Child psychosomatic medicine, based on the strong relation between body and mind, plays an important role in promoting the child's physical and mental health. This medical category should include broad fields influencing the child's mental development such as family, school, community environment and socio-cultural backgrounds in addition to regular medical research and practice. Here are also included enlightenment to the world as to what true mental development should be for children. The Society of Psychosomatic Pediatrics has started several projects including release of clinical guidelines, training of primary-care doctors and medical students, a qualification examination, and archived desirable successful results in contributing the progress of child psychosomatic medicine.

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Today, it is not rare to see anorexia nervosa even in pediatric clinics. Study on the clinical conditions of anorexia nervosa in Japan showed that al least 1,000 patients visited pediatric clinics per 1 year. Topics of anorexia nervosa in childhood are, (1) increase of pre-adolescent patients (the patients develop their disorder before menarche), (2) increase of patients who easily develop bulimia nervosa, (3) comorbidity of pervasive developmental disorders, and (4) child abuse as one of the most important background factors. The new diagnostic criteria (Great Ormond Street Criteria, GOSC) specific to eating disorders of children is proposed because children with these disorders develop many atypical clinical features.

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School non-attendance is often caused by a combination of several factors. In most cases, regardless of its underlying cause, school non-attendance is preceded by frequent, unidentified complaints. Physical symptoms identified in absentees include hyperactivity, chronic headache, and irritable bowel syndrome-symptoms similar to those of psychosomatic disorders (PSD), which indicate a close association between PSD and school non-attendance. If we properly address students at an early stage of absenteeism, carefully paying attention to their unidentified complaints, this may help prevent long-term school non-attendance. We should be careful not to confuse school non-attendance with truancy, or overlook physical symptoms in students.

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The current status and treatment of childhood psychosomatic disorders were reported by a practicing physician examining 558 children aged 15 or younger who had visited our clinic as psychosomatic outpatients during the decade from November 1998 (310 boys and 248 girls, with a mean age of 8.9±3.7 at the first visit). The reasons for their visits were classified into four groups: psychosomatic disorders (60.2%), behavioral problems (17.0%), developmental problems (14.0%), and nonattendance at school (8.8%). Overall, 25.6% had developmental disorders. While treatment was completed within 1 year in about 60% of children with psychosomatic disorders, it was suspended in about 30% of those with behavioral/developmental problems or not attending school. Treatment for these children was more effective when psychological care was concurrently given to their families and a network with other counseling centers in the community is formed to provide comprehensive support.

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The practice to establish a collaboration system in the field of childhood psychosomatic medical care is discussed. The significance and problems of the collaboration system were described through an experience of making collaboration systems in our hospital, with other clinics and hospitals and with the educational, administrative and welfare organizations. The face to face human relations are the basis to establish the collaboration system.

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The growth and development of the child is characterized by the process of becoming independent as a social member on the biological base while receiving enivironmental stimulus including human relations. A viewpoint of growth and development is demanded in medical examination and treatment for the child who is going ahead at his best under stress imposed upon him. Therefore author presented an outline of the following growth development theories of the child by contrasting them with one another: the separation-individuation process (Mahler), the attachment and loss theory (Bowlby), the self development thepry (Erikson), the psychoanalytical development theory (Freud) and the cognitive development theory (Piaget).

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Objective: The purpose of this study was to develop and validate Japanese version of the Short Health Anxiety Inventory (SHAI), which assesses hypochondriacal tendency (i.e., health anxiety). Method: At first, four hundred and sixty undergraduate students completed the SHAI and questions about medical utilization, and these data were used to examine factor structure, internal consistency, and concurrent validity of SHAI. Secondly, two hundred and three undergraduate students completed SHAI, Japanese versions of the Anxiety Sensitivity Index (ASI), the Penn State Worry Questionnaire (PSWQ), and the Social Interaction Anxiety Scale (SIAS). These data was used to examine convergent and discriminant validity of SHAI. Results: Exploratory factor analysis indicated that SHAI has two-factor structure which corresponded to the original version. Validity of this factor structure was supported by confirmatory factor analysis. Internal consistency of SHAI total and subscales were sufficiently high. High SHAI group (those who scored more than the mean score plus 1 standard deviation) reported significantly more medical utilization than low SHAI group (those who scored less than the mean score minus 1 standard deviation). Therefore, concurrent validity of SHAI was supported. In addition, results of correlation analysis between SHAI and other measures supported convergent and discriminant validity of SHAI. Conclusion: It is showed that SHAI has sufficiently high reliability and validity. This brief measurement seems to be useful for both clinical and research settings. Limitations of the present study and future issues were discussed.

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