Kids Love Dr. Barton

Our Doctor Says Our Kid Is Faking It!

by Dr. Douglas Barton, M.D., Pediatrician 12/07/2009

Usually, when I hear these words, it is with a sense of indignation that a doctor would accuse a child of faking symptoms. Usually, the child has a confusing set of symptoms that the parents are very frustrated about and don’t have answers to…and the last thing they want to hear is that their child’s symptoms are all in his or her head.

The truth of the matter usually is far more complex. Most parents are very familiar with the stomach ache every night before bedtime or every morning before school (except, of course, on weekends when the stomach ache magically disappears and the children are up a half hour earlier than normal watching TV). But, even though the parents are pretty sure they know “what’s really going on,” sometimes these children even make it into the doctor’s office because the pain seems so “real,” that parents start to wonder if it is.

What most parents do not know is that the pain IS real! For most of these children, they are having what are called psychosomatic symptoms. These symptoms can be anything from stomach aches to muscle aches to headaches to weakness. The common thread in all these symptoms is that there is no way to reliably measure how real they are, so many of us get very frustrated when we hear about the same symptom over and over and wonder if the child is crying “wolf.”

Psychosomatic symptoms are very real to the children (or, in many cases, adults). They do actually feel the complained-about pain or weakness. The problem is that these pains have no medical basis. That is, no test can reveal the source of the pain. The pain is a construction of the brain in response to some trigger. The brain truly does perceive the symptom, even though there is no medical reason for the symptom to be there. Therefore, while the child is having that muscle ache, stomach ache or weakness, for that child, at that time, the symptom is very real.

Triggers for these kinds of pain are very complex, incompletely understood and vary quite a bit from patient to patient. For most patients, the primary trigger is some kind of stress. “My kids don’t have stress!” you might say. But you must remember that stress for children is very different from stress for adults. The straight-A student at school who seems well adjusted may feel compelled to get straight A’s, and stay up late worrying about getting a B. Parents having frequent disagreements at home can cause stress. Being part of an excelling sports team, while very rewarding, can be very stressful. Often it takes several sessions with a counselor to break down what exactly is triggering the patient’s symptoms.

So the next time your doctor says it’s all in your child’s head, listen carefully to what comes next. Ask questions.  Make sure he or she has thought through the possibility that it is not psychosomatic. If the reasoning seems sound, then realize that your child’s symptoms, while very real to them, really may be all in their head. And then you can take steps to try to get to the root of the problem…and the pain.

Dr. Douglas Barton is a pediatrician with SSM Medical Group in Warrenton and Lake Saint Louis.




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