Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1496-1500 (doi:10.1542/peds.2004-1721T)
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Hepatitis C

SUPPLEMENT ARTICLE

Organic or Psychosomatic? Facilitating Inquiry With Children and Parents*

Abbreviations: recurrent abdominal pain • school refusal • communication skills • family pediatrics

The first 300 words of the full text of this article appear below.


   CASE
 
Eric (12 years old, 6th grade) saw a new pediatrician with concern about fatigue and intermittent abdominal pain for the past 2 to 3 months. His mother observed that he appeared more tired and that the "whites of his eyes are more cloudy" than usual. He continued to be active, however, and reported that he played basketball and football without any problems. He slept 8 hours each night without a problem either initiating or maintaining sleep. When asked about the abdominal pain, Eric reported that it was usually in the left upper quadrant, more noticeable after running, and subsided after 1 to 2 minutes of rest. He denied any physical trauma, constipation, hematochezia, joint symptoms, fever, night sweats, or weight loss. His mother inquired about whether he could have hepatitis because a family friend, who was at their home cleaning the garage, had been diagnosed with hepatitis. However, she stated that neither she nor her son had any casual or intimate contact with this person and that he was in the garage for only a few hours.

Eric and his mother lived alone. For several years, he saw his father only occasionally. Eric was struggling academically in school this year; his grades changed from A's and B's down to C's and D's. He had not changed schools and denied any problems getting along with either peers or teachers. When the pediatrician asked why Eric's grades changed, his mother reported that she thinks it is because he is missing a lot of school and not keeping up with his homework. She reported that recently he missed 1 to 2 days weekly because "he is too tired" in the morning.

Intrigued by the constellation of symptoms and concerns, the pediatrician asked Eric's mother to wait in her office while she examined the . . . [Full Text of this Article]

Martin T. Stein, MD

Professor of Pediatrics
University of California
San Diego, California

Janet Crow, MD

University of California
San Diego, California

Myles Abbott, MD

University of California
East Bay Pediatrics
Berkeley, California

J. Lane Tanner, MD

University of California
Associate Director
Division of Developmental and Behavioral Pediatrics
Children's Hospital Oakland