ABSTRACT
This chapter presents a case of 13-year-old girl who has been bed-bound for a week. Her parents are frantically worried because she has not been speaking or moving at all for the last 2 days. She was admitted and investigated after a 6-month history of fatigue and occasional muscle and body aches. The history taken shows that she was not low in mood. Meningitis or encephalitis are possibilities, although again unlikely given the history, investigations and clinical course. The severity of the symptomatology means that a magnetic resonance imaging (MRI) scan is advisable after assessment by a paediatrician or paediatric neurologist. Pervasive refusal syndrome is a term that has come into wide usage to describe children who have no other physical or mental health illness but cannot move or speak, and often refuse to eat or drink. This allows for a multi-disciplinary assessment including paediatrics, nursing care, the child mental health team, physiotherapy, dietician and if available a paediatric neurologist.
