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Mood Disorders

Mood disorders are interrelated sets of psychiatric symptoms characterized by a core deficit in emotional self-regulation. Classically, the mood disorders have been divided into depressive and bipolar disorders, representing the two emotional polarities, dysphoric (“low”) and euphoric (“high”) mood. Major and Other Depressive Disorders Heather J. Walter David R. DeMaso The depressive disorders include major depressive, persistent depressive, disruptive mood dysregulation, other specified/unspecified depressive, premenstrual dysphoric, and substance/medication-induced…

Anxiety Disorders

Anxiety, defined as dread or apprehension, is not considered pathologic, is seen across the life span, and can be adaptive (e.g., the anxiety one might feel during an automobile crash). Anxiety has both a cognitive-behavioral component, expressed in worrying and wariness, and a physiologic component, mediated by the autonomic nervous system. Anxiety disorders are characterized by pathologic anxiety, in which anxiety becomes disabling, interfering with social…

Motor Disorders and Habits

Motor disorders are interrelated sets of psychiatric symptoms characterized by abnormal motor movements and associated phenomena. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), motor disorders include tic, stereotypic movement, and developmental coordination disorders. Tic disorders (Tourette, persistent motor or vocal tic, provisional tic, other specified/unspecified tic) and stereotypic movement disorder are addressed in this chapter, along with habits. Although not DSM-5…

Rumination and Pica

Rumination Disorder Chase B. Samsel Heather J. Walter David R. DeMaso Rumination disorder is the repeated regurgitation of food, where the regurgitated food may be rechewed, reswallowed, or spit out, for a period of at least 1 mo following a period of normal functioning. Regurgitation is typically frequent and daily; it does not occur during sleep. It is not caused by an associated gastrointestinal illness or other medical conditions (e.g.,…

Somatic Symptom and Related Disorders

Pediatric psychosomatic medicine deals with the relation between physical and psychological factors in the causation or maintenance of disease states. The process whereby distress is experienced and expressed in physical symptoms is referred to as somatization or psychosomatic illness . Even though present in virtually every psychiatric disorder, physical symptoms are most prominent in the various somatic symptom and related disorders. In the Diagnostic and Statistical…

Psychotherapy and Psychiatric Hospitalization

Psychotherapy Psychotherapy is the first-line treatment for most child and adolescent psychiatric disorders, because this type of treatment generally produces outcomes similar to pharmacotherapy, with less risk of harm. Even with disorders such as schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder (ADHD) for which medication is the first-line treatment , adjunctive psychotherapy can convey considerable additional benefit. Because pediatric primary care practitioners (PCPs) likely will be referring…

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…