Modem advances in health-care knowledge and technology have resulted in complex modalities of treatment. As a consequence children suffering conditions, once incompatible with survival, are now experiencing a lifetime of chronic health care and treatment. Acute paediatric health care can be simultaneously life-saving and terrifying for the child. Children's expression of emotional and psychological distress through somatoform symptoms can be confusing and perplexing for clinicians. If unrecognized, particularly in the acute care setting, somatoform symptoms may lead to abnormal illness behaviour and abnormal treatment behaviour with the child being subjected to unnecessary `abusive' investigations and treatment. The complexity for paediatric nurses lies in recognizing the child's distress and interpreting the symptoms for the child, the parents and other health-care professionals. This is different from the intervention that a psychologist or social worker might provide because of the experienced nurse's understanding of the child's illness environment. Nursing demands that the biological, the psychological and the psychosocial are woven into the structure of daily care. Quality nursing care is dependent on expert nursing knowledge and understanding of this illness environment. The expert nurse, by connecting with and understanding the child, fulfils a twofold role: the child's advocate, facilitating the coordination and integration of management plans, and the child's interpreter. Increasingly developed nursing expertise enables an appreciation of the particular needs of the child from the child's point of view.
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