A 6 year-old girl is brought to the emergency room by her mother for evaluation of abdominal pain. For the last three days, the child has been reporting severe abdominal pain. No fever, no constipation, no nausea, no vomiting – just abdominal pain. She describes different hospitalizations and different invasive tests in a detached, unperturbed tone. Dr.Johnson at Mount Sinai Hospital recommended citalopram, Dr.Giriraj at Lakeview Hospital and Dr.Ahmed at Little Angels Hospital recommended surgery and Dr.Ambrose at Bluesky Hospital recommended CT guided biopsy. As you go over the medical records of the child, you notice that the child had multiple admissions for severe abdominal pain over the last two years with no identifiable diagnosis during any hospitalization, despite going through lots of blood, urine and imaging investigations. She becomes tearful as she recounts experiences of abuse when she was a child. In her childhood, she had similar problems like her daughter but eventually she grew out of them. She reports that her husband rarely spends time with her except for things related to her daughter, and if ‘he pays little more concern for her and her daughter, things like this would not happen’. As you proceed with the physical examination, the mother sticks to her child and prompts the child with directed questions, ‘Isn’t the belly pain so bad, sweetie?’. The child nods her head in agreement as the mother raises her voice. But when the mother walks away to attend to other things, the child makes a smiley face. You started to wonder what might be the underlying cause of this disorder but eventually realized the condition of the child. What is the next best step in the management of this individual and her child?
