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Pediatric psychosomatic medicine is the term used to describe the subspecialty of child and adolescent psychiatry that is dedicated to providing mental health services to youngsters with physical illness. Lipowski (1967) defined the specialty as including those diagnostic, therapeutic, teaching, and research activities provided by psychiatrists in the nonpsychiatric part of the general hospital. Herzog and Stein (2001) outlined the goals of a pediatric consultation-liaison psychiatry service as follows: 1) to facilitate the early recognition and treatment of psychiatric disorders in physically ill children and adolescents; 2) to help differentiate psychological illnesses presenting with physical symptoms; 3) to help avoid unnecessary diagnostic tests and procedures; 4) to support pediatric patients and their families in coping with their disease and its treatment; and 5) to assist the medical team in understanding the reactions and behaviors of physically ill children, adolescents, and their families.

Patients seen in this subspecialty commonly fit into one of three categories: 1) patients with comor-bid psychiatric and physical illnesses that complicate each other's management, 2) patients with so-matoform and functional disorders, or 3) patients with psychiatric symptoms that are a direct conse quence of a primary physical illness or its treatment. The term coincidental comorbidity may be used to describe patients with unrelated psychiatric and physical illnesses, whereas causal comorbidity refers to instances in which the psychiatric disorder is a direct result of physical illness or has a significant impact on the course or severity of the illness. Causal co-morbidity also captures psychological symptoms that develop as a direct result of the stress of the illness or its treatment (Shaw and DeMaso 2006).

This chapter provides a brief historical overview of the field of pediatric psychosomatic medicine and the development of the specialty within the United States. This section is followed by a description of how services are organized based on a small number of national surveys, including data on issues related to funding and reimbursement. The chapter concludes with a section describing the psychosomatic services from an international perspective.

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