PMU, Emma Children's Hospital, AMC Amsterdam, tertiary referral centre for children with invalidating functional complaints (at least two present):

1. - impact on their social/family life's

2. - given up their hobbies

3. - school absenteeism

Complaints; long-lasting (> 3 months) and therapy resistant

PMU-approach:

• • integrated approach starting at intake by paediatrician and psychiatrist/psychotherapist; → Explanation; body and mind belong together

• • Validation of complaints by full history and thorough physical examination → Complaints are real, no doubt.

• • Explanation of complaints by models (stress model, brain-gut axis, sensitisation model)

• • Individual treatment (rehabilitation, graded exercise, cognitive behavioural therapy etc.)

:

• • Retrospective observational study (charts) in children with abdominal pain (ap) and headache as primary complaint

• • Measuring persistence of complaints/ invalidation level

• • 66 pt evaluated (42 pt with ap, 24 pt with headache), 43 girls (65.2%) Age at first visit; mean 13.5 yr (range 6-17):

  1. - 34 pt finished treatment

  2. - 19 pt in treatment

  3. - 6 pt one consult planned

  4. - 5 pt no follow-up after intake

  5. - 2 pt no complaints at moment of intake

• • Duration complaints: >2 yrs in 31 pt (47.0%), school absenteeism ≥ 20% in 46 pt (69.7%), 33,3% visited > 5 care providers for complaints.

• • 16 pt (47.1%) treatment < 6 months

• • 25 pt (73,5%) lost/minimized complaints, 22 pt (64.7%) no school absenteeism.

PMU-approach; good results for this serious invalidated patient group with therapy resistant functional complaints. Note; relative small group, not yet long term follow-up.