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Psychopharmacology

Psychopharmacology is the first-line treatment for several child and adolescent psychiatric disorders (e.g., ADHD, schizophrenia, bipolar) and is used adjunctively with psychosocial treatments for other disorders (or coexisting conditions), including anxiety, depression, autism spectrum, tic, trauma-related, and obsessive-compulsive disorders. Although pediatric primary care practitioners (PCPs) may routinely manage medications for attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression, they may be called on to manage psychotropic medications with…

Psychosocial Assessment and Interviewing

It is estimated that 20% of children living in the United States experience a mental illness in a given year, at a cost of almost $14 billion. In children, mental illness is more prevalent than leukemia, diabetes, and AIDS combined; more money is spent on mental disorders than on any other childhood illness, including asthma, trauma, and infectious diseases. Although nearly 1 in 5 youths suffers…

Sleep Medicine

Basics of Sleep and Chronobiology Sleep, with its counterpart of wakefulness, is a highly complex and intricately regulated neurobiologic system that both influences and is influenced by all physiologic systems in the body, as well as by the environment and sociocultural practices. The concept of sleep regulation is based on what is usually referred to as the “2-process model” because it requires the simultaneous operation of…

Loss, Separation, and Bereavement

All children will experience involuntary separations, whether from illness, death, or other causes, from loved ones at some time in their lives. Relatively brief separations of children from their parents, usually produce minor transient effects, but more enduring and frequent separation may cause sequelae. The potential impact of each event must be considered in light of the age, stage of development, and experiences of the child,…

Childcare

In the United States, approximately half of all children under the age of 3 yr and 60–75% of children age 3-5 yr had at least 1 regular nonparental childcare arrangement in 2012. Young children of employed mothers spend on average 36 hr per week in a childcare arrangement. Childcare provision is affected by many factors, derived from family demand, childcare supply, and child/family policy. With increasing movement of mothers…

Developmental and Behavioral Surveillance and Screening

In healthy development, a child will acquire new skills beginning prenatally and extending into at least young adulthood. The roots of this acquisition of skills lie in the development of the nervous system, with additional influences from the health status of other organ systems and the physical and social environment in which the development occurs. Development and its milestones are divided into the “streams” of gross…

Assessment of Growth

Growth can be considered a vital sign in children, and aberrant growth may be the first sign of an underlying pathologic condition. The most powerful tool in growth assessment is the growth chart ( Fig. 23.1, Fig. 23.2, Fig. 25.1 , and 27.1 ), used in combination with accurate measurements of height, weight, head circumference, and calculation of the body mass index. Techniques to Measure Growth…

Middle Childhood

Middle childhood (6-11 yr of age) is the period in which children increasingly separate from parents and seek acceptance from teachers, other adults, and peers. Children begin to feel under pressure to conform to the style and ideals of the peer group. Self-esteem becomes a central issue, as children develop the cognitive ability to consider their own self-evaluations and their perception of how others see them. For…

The Preschool Years

The emergence of language and exposure of children to an expanding social sphere represent the critical milestones for children ages 2-5 yr. As toddlers, children learn to walk away and come back to the secure adult or parent. As preschoolers, they explore emotional separation, alternating between stubborn opposition and cheerful compliance, between bold exploration and clinging dependence. Increasing time spent in classrooms and playgrounds challenges a child's…

The Second Year

The 2nd year of life is a time of rapid growth of development, particularly in the realms of social-emotional and cognitive skills as well as motor development. The toddler's newly found ability to walk allows separation and independence; however, the toddler continues to need secure attachment to the parents. At approximately 18 mo of age, the emergence of symbolic thought and language causes a reorganization of behavior,…

The First Year

The prenatal period and the 1st yr of life provide the platform for remarkable growth and development, setting the trajectory for a child's life. Neural plasticity , the ability of the brain to be shaped by experience, both positive and negative, is at its peak. Total brain volume doubles in the 1st yr of life and increases by an additional 15% over the 2nd yr. Total…

The Newborn

(See also Chapter 113 .) Regardless of gestational age, the newborn (neonatal) period begins at birth and includes the 1st mo of life. During this time, marked physiologic transitions occur in all organ systems, and the infant learns to respond to many forms of external stimuli. Because infants thrive physically and psychologically only in the context of their social relationships, any description of the newborn's developmental…

Assessment of Fetal Growth and Development

The developing fetus is affected by social and environmental influences, including maternal nutritional status; substance use (both legal and illicit); and psychologic trauma. Correspondingly, the psychologic alterations experienced by the parents during the gestation profoundly impact the lives of all members of the family. Growing evidence implicates the importance of these and other maternal and paternal experiences that occur during and prior to the pregnancy (and…

Positive Parenting and Support

No force may be more important to a child's development than the family. Many factors contribute to the family's influence, including family structure, functioning, economics, and stress. Parenting provides the foundation to promote healthy child development and to protect against adverse outcomes. The term positive parenting describes an approach to parenting that achieves these goals. The Importance of Parenting Interactions between parents and their children provide…

Developmental and Behavioral Theories

The field of pediatrics is dedicated to optimizing the growth and development of each child. Pediatricians require knowledge of normal growth, development, and behavior in order to effectively monitor children's progress, identify delays or abnormalities in development, help obtain needed services, and counsel parents and caretakers. To alter factors that increase or decrease risk, pediatricians need to understand how biologic and social forces interact within the…

Strategies for Health Behavior Change

To improve the health of children, pediatricians often ask patients and caregivers to make behavioral changes. These may be lifestyle changes to manage a chronic condition (e.g., obesity, asthma), adherence with the recommended timing and frequency of medications, or recommendations to seek assistance from other health providers (e.g., dieticians, mental health providers, physical, occupational, or speech therapists). However, change is difficult and can cause distress, and…

Abused and Neglected Children

The abuse and neglect ( maltreatment ) of children are pervasive problems worldwide, with short- and long-term physical and mental health and social consequences. Child healthcare professionals have an important role in helping address this problem. In addition to their responsibility to identify maltreated children and help ensure their protection and health, child healthcare professionals can also play vital roles related to prevention, treatment, and advocacy.…

Child Trafficking for Sex and Labor

Human trafficking violates the fundamental human rights of child and adult victims and impacts families, communities, and societies. Trafficked persons originate from countries worldwide and may belong to any racial, ethnic, religious, socioeconomic, or cultural group. They may be of any gender. According to the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons , child trafficking refers to the “recruitment, transportation, transfer, harboring…

Impact of Violence on Children

The reach of violence, whether as the victim, perpetrator, or witness, whether in person or through the media, is far, deep, and long-standing across the globe. In the home, it is estimated that 80–95% of such aggression is witnessed by a child. Exposure to violence disrupts the healthy development of children in a myriad of ways. Pediatric clinicians must be competent to address these issues in…