Pervasive refusal syndrome (PRS)/pervasive arousal withdrawal syndrome (PAWS) and conversion disorder (CD) are two rare mental health disorders that commonly affect children and young people. In the most extreme cases of PRS/PAWS, young people may be unable to perform activities of daily living and rely on adults for physical and emotional support. CD can present as loss of sensation in vision and touch, pain in certain areas and an inability to walk. It is important that children’s nurses are aware of these disorders and have some insight into the most helpful approaches. Young people need to feel that their experiences are validated, which can elicit feelings in staff from an urge to help to intense frustration. It is essential for staff to be able to talk and reflect to allow such feelings to be understood. Although these are rare conditions, this article outlines what to do if young people present with features of PRS/PAWS or CD in a general healthcare setting.