Review of the literature on the psychological effects of hospitalization on children reveals that it has not increased substantially in quality or quantity since Vernon and his associates published their extensive review a decade ago. More recent research supports the earlier contentions that children between the ages of 6 months and 4 years are especially vulnerable to upset but are also more amenable to change and growth than other age groups. Maternal separation appears to be the primary stressor, but the presence of emotional disturbance prior to hospitalization and the child's level of cognitive development at the time may also be significant factors. Attempts to prepare children for hospitalization and surgery have met with some success, but not for preschool children.

Hospitalization as a life crisis for the preschool child: a critical review.

Clinical psychological practice in a pediatric hospital.

http://psycnet.apa.org/journals/pro/10/4/558.pdf

Psychology and the creation of health care settings.

thinking has aided our understanding of the processes, and contributed to our management of both organically and non-organically induced physical complaints. The interactive and circular nature of the relationship between psyche and soma have been illustrated by Minuchin et al (figure).2 Psychological sequels of both childhood illness and admission to hospital have also been documented.3 The value of a systemic approach to paediatrics.-that is, seeing the child in the context of his family and social surroundings-has been highlighted by Bingley et al.5 'Liaison child psychiatry' refers to the partnership of child psychiatry, paediatrics, and other specialities concerned with children to provide integrated medical and psychological care for children. The development of liaison services has been described by a number of authors,68 and different models of functioning have been proposed.9'2 Obstacles to liaison,3 and ways of overcoming them,'6 17 have also been discussed. Graham has outlined principles of referral appropriate to a child psychiatry consultation seryice, but has pointed out that these are less necessary when there is regular contact between specialists.18

https://adc.bmj.com/content/archdischild/65/12/1373.full.pdf

Development of a psychiatric liaison service.

The increasing number of pediatric patients with end-stage renal disease who undergo dialysis and transplantation have necessitated the development of psychological interventions to lessen the emotional impact of these procedures. This report describes the dilemmas involved in mental health interventions and consultation in a treatment program for end-stage renal disease. Case illustrations of a young child's severe anxiety reaction to dialysis, an adolescent's depression, and a family's withdrawal document the varied patterns of adaptation to treatment for renal failure. Psychotherapeutic approaches are presented to illustrate the flexible use of a number of treatment modalities including brief crisis-oriented intervention which emphasizes the patient's cognitive mastery of procedures. The development of viable mechanisms of professional collaboration improves the quality of patient adaptation by lessening the fragmentation of care and problems of interdisciplinary communication often associated with the...

Mental health intervention with children and adolescents with end-stage renal disease.

This paper describes the development of a child psychiatry liaison service to pediatrics in a university hospital setting and discusses the authors' preference for the liaison type of relationship over strictly consultative psychiatry.The success of the liaison service in promoting comprehensive pediatric care can be related to an effective team approach which includes a pediatric social worker and a child psychiatry nurse specialist. In addition to the usual methods of handling consultation requests for psychiatric services, weekly teaching conferences on the pediatric wards were established to draw the house officers' attention to a bio-psycho-social approach to pediatric care, to allow ventilation of intradepartmental conflicts, and to enable nurses and residents to express their feelings freely about difficult patient problems such as the chronically ill and the dying child.The common lack of continuity of house officers and attendings on the pediatric wards hampers efforts to provide well planned and...

"For the sake of the children": trials and tribulations of child psychiatry-liaison service

This paper describes the development of crisis situations in the parents of three pediatric inpatients. The cases illustrate that psychiatric techniques, when applied to the evaluation of family and social environments, might result in the uncovering of complicated psychopathology. Precipitating factors may include: a stressful initial interview; biases of the referring physician; exaggerated parental treatment expectations; the sudden release of repressed material; and the disadvantages of rooming-in. Resolution was influenced in several ways, including the further crisis presented by the improvement in the child's illness to the point of discharge and the necessary reconsideration of this because of the parent's urgent emotional needs. The child's discharge was governed by the management of the mother's illness. Close coordination between liaison psychiatrist and pediatrician was essential to the treatment plan.

Kenneth A. Naylor

Papers

"For the sake of the children": trials and tribulations of child psychiatry-liaison service

Crisis precipitation as observed in pediatric--child psychiatric liaison.