Unexplained somatic symptoms present difficult problems for the emergency physician. Conversion reactions as etiologies for such symptoms can be assessed by using a biopsychosocial framework that has been previously described. To make the diagnosis of conversion reaction, an assortment of positive psychosocial findings in the face of negative organic findings is usually required. This paper describes general features of childhood conversion reactions and specific discriminative findings between organic and conversion etiologies for some of the more common presentations of conversion reactions.