but not fully and often not for long.
Just to add insult to injury they seem not to have anything else to offer and now they’re saying it’s all in your child’s head! You are getting towards your wits end and are ready to demand a second opinion (or accept granny’s offer to ‘go private’).
I HEAR YOU.
NO I MEAN IT – I REALLY HEAR YOU
Please don’t take this the wrong way, but let’s look at it the other way around. If I were to suggest that a child has psychological elements to their symptoms, what does that really mean? Well, usually with any of these sorts of symptoms, I could introduce this as an element even if not the major factor in causing it. And if I were to suggest it up front, right at the start as something it could be treated just like constipation or stomach acid for example.
What I mean is that if you have (for example) diarrhoea relating in any way to stress, it must be stressful to think this might happen unpredictably on any given day at any particular time – worse than that – it always seems to happen when you’re already stressed about something else or at a time when you’re just too busy to figure out why it might be happening. That doesn’t mean it’s ‘just in their head’ but that having symptoms like these (particularly unpredictable ones) is enough to cause most of us stress.
does it start with anxiety?
What about those that I think might have started with stress and anxiety – why do they get these symptoms? Being a young person has changed quite a lot recently – the huge benefits from social media for example also have some downsides. While most responsible adults (i.e., us) use these sites for fun and generally positively, children seem to almost routinely use them in much more malevolent way. Not all children of course, but the ‘good’ children can’t win. If they avoid or ignore it they get teased, and if they join in they get teased. It’s texting as well as Facebook and other more ‘in’ social media sites. The changes include the 24hr barrage of this (there’s no escape) and the permanency of it – you can never erase these hurtful comments). We also forget that often texts or tweets or Facebook updates can be misinterpreted (partly due to their brevity and abrupt nature) – adults are often much more mature in accepting this.
2 different groups
There seem to be two groups who experience physical symptoms from this sort of stress. The first is the highly strung children who just look very anxious or edgy (and they’re usually pretty easy to spot). The second group are almost the opposite – they are so laid back as to be horizontal! Except that underneath it all, they often have a simmering level of anxiety. One clue is that they usually have high heart rates when they’re examined especially when they have the symptoms. The group in the middle just never seem to be quite so affected.
how does this lead to symptoms?
So how does this translate into symptoms? In the same way that adults get tension headaches or irritable bowel, children can’t or find it difficult to rationalise or express psychological distress – particularly if it is constant but at a low level. One way of doing this is by experiencing it as medical symptoms. Their symptoms are 100% genuine – they have a sore head or stomach or whatever. It’s the cause that seems not to fit. Medicines may help a bit (one example is in children with stress who get stomach acid – medicines help most and cure about 50%, and the other 50% seem to gain extra benefit from psychological approaches). It’s not ‘in their head’, it just needs a different approach to treatment.
Not all children who have a large psychological component even need psychological support. I would think around half once it’s explained why they feel the way they do and why it’s happening (and that they’re not nuts!) get better all on their own. By introducing the idea early, and most importantly offering solutions, it’s not a cop-out diagnosis, it’s just part of the spectrum of disease. Just like stomach pains can be caused by constipation or stomach acid, or any combination of the two, so can any ‘real’ medical cause overlap to a greater or lesser extent with psychological distress or stress.
In my next post, I’ll explore a bit around the treatment approaches to these symptoms.