Pediatric psychiatry is a branch of medicine that deals with the diagnosis and treatment of
mental disorders in children and adolescents (under 18).
A recent EU-wide study by Eurostat placed Romania in 1st place in terms of children’s health.
More than 99% of them were in very good or average health, according to their parents.
While this is good news, it does not accurately reflect reality. For many parents, health is the absence of pain or physical ailments.
According to the World Health Organization, „health is physical, mental and social well-being, and not merely the absence of disease or disability”. Many adults pay disproportionate attention to children’s physical health, neglecting their mental health, and this attitude can have negative consequences on them for the rest of their lives.
Worldwide, 20% of children and teenagers suffer from a mental illness, suicide being the 3rd leading cause of death among adolescents.
What can we do to prevent our children from becoming a statistic?
Get professional help. The Hope Clinic offers a large number of specialists with extensive training in Bucharest, Cluj and Iasi.
Specialist in Pediatric psychiatry
Our ally in assessing a child’s mental health and treating (where appropriate) or preventing mental disorders is your pediatric psychiatrist. They diagnose, treat and prevent neuropsychiatric and developmental disorders in patients up to the age of 18.
The need for mental health professionals specializing in working with children and adolescents stems from the specificities of mental disorders at this age. They are due to rapid neuro-biological and social changes at this stage of life.
Pediatric psychiatry
A very delicate, special branch of medicine, like children generally are.
A challenging specialty due to the fact that we always have to work with the whole family, as the child’s mental health is often a “symptom” of the family
Pediatric psychiatry was created as a clinical discipline distinct from adult psychiatry in the 19th century by French psychiatrist Marcel Manheimer. In his book, Childhood Mental Disorders, the term “Pediatric psychiatry” appears for the first time.
His textbook on child psychiatry showcases the first comprehensive classification of mental disorders in children beyond mental retardation and cretinism. Since then, the specialty of pediatric psychiatry has developed in the context of world wars and crises, who have subjected children to a multitude of traumas and stressors: (violence; loss of parents; homelessness and relocation; hunger; financial and emotional instability; etc.).
In addition to these, there are also private practices, some of which also have a contract with CASMB. This way patients can benefit from services free of charge.
The biggest impediments to accessing these services are:
- Stigma associated with mental disorders
- Parental fear of a diagnosis that could lead to discrimination against children.
But the consequences of ignoring mental health problems are far more serious. Childhood mental illnesses progress and sometimes worsen in adulthood.
50% of adult mental disorders (excluding dementia) start before the age of 15 and 75% of them start before the age of 18.
Lack of adequate treatment leads to increased rates of unemployment, violence, behavioral disorders and illegal activities. Physical health and social integration are also affected. On the other hand, increased attention to mental health, with prevention and appropriate treatment, leads to better physical health, greater productivity and increased stability.
Mental disorders in children and adolescents
Which mental disorders occur in children and adolescents?
Early childhood (3-8 years)
- Learning disabilities – have an increased frequency of cases and a significant impact on future productivity. Treatment is limited and focused on school work. The aim is to achieve occupational independence. May be associated with hyperkinetic disorders.
- Hyperkinetic disorders (ADHD) – the frequency of cases has increased significantly in recent years, driven by pharmaceutical awareness campaigns and the media. The treatment has an increased success rate at a relatively low cost. The long-term consequences are linked to modest professional achievements, as well as an increased incidence of other mental disorders.
Late childhood (9-11 years)
- Tics (Tourette Syndrome).
Diagnosed with an increased incidence in recent years, the syndrome can be treated without highly specialized interventions. Without treatment, there is a high level of stigma and social isolation.
Adolescence
- Depression and thoughts of associated suicide. Depression is now recognized as a diagnosable disorder in both children and adolescents. Long-term studies show that major depressive episodes with onset in adolescence are more likely to continue into adulthood. They are associated with increased risk of suicide. In children with depressive episodes before puberty, studies show increased rates of bipolar disorder, depressive disorders, substance abuse and suicide.
- Psychosis is a symptom that can occur in several disorders. The best known of these being schizophrenia. Early identification of psychotic conditions is important, and they are not as obvious as we would expect them to be. Psychosis can lead to a variety of maladaptive behaviors. Early treatment of schizophrenia, for example, brings innumerable benefits to the patient, family and society.
Although in most cases, symptoms of schizophrenia appear around the age of 25, there is also early-onset schizophrenia before the age of 18. Additionally, there are very rare cases of very early onset schizophrenia, before the age of 13.
Other conditions
Autism Spectrum Disorder (AUTISM).
It is a developmental disorder that affects communication and behavior. Symptoms appear very early, in the first 2 years of life. Parents observe atypical behaviors, such as difficulty interacting with other people; avoidance of eye contact; restrictive and repetitive behaviors (repeating words – echolalia).
It is important for parents to see a doctor as soon as they notice these signs so that treatment can begin. This can consist of medication, but mainly, treatment is based on behavioral and educational therapy as well as psychotherapy.
Anxiety disorders
This category includes a wide range of conditions, from phobias to panic attacks. These can lead to social isolation and lower academic achievement. Treatment consists of medication and/or therapy.
Eating disorders
(Anorexia; bulimia; compulsive eating disorder). Their incidence has risen significantly in recent years, affecting mainly females. Early treatment is vital because their long-term prognosis is grim. Anorexia is the mental disorder with the highest mortality rate. Its chances of cure decrease with the passing of years from the time of onset.
