The Pediatrician frequently encounters children who complain of recurrent pain such as abdominal colic ,headache , ear , or limb pain, conditions very common in childhood.
The child who always complains and cries very often does not fall into a category that can be attributed to a specific etiology but rather falls into a number of different causes that need to be identified.
When faced with a child with recurrent pain, the pediatrician should follow up with a complete history and physical examination to assess the possibility of an organic reason.
An accurate medical history can allow identification of signs of possible psychogenic factors and prevent the performance of diagnostic procedures not necessary for the diagnosis in question.
What is the child’s personality type?
Recurrent pain may occur in anxious or depressed children.
Is the child often tense, nervous, overly dramatic, or a perfectionist?
Is the child introverted, has sleep or appetite disturbances consistent with a depressive state?
It might be useful to conduct part of the interview with the child alone, to try to understand what the family climate is and whether there are any stressors.
When does the pain occur, if in the morning before school it may be psychogenic in origin does the pain occur over the weekend or during pleasurable activities?
Are there particularly stressful factors that trigger pain? Does the pain begin after disagreements with family members or peers?
Does the pain occur before anxiety-provoking events such as a school exam or sports competition?
Is the child frequently absent from school?
School absenteeism is frequently an indication of the presence of an underlying psychosocial problem the child’s teachers can provide considerable help
This type of approach also conveys to the child’s family the idea that their concerns are taken seriously thus setting the stage for potential psychosocial intervention, which is often more acceptable to the family if the message is conveyed that the child’s symptoms may be stress-related rather than consequent to an emotional problem.
Pain of an organic nature, on the other hand, usually presents as constant and well localized and may wake the child from sleep, as in the case of abdominal pain from painful colic, or pain that may occur immediately after meals, mouth pain from stomatosis or tooth distress, or resulting from skin eruptions, or coming from the ear as in the case of Parotitis.
