How Were Functional Somatic Symptoms in Children Influenced by the COVID-19 Pandemic? A Retrospective Study of Children Admitted to a Tertiary Pediatric Emergency Hospital in Bucharest, Romania

Background: Functional somatic symptoms (FSSs) represent a significant clinical challenge in pediatric populations, with prevalence estimates ranging from 10 to 30%. The COVID-19 pandemic introduced unprecedented psychosocial stressors that may have influenced the presentation and precipitating factors of these conditions. This article aimed to characterize the clinical presentations, precipitating factors, and temporal patterns of functional somatic disorders in children admitted to a tertiary pediatric hospital in Bucharest, Romania, across pre-pandemic (2017–2019), pandemic (2020–2022), and post-pandemic (2023–2025) periods. Methods: This retrospective study included 1043 patients aged 3–17 years admitted with somatic symptoms without identifiable organic pathology. Data were extracted using ICD-10 diagnostic codes and confirmed through individual chart review. Variables analyzed included demographics, symptoms, precipitating factors, symptom duration, and family psychiatric history. Results: Female patients predominated (67.0%), with a median age of 14 years. Cardiovascular symptoms were most frequent (43.9%), followed by neurological (30.4%), digestive (19.0%), and respiratory (6.3%) manifestations. Family-related factors (38.6%) and school-related stress (32.7%) were the primary precipitating factors. Significant pandemic-related differences emerged: medical-related precipitating factors increased during the pandemic (18.5% vs. 10.7% pre-pandemic, p < 0.001), respiratory symptoms were more frequent (9.8% vs. 5.9% pre-pandemic), and symptom duration before admission was significantly longer (median 1 vs. 1 pre-pandemic and 0 months post-pandemic; p < 0.001). Conclusions: The COVID-19 pandemic substantially influenced pediatric somatic presentations, with increased health anxiety, respiratory symptoms, and delayed healthcare-seeking behavior. Post-pandemic patterns suggest the persistent influence of traditional stressors alongside pandemic-related effects.