Table of Contents

HK J Paediatr (New Series)
Vol 9. No. 2, 2004

HK J Paediatr (New Series) 2004;9:184-185

Proceedings of Update Series

Need for Early Identification and Intervention: Paediatricians' Role

J Lau

HK J Paediatr (new series) 2004;9:176-185

2001 Paediatric Update No.4: Parent - Promoting Parent-child Well-being
2 September 2001

When a child leaves the mother's womb, he/she is intricately involved in a network of social relations. Family is the major social force that influences children's well-being - what happens in the family often have more impact on the child's development than the disease he/she is having. A few studies were highlighted about the influence of the family on children's illness. Maternal reactions are reportedly of major importance in consultation behaviour, demands for medication and negotiation for treatment.1 Need for paediatricians to adopt a psychosocial perspective to patient care is emphasised. Many physical diseases generate psychological problems for patients; so do many investigations, treatment and health care procedures children undergo.2 When paediatricians avoid dealing with patient's emotional and other psychological needs, they are defeating their own best efforts.

The intention to help the family to cope with disease of its members should start with an understanding of the possible factors affecting children's health in a holistic sense before moving toward recommending appropriate intervention or support. A number of family variables: parental disagreement on child discipline, frequent change of primary caregivers in the early years, maternal and paternal parenting qualities, depression and social isolation of the parent were examined on their effects on children.

Worldwide statistics estimate 20% of children and adolescents suffer from mild to severe mental disorders that compromise their functions. By conservative estimate 2-5% of children have a diagnosable mental disorder requiring treatment to allow meaningful participation in the community. Paediatricians are urged to be aware of the possible risk and protective factors that affect the parent-child relationship. They need to assess the severity and potency of these factors before they decide that the child and/or parent need assistance and promote their help-seeking behaviour.

Medicine in modern society has defined its mission in curing disease - the medical disorder while often overlooking illness - the patients reaction to and experience of disease. However, medicine is expanding its view of health to include the emotional realities of illness. It involves treating the physical, psychological and social aspects of a person. I believe that the medical value of an empathic paediatrician, attuned to the feelings of patients and their families, able to listen and be heard adds to the healing power of the encounter. An informal survey on parental expectations on their 'doctor' was presented. Responses from parents, such as "I will go to a paediatrician I can trust", "want support and understanding before answers", and "willing to explain things patiently" echoed their concerns and expectations. Some criteria of 'good practice' from the perspective of a helping professional and a parent were proposed. They include: Attitude - prepared to help parents to promote children's well-being and adopt a psychosocial perspective to patient care; Knowledge - aware of children's developmental needs and social changes impacting on their mental health, able to identify children and families at risk; Skills - professional judgement, clinical communication skills, facility in managing emotions in self and patients. In many healthcare surveys, the attitude of the doctor is most valued by the patients while empathic understanding and the art of listening can be learned and improved on.

Paediatricians assume a unique role and position in the early detection and identification of parenting problems and families at-risk and the promotion of help-seeking behaviour in patients. They often provide continuity of care and know the child well; they have trust and confidence of the family. High EQ paediatricians who know and manage their emotions well and who can read and deal effectively with patient's feelings and concerns could make an immense impact on the well-being of their patients and the outcome of clinical care and treatment. Paediatricians are also reminded to be aware of community resources for parent education and support in their district of practice for necessary referrals.

To conclude, I like to share with you the following thoughts from the book 'Emotional Intelligence'3:

Many children and their families can benefit measurably when their psychological and social needs are attended to along with their purely medical ones. It's a challenge to the medical profession to practice the art of psychosocial care as medicine is becoming more responsive to the imperatives of business.


1. Howie JG, Bigg AR. Family trends in psychotropic and antibiotic prescribing in general practice. Br Med J 1980;280:836-8.

2. Fielding R. Clinical Communication Skills. Hong Kong University Press, 1995.

3. Goleman D. Emotional Intelligence. Bantam Books, New York, 1996.


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