Pediatric Annals

EDITORIAL 

A Pediatrician's View: Sometimes It's Tough To Be a Parent

Robert A Hoekelman, MD

Abstract

Our Guest Editor, Dr Edward R. Christophersen, is one of the world's leading experts in the field of behavioral pediatrics. He has brought together for this issue of Pediatrie Annals six other experts who present the current thinking about five problems that beset many parents - a baby or a child who doesn't sleep, can't be toilet trained, can't sleep through the night without wetting the bed, can't concentrate, or can't be disciplined. It's hard enough to deal with one of those behavioral difficulties, but reading these articles carefully, we see that a child afflicted with one is likely to be afflicted with two, or three, or four, or even all of them. That's real trouble.

The parents are stressed from dealing with their child's problem day in and day out and from feelings of ( 1 ) inadequacy, because they suspect they have done something wrong, (2) resentment, because their child hasn't lived up to their expectations, (3) guilt, because their child's problem has caused them to neglect each other and the rest of their family, (4) frustration, because things don't seem to get any better, and (5) fear that the problem will get worse, no matter what they do to resolve it.

As Dr Christophersen points out, primary care pediatricians encounter such problems every day in their practices, being the most constant source of professional support for these troubled parents. Primary care pediatricians must spend time counseling and reassuring parents, prescribing complicated treatment and behavioral modification regimes, following the child's progress closely, and obtaining consultation when appropriate. That adds up to a lot of time - much more than most pediatricians are able to give. The average office visit lasts less than 15 minutes, according to studies performed over the past 50 years in New York, New York (1948),1 Baltimore, Maryland (1959),2 Seattle, Washington (1964),' Los Angeles, California (1969),4 Rochester, New York (1975), 5 and Pittsburgh, Pennsylvania (1980).6 That doesn't allow much time for dealing with complicated behavioral problems. The Pittsburgh study showed that less than a minute of each office visit was spent on anticipatory guidance and counseling.

No time-motion studies of pediatrie practices have been published during the past decade, but any practitioner will tell you that things haven't changed all that much. However, with the "new morbidities"7 subject matter having been introduced to the curricula of most pediatrie residency training programs, as recommended by the Task Force on Pediatrie Education,8 we might expect that during the 1990s pediatricians will schedule longer office visits and counseling time for patients and parents experiencing new morbidity problems, including the five described in this issue. Let's hope so. These parents need all the help they can get and all the time we can give them.

1. Blum LH. Some psychological and educational aspects of pediatrie practices a study of well baby clinics. Genetic Psychology Monographs. 1950;41:1.

2. Stine O. Content and method IA health supervision by physicians in child health conferences in Baltimore. Am J Public Health. 1%2;52;I85H.

3. Bergman AB, Prohsttield JL. We JRWIKX] RJ. Performance analysis m pediatrie practice: preliminary report. Jtnanai a Medical Education. 1967;42:249.

4. Korsch BM, Negrete VF, Mercer AS, et al. HLW comprehensive are well-child visits.' AmJ Du ChM. 1971 ;1 22:483.

5. Foye H, Chamherlm R, Charney E. Content and emphasis of well-chiid visits: experienced nurse practitioners vs pediairitians. Am J Dis Child. 1977:111:794.

6. Reisinger KS, Bires JA. Anticipatory guidance in pediatrie practice. Pediomcs. 1980;66:889.

7. Haggerty RJ. Foghmann KJ, Plcss iB (eds). Chiid Health and the Community. New York, NY: John Wiley & Sons; 1975.

8. Task Force on Pediatrie…

Our Guest Editor, Dr Edward R. Christophersen, is one of the world's leading experts in the field of behavioral pediatrics. He has brought together for this issue of Pediatrie Annals six other experts who present the current thinking about five problems that beset many parents - a baby or a child who doesn't sleep, can't be toilet trained, can't sleep through the night without wetting the bed, can't concentrate, or can't be disciplined. It's hard enough to deal with one of those behavioral difficulties, but reading these articles carefully, we see that a child afflicted with one is likely to be afflicted with two, or three, or four, or even all of them. That's real trouble.

The parents are stressed from dealing with their child's problem day in and day out and from feelings of ( 1 ) inadequacy, because they suspect they have done something wrong, (2) resentment, because their child hasn't lived up to their expectations, (3) guilt, because their child's problem has caused them to neglect each other and the rest of their family, (4) frustration, because things don't seem to get any better, and (5) fear that the problem will get worse, no matter what they do to resolve it.

As Dr Christophersen points out, primary care pediatricians encounter such problems every day in their practices, being the most constant source of professional support for these troubled parents. Primary care pediatricians must spend time counseling and reassuring parents, prescribing complicated treatment and behavioral modification regimes, following the child's progress closely, and obtaining consultation when appropriate. That adds up to a lot of time - much more than most pediatricians are able to give. The average office visit lasts less than 15 minutes, according to studies performed over the past 50 years in New York, New York (1948),1 Baltimore, Maryland (1959),2 Seattle, Washington (1964),' Los Angeles, California (1969),4 Rochester, New York (1975), 5 and Pittsburgh, Pennsylvania (1980).6 That doesn't allow much time for dealing with complicated behavioral problems. The Pittsburgh study showed that less than a minute of each office visit was spent on anticipatory guidance and counseling.

No time-motion studies of pediatrie practices have been published during the past decade, but any practitioner will tell you that things haven't changed all that much. However, with the "new morbidities"7 subject matter having been introduced to the curricula of most pediatrie residency training programs, as recommended by the Task Force on Pediatrie Education,8 we might expect that during the 1990s pediatricians will schedule longer office visits and counseling time for patients and parents experiencing new morbidity problems, including the five described in this issue. Let's hope so. These parents need all the help they can get and all the time we can give them.

REFERENCES

1. Blum LH. Some psychological and educational aspects of pediatrie practices a study of well baby clinics. Genetic Psychology Monographs. 1950;41:1.

2. Stine O. Content and method IA health supervision by physicians in child health conferences in Baltimore. Am J Public Health. 1%2;52;I85H.

3. Bergman AB, Prohsttield JL. We JRWIKX] RJ. Performance analysis m pediatrie practice: preliminary report. Jtnanai a Medical Education. 1967;42:249.

4. Korsch BM, Negrete VF, Mercer AS, et al. HLW comprehensive are well-child visits.' AmJ Du ChM. 1971 ;1 22:483.

5. Foye H, Chamherlm R, Charney E. Content and emphasis of well-chiid visits: experienced nurse practitioners vs pediairitians. Am J Dis Child. 1977:111:794.

6. Reisinger KS, Bires JA. Anticipatory guidance in pediatrie practice. Pediomcs. 1980;66:889.

7. Haggerty RJ. Foghmann KJ, Plcss iB (eds). Chiid Health and the Community. New York, NY: John Wiley & Sons; 1975.

8. Task Force on Pediatrie Education. The Future of Pediatric Education. Evanston, Ill: American Academy of Pediatrics; 1978.

10.3928/0090-4481-19910501-04

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