Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.
Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.
Objective Psychiatric boarding occurs when patients remain in emergency departments (ED) or are admitted to inpatient medical/surgical units to await placement at psychiatric treatment programs. Boarding was already increasing in the United States (US) over the past decade, and the COVID-19 pandemic has only further profoundly affected the mental health of youth. The current study aims to describe psychiatric diagnoses and boarding among pediatric patients presenting to the hospital after the pandemic onset. Methods We performed a retrospective chart review from March 2019 to February 2021 of all youth ≤ 18 years with ED or inpatient medical/surgical admissions related to mental health complaints at a large US Northeast pediatric hospital and compared psychiatric diagnoses and boarding during the 12-months before and after the pandemic onset. Inferential statistics included chi-square and t-tests. Interrupted time series analyses evaluated trends during the study period. Results Proportion of hospital presentations of pediatric patients with suicidal ideation/suicide attempts (p<0.001), depression (p<0.001), anxiety (p=0.006), eating disorders (p<0.001), substance use disorders (p=0.006), and obsessive compulsive and related disorders (p<0.001), all increased during the first pandemic year, compared with the prior year. Average length of psychiatric boarding more than doubled [2.1 vs 4.6 days, p<0.001] and 50.4% of patients experienced extended boarding periods ≥ 2 days during the first pandemic year. Conclusions This study highlights the vulnerability of a US healthcare system that has been chronically inadequate at meeting the mental health needs of children and adolescents and raises an urgent call to reform pediatric mental health care.
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