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Patterns and seasonality in pediatric referrals for functional somatic symptoms
  1. Pepijn den Braber1,
  2. Joris van Driel1,
  3. Dorien Broekhuijsen1,
  4. Bert Wienen2,
  5. Jolita Bekhof1
  1. 1 Pediatrics, Isala Hospital, Zwolle, The Netherlands
  2. 2 Windesheim University of Applied Sciences, Zwolle, The Netherlands
  1. Correspondence to Dr Jolita Bekhof, Pediatrics, Isala Hospital, Zwolle, Overijssel, Netherlands; j.bekhof{at}


Functional somatic symptoms (FSS), or medically unexplained physical symptoms, are common in children and it has been suggested that the incidence is increasing. To determine the incidence and pattern of referrals for FSS to pediatricians, we performed a retrospective analysis including newly referred pediatric patients to our secondary pediatric practice in Zwolle, The Netherlands, ultimately diagnosed with FSS between 2013 and 2018. FSS was defined as functional abdominal pain, chronic fatigue, chronic musculoskeletal pain and chronic headache without an underlying medical diagnosis. In the 6-year period, 10.4% of elective referrals were related to FSS without a significant upward trend. We found clear seasonal variation with peaks in incidences in March (+31%) and November (+21%) and a nadir around August (−48%). In conclusion, FSS account for 1 in 10 non-acute pediatric referrals, without an increase in incidence in the past 6 years. The seasonal pattern is remarkable and warrants further analysis.

  • abdominal pain
  • pain
  • stress, psychological

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors The manuscript has been read and approved by all authors, and all authors have contributed to preparing the manuscript. PdB performed data analysis, interpreted data and wrote the initial version of the report. JB supervised data analysis and edited the report. PdB and JB designed the study and had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. DB, JvD and BW contributed to the study design and reviewed the report. JB is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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