Signs that your child needs pediatric psychiatry
persistent hopelessness and sadness constant anger
tendency to overreact to situations
the child is not reaching normal developmental milestones persistent worry
fear and anxiety
excessive preoccupation with appearance
illness-related fear that someone is controlling their mind
they feel out of control
suddenly gets bad grades at school
which cannot be explained
loss of interest in activities they used to enjoy
social withdrawal
prefers to be alone
suicidal thoughts
inability to concentrate, think clearly, make decisions
inability to sit still
performing routines obsessively throughout the day (e.g., washing hands, or cleaning things)
regular nightmares
excessive dieting or compulsive eating followed by vomiting
participating in violent activities, such as killing animals or setting things on fire
It is important to note that these are not the only signs that may appear.
Children are different, and so are the manifestations of different mental disorders. In addition, some children are very good at hiding their feelings from their parents. They do this out of fear of upsetting them or being punished.
It’s very important to listen to your instincts if you feel something is wrong, even if you don’t know exactly what it could be.
It’s better to reach out for a pediatric psychiatric assessment and find out that everything is fine, rather than wait until the situation worsens. In addition, if you take your child to the psychiatrist, it could be a great opportunity to educate them about mental health. It can teach them how important it is and that there is no shame in asking for help from specialists when you need it. This makes it more likely that in the future, if there is a problem, they will come to you to solve it.
Evaluarea psihiatrică
When evaluating a child or teenager’s mental health, pediatric psychiatrists have more than one patient. Rather, they work with the entire Family. Family is a complex system, which plays a vital role in a child’s growth and development. All of its members and their interactions are important to a kid’s mental health. To navigate through these sensibilities, the pediatric psychiatrist will talk with the patient, and all of their caretakers, so they can draw a better picture of the environment the child is raised in.
Usually, children either can’t or don’t want to explain their symptoms. Because of this difficulty, child psychiatrists use a creative approach, depending on the child’s age and upbringing. This approach includes games and building an environment based on trust.
Another of psychiatrists’ useful tools, are standardized tests and quizzes. They will examine the patient’s physical state as well, potentially recommending blood sample testing, in order to exclude any chances of the symptoms’ origins being organic or physical.
Establishing a pediatric psychiatric diagnosis
One of the biggest fears parents have when seeking Pediatric psychiatry is getting a psychiatric diagnosis for their child. The fear is caused by the stigma of mental illness. But it should not be viewed with fear and uncertainty. It is a simple first step towards healing and harmonious development of the child.
Once the diagnosis is known, the pediatric psychiatrist will establish a treatment plan. It most often consists of therapy and/or medication, depending on the case. Parents play an active role in the treatment process, which can cement family bonds and ultimately lead to more harmonious relationships.
For many conditions, such as depression or anxiety, treatment is very effective in children and adolescents.
A study shows that after one year of treatment, 66% of the children and adolescents included in the research had no clinical symptoms of these conditions.
When should we really call the specialist?
If we observe delay in expressive language development of the child
Example: child does not speak at age 2, although understands most commands
If the child presents delayed psychomotor development by age stages.
normally the child should be able to stand on his own at 3 months, sit up at 6 months, walk on all fours at about 8 months, stand unsupported at 9 months, walk unsupported at 1 year, 1 year and 6 months, say his first meaningful words at about 1 year)
If the child shows signs that might suggest a autism spectrum disorder
Absent/intermittent eye contact, does not respond by turning head when called, although he hears. Delayed language development – either does not speak, has a certain pronunciation peculiarity, or has echolalia (repeats what he has heard, but without meaning and with the same intonation). Has difficulty socialising with children, shows stereotypical interests in particular games, objects, colours, etc. Shows motor stereotypies – waving hands when happy, walking on tiptoes, spinning in circles, etc.
If the child has eating disorders
Anorexia, bulimia and elimination. Enuresis = involuntary urination, absence of sphincter control in children over 5 years of age. Encopresis = involuntary faecal elimination, with soiling of linen, in children over 4 years of age.
In the case of opposition and conduct disorders
The “stubborn” child, who does not obey the rules and is aggressive. Or who steals, leaves home without asking before the age of 13 several times, is aggressive with others, lies.
In the case of mood disorders
1. Depression
Unmotivated or insufficiently motivated sadness persisting for at least 2 weeks or irritability. Lack of playfulness or previously enjoyable activities, weight loss or weight gain, decreased or increased appetite, fatigue, sleep disturbance, difficulty concentrating or memory impairment. Ideas of worthlessness, suicidal thoughts or suicide attempts;
2. Manic episode
Persistent euphoric mood for more than a week, weariness, flight of ideas, difficulty concentrating. Inability to complete started activities, overspending, sleep and eating disorders;
3. Anxiety
Generalized fear without a specific object, permanent worries accompanied by mental tension, inability to relax, difficulty concentrating, insomnia.
In the case of psychotic disorders
When they have thought disorders – incoherence, ideas that do not correspond to reality. E.g. stalking, poisoning; visual, auditory, “blank stare” hallucinations, as if watching or talking to someone when alone. Bizarre behavior, altered from the child or adolescent’s usual behavior.
In the case of suspected substance use
Psychomotor agitation, overspending, stealing to obtain money to purchase prohibited substances. Altered behavior, enlarged or shrunken pupils, eye congestion, tearing, tremor, chills, etc.
How is the consultation conducted?
- In the first part: the anamnesis data are taken from the parents or the adult person accompanying the child, in most cases the child is also present and can intervene in the discussion; the children are given various activities, such as drawing, playing, writing, depending on their age, in order to get used to the first session.
- In the second part the interview with the child/adolescent takes place
- In the third part the discussion with parents
- In the fourth part the conclusions are formulated: diagnosis, possible further investigations and treatment plan (family psychological counselling, psychopharmacological – where appropriate, individual psychotherapy – where appropriate)
