The Role of Pediatrician in Children’s Mental Health

July 30, 2024

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Being a parent is an incredible journey full of experiences, and challenges, filled with milestones and precious moments to shape the individual they become.

Pediatrician care plays a crucial role in supporting the mental or behavioural health of children by providing early detection, intervention, and therapies for mental health disorders. They are often the first point of contact for parents seeking help for their children’s emotional and behavioural concerns.

Mental Health in Children

Growing up mentally well involves attaining developmental and emotional milestones, gaining positive social skills, and picking up problem-solving strategies. Children with healthy mental health can function successfully in their communities, at home, and school.

Children with mental disorders experience significant alterations in their usual learning, behaviour, or emotional regulation, resulting in anguish and difficulties navigating daily life. Many children exhibit disruptive behaviours from time to time. If the child’s symptoms are severe/persistent, and interfere with play, schoolwork, or family activities, a mental condition may be diagnosed.

Several mental health conditions that are more prevalent in children include attention-deficit/hyperactivity disorder (ADHD), anxiety, and behavioural issues (fears or concerns).

Common Mental Health Disorders in Children

1. Anxiety

A child may be diagnosed with an anxiety disorder if they do not outgrow their typical young concerns and worries or if their excessive fears and worries interfere with their play, school, or home life. Various forms of anxiety disorders include, for example.

Having separation anxiety, which is the fear of being away from one’s parents.
Phobias are intense fears related to a particular thing or circumstance, such as dogs, insects, or visiting a doctor.
Having social anxiety where children are being afraid of school and other places.
Having anxiety about the future and bad situations happening.

2. Depression

Every child experiences sadness or hopelessness from time to time. Nonetheless, some kids experience melancholy or lack interest in activities they once found enjoyable, or they feel powerless or hopeless in circumstances they can alter. Diagnosis of depression if they experience sadness and hopelessness regularly in children is important.

Children suffering from depression can show various behaviours, such as:

Experiencing constant sadness, hopelessness, or irritability.
Avoid taking part in play activities.
Displaying changes in eating habits, such as eating more or less than usual.
Displaying changes in sleep habits, such as sleeping more or less than usual.
Having trouble paying attention.
Feeling worthless, useless, or guilty.
Engaging in self-destructive behaviour.

3. Behaviour or Conduct Problems in Children

Around adults, children can dispute, act aggressively, or show angry or aggressive behaviour. When these disruptive behaviours are severe, persistent, or unusual for the child’s age at the time, a behaviour disorder may be identified. Disruptive behaviour disorders are commonly referred to as externalizing disorders since they entail acting out and displaying undesirable conduct toward others.

Some examples of activities or issues linked to behaviour are:

Disobeying basic regulations, including escaping, remaining out late when instructed not to, or missing class.
Engaging in harmful behaviours, including bullying, fighting, or mistreating animals, is an example of being aggressive.
Lying, stealing, or intentionally causing damage to someone else’s property.

Screening and Assessment for Children’s Mental Health

A simple process used for identifying newborns and young children who might be vulnerable to developmental or social-emotional issues. it finds children, who might benefit from diagnostic examination or education evaluation.

1. Developmental Screening

Children at risk for cognitive, motor, interpersonal, or social-emotional impairments are identified through developmental screening. These delays can prevent expected learning, development, and growth, and they may require additional testing, diagnosis, and assessment.

To determine whether a child is reaching his or her developmental milestones, screening tests for behaviour and development are utilized.

Here are a few examples of developmental milestones for newborns and toddlers:

Birth to four months includes putting hands to mouth, grinning, and drooling.
6 months: includes rolling over, peering at oneself in the mirror, playing with others, and sitting unassisted.
At nine months, a baby can make noises like “mama” and “dada,” comprehend the meaning of “no,” crawl and stand on their own.
A year includes moving while clinging to furniture, playing peekaboo, and obeying basic instructions.
A period of 18 months. includes using a spoon to eat, walking, climbing, and descending stairs, and speaking and understanding multiple words.
For two to three years. includes the ability to identify colors and labels, name images of everyday objects, dress, and undress with ease, and run and walk with ease.
Scales used for Developmental delay screening in children include:
- Bayley Scales of Infant Development (BSID-I, 1st edition; BSID-II, 2nd edition; BSID-III, 3rd edition): Evaluate newborns and toddlers’ growth across a variety of dimensions. The test’s main benefits are for the diagnosis of developmental delays and the design of intervention plans.
- British Ability Scales (BAS): Measures subscales for differentiated abilities, achievement assessments in the children, and core abilities (verbal, visual/spatial, and non-verbal). The purpose is to classify the goals to test cognitive abilities to comprehend and support intervention.

2. Social-Emotional Screening

A part of developmental screening for young children is social-emotional screening, which focuses on a child’s capacity to:

Express and control emotions
Establish safe and intimate relationships
Learn and explore their environment

Since general developmental screening instruments do not sufficiently assess social-emotional development early in children, separate screening is required for children under age 6 years.

Scales used for Social-Emotional screening in children include:

Disruptive Behaviour Rating Scale: 45-item versions for teachers and parents. evaluates for impulsivity/overactivity, oppositional/defiant behaviours, and inattention 5 to 10 years old.
Ages and Stages Questionnaires: Social-Emotional, (ASQ: SE-2): A screening instrument called the ASQ: SE-2 is used to identify infants and young children whose social and emotional development requires further evaluation to decide whether or not to refer them for intervention therapy. There are nine distinct age categories for which there are surveys available: 2, 6, 12, 18, 24, 30, 36, 48, and 60 months. Every screen for affect, interpersonal interaction, self-control, obedience, communication, and adaptive actions.

