AIMS: This study investigates the association between psychosomatic complaints (PSC) and background factors from children in the five Nordic countries, their families, and their social context in a model using proximal (child), intermediate (family), and distal (society) levels. Similarities and differences between the countries were compared. METHODS: A questionnaire was sent to the parents of a representative sample of 3,760 Nordic children aged seven to 12 years. The relationship between PSC and background factors was analysed using structural equation modelling. RESULTS: Headaches and stomach complaints were most common. The prevalence was higher in girls than in boys. A LISREL analysis showed that determinants of PSC varied little between countries. The most important factors associated with PSC were the mother's health and well-being, the child's mental stability and social competence, and the family's socioeconomic status. Families with low education, blue-collar work, low income, and unemployed fathers were found to be most vulnerable. High risk factors could be influenced by other intervening protective factors. The greatest country differences were found on the distal level, where macroeconomic, legislative, and social factors dominated. CONCLUSIONS: The pattern of PSC was quite similar between the Nordic countries, although there were some small differences. The results also confirm that the determinants of PSC are multidimensional. Longitudinal studies are needed to clarify the complex reality.