Medically unexplained physical symptoms: information for parents, carers and anyone who works with young people

Medically unexplained physical symptoms (MUPS) are when someone suffers from physical symptoms for which no underlying physical cause can be found.

About one in 10 children and adolescents suffer from this condition. Common symptoms are headaches, stomach aches, joint pains and tiredness. Less commonly, young people can have significant unexplained physical symptoms, including muscle weakness, collapses, ‘fit-like’ episodes, and severe and chronic pain.

For most children and young people, with appropriate reassurance, the symptoms are short-lived. However, for some, everyday life can become very uncomfortable and stressful . Unexplained physical symptoms can also be very worrying for parents.

The symptoms may result in young people:

• missing a lot of school; they may not achieve what they should socially and academically;
• seeing less of their friends – this means fewer interests, hobbies and fun;
• becoming anxious and depressed;
• being less independent than other young people their age.

Your GP will be able to assess your child and help decide if any specialist investigation or treatment is required. If necessary, they will refer your child to the local paediatrician or child and adolescent mental health service (CAMHS),

Specialists, such as psychiatrists, can help identify the psychological factors that may be contributing to the symptoms, and can also help to distinguish unexplained physical symptoms from other mental health problems, such as depression.

Talking treatments can help you and your child to manage unexplained physical symptoms better. Medication can also play a part, particularly in treating any anxiety and depression that they may also be suffering from.

Everyone needs to work together as a team towards the same goals: you, your child, the paediatrician, psychiatrist, general practitioner and school may all need to get involved.

It can be helpful for everyone involved in helping the child to meet and review their progress from time to time. This allows ideas to be shared about the best ways forward – physical, psychological and educational.

For the most severe unexplained physical symptoms, specialist help through CAMHS can be helpful in developing a planned approach to the problem.

Caring for a young person with unexplained physical symptoms can be very stressful. Family life can become dominated by your child’s difficulties. Parents will need to be caring, but also determined and positive even when things seem bleak and uncertain.

Often parents find it hard to know what to do for the best – when to encourage and when to comfort, when to insist and when to take the pressure off. You may benefit from expert help and advice about this.

Treatment is best done with active participation from the family. It will involve:

• finding ways of paying less attention to the symptoms
• a small, but steady, increase in everyday and social activities
• the young person will be encouraged to do more for themselves and to regain their confidence and independence
• asking teachers to help with looking at ways of overcoming any school or education problems.

Family or individual counselling may be helpful if focused on issues such as how to:

• respond to pain and other symptoms more effectively
• increase levels of physical and social activity
• manage depression, anxiety, lack of confidence and poor motivation
• deal with family relationship difficulties when these become part of the problem.

ChildLine - Provides a free and confidential telephone service for children. Helpline 0800 1111.

Mental Health Foundation - Charity involved in improving the lives of those with mental health problems or learning disabilities.

YoungMinds - Provides information and advice on child mental health issues. Parents’ helpline: 0800 802 5544.

• Garralda, M. E. (1999) Practitioner review: assessment and management of somatisation in childhood and adolescence: a practical perspective. Journal of Child Psychology and Psychiatry, 40, 1159–1167.
• Garralda, M. E. (2000) The links between somatisation in children and adults. in Family Matters: Interfaces Between Child and Adult Mental Health (eds P. Reder, M. McClure & A. Jolley), pp.122–231. London: Routledge.
• Taylor, S. & Garralda, E. (2003) The management of somatoform disorder in childhood. Current Opinion in Psychiatry, 16, 227–231.
• Eminson, M. (2001). Somatising in children and adolescents. 1. Clinical presentations and aetiological factors. Advances in Psychiatric Treatment. 7, 266-27
• Eminson, M (2001) Somatising in children and adolescents. 2. Management and outcomes. Advances in Psychiatric Treatment. 7, 388-398

Series Editor: Dr Vasu Balaguru

With grateful thanks to Dr Warren Levine.

This leaflet reflects the best possible evidence at the time of writing.

© March 2012. Due for review March 2014. Royal College of Psychiatrists.