3. Mental Health Screening

The process of early detection of children who may have mental health disorders that may inhibit their normal development, learning, and growth and require additional testing, diagnosis, and assessment is known as mental health screening.

Scales used for Mental health screening in children include:

Spence Children’s Anxiety Scale (SCAS): In addition to a preschool version completed by a parent (34 items) or teacher (22 things), there are kid (45 questions) and parent (39 questions) versions for ages 8 to 15. The screen scores for generalized anxiety/over-anxiousness, separation anxiety, social phobia, OCD, panic/agoraphobia, symptoms, and worries of physical harm in addition to the overall anxiety disorder. T-scores greater than 60 are associated with a higher likelihood of having an anxiety disorder; normative data is not available for the teacher-completed preschool measure, which is excluded for informative purposes.
Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS): Evaluates existence and intensity of obsessions and compulsions in children aged 6 to 17 to diagnose OCD and track treatment response. Instructions and pointers on how to conduct a semi-structured interview with a kid and/or parent, conducted by a clinician.

Note: For further information on the Mental Health questionnaires and scale assessments utilized in evaluations, you can find relevant links provided at the conclusion of the blog.

Therapies for Children’s Behavioural Health that is Preventive in Nature

1. Psychodynamic Therapy

Using the psychodynamic model children can benefit from identifying the feelings and experiences that are suppressed or unexpressed. Role-playing, storytelling, art or other various activities assisted by therapists to explore children’s inner world and understand their experiences Finding the primary causes of problems, advancing self-awareness, and encouraging positive emotional growth are the objectives.

As a demonstration, the therapist can ask the youngsters to sketch pictures of themselves either alone or with their families. To have a therapeutic conversation with the child and assist them make an emotional connection with whatever issues they may be going through, the therapist watches this process as well as how the picture comes together, and the characters are portrayed.

2. Cognitive Behavioural Therapy

Cognitive behavioural therapy is a type of talk therapy that is appropriate for people of all ages, including teenagers and children. Its main goal is to understand how thoughts and emotions influence behaviour. Even without a diagnosed mental health condition, children can benefit from CBT. Typically, therapy sessions are structured with agreed-upon objectives and a set duration. The therapist helps the child replace harmful thought patterns with helpful therapy. Techniques like role-playing enable the child to practice handling challenging situations differently.

3. Child-centred Play Therapy

In child-centred play therapy (CCPT), kids are given a secure and encouraging setting in which they can express themselves via play. Developed by Virginia Axline, CCPT is based on the belief that play is a natural medium for children to communicate their thoughts, feelings, and experiences.

In CCPT, the therapist creates a playroom filled with toys, art materials, and other expressive tools. The child is encouraged to choose activities and play freely, while the therapist observes and follows the child’s lead. To assist the child, in feeling understood and accepted, the therapist may periodically reflect on the child’s feelings or thoughts.

Continuous improvement is the standard in the field of pediatric care, reflecting the dynamic character of healthcare. To remain updated on the latest advancements in treating conditions in pediatric care settings, it’s vital to consistently refer to recent mental health guidelines or literature, monitor ongoing clinical trials, engage in relevant webinars, or enroll in pediatric online courses led by esteemed pediatric specialists. These platforms offer valuable access to the most up-to-date information on existing treatments and therapeutic strategies. One of the most popular pediatrics courses for MD students is Pediatrics MD by Dr. Piyush Gupta.

Checklist for MD Pediatrics resident to have a comprehensive understanding of the condition:

Adolescent Health- Growth and Development
Assessment of Nutritional Growth
Recent IAP Guidelines
Neonatology – Assessment of Gestational Age & Neonatal Reflexes
Genetics and Metabolic Disorders
Surgical Emergencies in Pediatrics

To expand your expertise, read up on the most recent books and take part in relevant conferences or seminars. The latest developments in pediatric care can help you stay informed to become an expert healthcare practitioner.

Frequently Asked Questions (FAQs)

Q1. What part of parental engagement provides mental health support in child psychiatry?

Ans. In mental health assistance, parental involvement is important as it provides a thorough grasp of the children’s surroundings, upbringing, and family dynamics. Working with parents helps to create individualized treatment programs, carry out successful interventions, and encourage favourable results for the well-being of children given by paediatricians.

Q2. How does developmental psychology inform mental health support for children?

Ans. Cognitive, emotional, and social milestones as well as the normal phases of childhood development are all explained by developmental psychology. Comprehending these developmental processes facilitates the ability of mental health practitioners to recognize precocious indications of mental health problems, customize therapies based on the child’s developmental stage, and foster sound growth and functioning.

Q3. What are the benefits of integrating parental involvement into mental health support services for children?

Ans. Parental participation increases treatment efficacy, encourages long-term success, and develops collaboration between families and mental health professionals when it is incorporated into mental health support programs for children. Involving parents in parenting classes or therapy sessions also gives them the tools they need to improve family dynamics and promote their child’s mental health.

Link for the Scales

For Development Delay:

http://pustaka.unp.ac.id/file/abstrak_kki/EBOOKS/Bayley%20III_Clinical_Use_and_Interpretation__Practical_Resources_for_the_Mental_Health_Professional_.pdf
https://cls.ucl.ac.uk/wp-content/uploads/2018/06/British-ability-scales-annotated.pdf

Social-Emotional Screening: