BACKGROUND: Young children frequently experience physical symptoms, such as common cold, vaccination pain or a playground injury. Picture books about physical symptoms and illness are a source of information for young children. This study assessed the nature and causes of and responses to physical symptoms depicted in Dutch children's picture books. METHODS: A systematic search for Dutch picture books for children between the ages of 2 and 8 years about physical symptoms or illness was conducted in public library catalogues in the Netherlands, with terms such as 'pain' and 'doctor'. Only picture books with a fictional storyline, in which the main character experienced symptoms or illness, were included. A content analysis was conducted by two independent reviewers. RESULTS: Fifty-five books met the inclusion criteria. The most common symptoms were injuries (29%), cold symptoms (21%), fatigue/malaise (14%) and fever (11%). Causes were mostly unknown (41%), due to accidents (38%) or infections (18%). Accidents were always caused by the main character. In 89% of the picture books, remedies were necessary to resolve the symptoms, including bandages (36%), bedrest (33%), medical interventions (33%) or medication (27%). Fifty-six percent of the books depicted seeking medical care. Four themes regarding the morals of the stories were identified: the seemingly scary hospital or doctor, the responsibility of the main character to engage in coping strategies, the importance of social contacts, and illness gains after possible unpleasantness of symptoms. CONCLUSIONS: The picture books about physical symptoms and illness in our sample depicted various symptoms, limited causes and a range of responses. Physical symptoms and illness were rarely normalized in the stories, often requiring medical intervention rather than spontaneous resolution.