Functional somatic symptoms (FSS), defined as physical symptoms that cannot be fully explained by organic pathology, are prevalent in youngsters worldwide. When severe, they can pose a major burden on the affected individual as well as on society. FSS seem to aggregate in families, and family variables may play a key role in symptom development and perpetuation. It may, therefore, be important to work with the family when managing FSS. The aim of this systematic review was to explore and describe family‐based interventions used for children and adolescents with FSS, further to evaluate the overall quality of the research in this area. Sixteen studies were included. The psychological orientation for the applied treatment was based on systemic or cognitive behavioural therapy. Treatment focused on family illness beliefs and on a shift away from somatic symptom attribution to alternative explanations that were shaped by the psychological orientation of the applied treatment. Practitioner points Family influences are significant for functional somatic symptoms in youngsters Family intervention may be a relevant treatment approach for youngsters with functional somatic symptoms Family‐based psychotherapy for youngsters with functional somatic symptoms is mainly based on cognitive behavioural therapy or on systemic family therapy Illness beliefs of the child/adolescent as well as illness beliefs of the family as a whole could be important treatment targets in young people with functional somatic symptoms

Background: Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. Methods: A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11–15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. Results: Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants’ illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. Conclusions: The label ‘functional disorder’ was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.

Functional disorders in children and adolescents are common. Still, little is known about parents’ experience of having a child with a functional disorder. The aim of this qualitative interview study was to explore challenges encountered by parents caring for a child undergoing treatment for functional disorder. Sixteen parents to children with functional disorders were interviewed when their child was referred from a paediatric department for further specialized treatment with family therapy in child and adolescent mental health services. Analysis identified three themes, reflecting the parental experiences: parents in limbo, which described how limited knowledge about functional disorders among professionals in non-specialized settings influenced parental roles; a counterintuitive kind of caring, describing parental struggles with adhering to treatment recommendations for functional disorders; and challenges to parental identity, describing parental emotional challenges. These challenges may bar the acceptance of psychological treatment approaches in families with a child with functional disorders.