Caring for children with functional neurological disorders in the emergency department

Functional neurological disorder is a common reason for children to present to the emergency department, but education gaps contribute to delays in diagnosis. This can result in unnecessary diagnostic testing and interventions, which lead to increased healthcare costs and, at times, patient harm. In this narrative review, we provide practical recommendations regarding emergency department management of paediatric functional neurological disorder. We recommend that emergency physicians use the described rule-in signs rather than negative medical tests to make a positive diagnosis of functional neurological disorder. We advocate for timely communication of this diagnosis to the patient and family in a clear and validating way. We also discuss considerations for patient triage, outpatient referrals and special scenarios that emergency physicians may frequently encounter.