Identifying somatic and social concerns that may suggest an underlying mental health condition in pediatric primary care

Most adult mental health conditions begin in early childhood and adolescence, the most common being anxiety and behavioral disorders. Early intervention can improve outcomes and may reduce the risk of developing a clinical disorder in the future. However, children may not have the communication or understanding to share their symptoms with those around them, leaving pediatric primary care providers responsible for identifying concerning signs. This paper reviews both general symptoms that suggest possible mental health conditions as well as specific correlations between symptoms and psychiatric diagnoses. A literature search utilizing PubMed identified nine relevant articles that were supplemented with additional sources. The findings found that impaired coordination or balance, weakness, paralysis or loss of sensation, seizure-like activity, blindness, double vision, deafness, or one severe symptom, typically pain, were general signs that may indicate a psychiatric illness. More specific associations were also identified. For instance, children who report somatic complaints and school refusal have been linked to anxiety; in addition, reported stress, anger, and worries about family alcohol and drug use have been linked to depression, among many others. Awareness of the somatic and social concerns presented by children to primary care can reduce the delay from the onset of symptoms to diagnosis, leading to earlier identification, treatment, and improved outcomes. Early intervention may delay or prevent symptoms from developing into a diagnosable psychiatric disorder and/or may reduce the severity of symptoms in a child who already has a psychiatric condition.