• Young people need support during their growing years to help them develop emotional resilience, navigate challenges and thrive in life.

• Recognising psychosomatic symptoms early is key to timely intervention. With family support, this can prevent unnecessary medical procedures, and the worsening of symptoms, which can negatively affect their long-term well-being.

• Frontline physicians play a significant role in identifying symptoms in children early, educating caregivers and advocating on the child’s behalf, and providing timely referrals for appropriate interventions.

The early years of life form the foundation stone of a person’s attachment style, social relationships, learning and overall emotional resilience.

Navigating this growing period with support and learning from difficulties, including failures, helps young people to grow up into resilient adults. This enables them to go on to form meaningful lasting relationships, bounce back from challenges and process emotional turmoil in a way that promotes growth. These key early fundamental experiences are essential in helping a person thrive in life.

Recognising psychosomatic symptoms as a cry for help

Due to their tender age and still developing bodies, young people can struggle with articulating their worries. However, physical symptoms stemming from emotional distress, known as psychosomatic symptoms, can be a tell-tale sign that a child is experiencing stress, and can be an indicator of poor mental health. In these cases, the child’s body “speaks” for the mind to express what the young person may not know how to talk about.

Commonly presenting as pain in the head, abdomen and chest, psychosomatic symptoms are on the rise amongst young people locally. Preliminary surveys found that one in eight (12.5%) of the total attendances at the Children’s Emergency in KK Women’s and Children’s Hospital (KKH) constituted children and adolescents with possible somatic symptoms.

Poor recognition of psychosomatic symptoms may result in unnecessary, repeated medical visits and investigations, which can lead to increased stress to the child and their caregivers1. Delay in timely diagnosis and treatment can result in worsening symptoms or lead to other comorbid mental health disorders such as depression and anxiety^1,2.

These can cause the young person to experience negative impacts such as poor school attendance, falling behind in studies, and disruption to their social and family relationships, confidence and self-esteem.

Community healthcare provider and family support – A crucial partnership for change

Parents are not always the first to be aware of a young person’s stressors. In some cases, a psychosocial screening may be the first touchpoint to reveal these issues. Hence, there is an impetus to extend screening efforts and interventions upstream, and facilitate service integration across care settings, for early and effective identification and management of psychosomatic symptoms.

Frontline physicians play a significant role in the early identification of symptoms in children; educating caregivers and advocating on the child’s behalf and providing referrals for appropriate interventions.

With new awareness and subsequent open discussions to support and find solutions, both the young person and caregivers can learn healthy ways to tackle difficult stressors and accompanying emotions, and respond and cope individually and as a family.

Four ways for community healthcare providers to support child mental health:

1. Promote mental well-being by educating families on healthy coping strategies

If a young person proactively shares about challenges that they face in their daily life, validate their experience and acknowledge that the symptoms that they face are real. Avoid saying that it is “all in the mind” or that the symptoms are “not real” or that “nothing is wrong”. Build a blame-free narrative and help both the child and caregiver develop a good understanding of the mind-body connection by sharing this KKH-developed video with them: https://youtu.be/-yZVqRBnJcI

2. Identify symptoms early

Recognise and address underlying physical symptoms and medically investigate as needed. The HEADSS (Home, Education, Activities, Drugs, tobacco, and alcohol, Sexuality and relationships, and Suicide and Depression) Assessment Tool is a useful instrument to explore areas of difficulties in the child’s family, interpersonal relationships, learning, mental health and at-risk behaviours. It is equally important to explore psychosocial stressors when there is a suspicion of an underlying psychosomatic process.

3. Refer for appropriate psychological intervention

Psychological interventions should be provided at the earliest opportunity as young people often worry about and struggle to cope with the symptoms, and experience added distress as their studies and relationships are increasingly impacted.

Children with milder psychosomatic presentations can be referred to other trained professionals, including school and community-based counsellors. Those with more severe presentations will need to be right sited for an appointment with a psychologist.

At KKH, children and adolescents may also be enrolled in the Resilience in Children and Adolescents with Psychosomatic symptoms Programme (RECAP), to enable them to receive the appropriate help they need to thrive at home, school and in their communities. Learn more about the programme here.

4. “Gatekeep” to avoid unnecessary medical investigations and treatments

Parents and caregivers may be anxious and worried about the young person’s symptoms and “doctor shop” or request for additional medical investigations or hospital admission. They may also encourage the young person to avoid certain activities out of fear of “triggering” the symptoms, which can perpetuate and deepen the underlying anxiety.

Encourage caregivers to have a trusted doctor as a “gatekeeper” for ongoing monitoring and education, and advocate for them to engage in appropriate responses and behaviours, such as being sensitive to a child’s needs, setting realistic goals, to help the child gradually return to their daily function.

Meeting the child’s needs as a community

Sustaining mental well-being of our young people requires a community focus on proactively meeting their needs, building their strengths and a biopsychosocial approach towards managing the challenges they face.

Collaboration across healthcare, community care and education is crucial in enabling integrated care for a young person’s physical and mental health, and supporting the needs of their life stage of emerging adulthood – navigating family relationships, and the pursuit of education and vocation.

Dr Vicknesan Marimuttu, Head and Senior Consultant, Department of Psychological Medicine, KKH Dr Vicknesan Marimuttu has a broad range of experience in treating children and adolescents with mental health disorders. His areas of clinical and research interest include mood disorders, self-harm, suicidality, somatoform disorders and brief psychotherapeutic interventions. Dr Vicknesan is also Clinical Assistant Professor, Duke-NUS Graduate Medical School.