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Helping Children Sweat the Small Stuff

Pediatricians can work with parents to overcome common behavioral problems

TUESDAY, Oct. 22, 2002 (HealthDayNews) -- It's the smaller behavioral problems that are most common among children.

However, those problems are also the ones that get the least attention, sometimes to the detriment of the child, a Missouri pediatrics professor says.

His advice: Enlist the child's pediatrician to help head off little problems before they grow into big ones.

"Parents can't get their children to eat, sleep, or go to the bathroom. These are the things that get parents frustrated. They're not exciting, but they affect a lot of people," says Edward Christophersen, a psychologist and pediatrics professor at Children's Mercy Hospital in Kansas City.

"Yet, while we have professionals in the mental health field to work with those children who have severe problems, common behavioral problems are not addressed. It's a missing piece," Christophersen says. "A parent isn't going to take his child to a psychologist three times at $150 for each visit because his son won't brush his teeth."

Christophersen outlined his recommendations to pediatricians during a workshop this week at the American Academy of Pediatrics' National Conference and Exhibition in Boston.

What's needed, he says, is for pediatricians to be on the lookout for common behavioral problems -- such as trouble getting along with other kids -- when children come for checkups. Then the doctor can advise parents on the best course of action.

"Parents see their pediatricians as the best source of information for their children, but that expertise is not being capitalized on," Christophersen says, adding that only 40 percent of parents ask their doctors questions about their child's behavior.

"People say, 'Oh, he'll grow out of it.' But if problems are identified at age 3 and left untreated, by age 9, 67 percent of those children will still have problems," he says.

Mindful of the limits on a doctor's time, Christophersen suggests that when parents bring their children in for a checkup, they could fill out a simple questionnaire in the waiting room.

Two short tests that have been developed are called "PEDS" and "IEYBERG." They ask parents questions like, "Do you have a concern about your child's behavior?" And, "Does your child get along with other children?" Christophersen says.

"This is much better than asking parents if they have any questions, or asking, 'How's this boy of yours?'" he says.

The results of the questionnaires would give the doctor a much better idea of how to help the child -- and the parent.

"It will shift the doctor's focus a little bit, and they will begin to identify resources to help, in the same way she now recommends a good orthopedist to set a broken leg," Christophersen says.

Resources include pamphlets, as well as teaching parents simple skills, such as how to set examples for what they consider appropriate behavior in the home.

"As parents get more stressed, they become reactive rather than proactive," Christophersen says. Doctors can recommend to the parent that instead of ordering a child to pick up his room, a parent can suggest they work together to do it more quickly, he says.

"It's not a trick to get the children to behave, but teaching them a different lifestyle that encourages good behavior," Christophersen says.

Pediatricians are eager for this kind of information, he says. In 1978, when Christophersen did his first workshop at an American Academy of Pediatrics conference, 350 doctors signed up. Now the academy has an entire section of experts devoted to behavior and development.

Matthew Silvan is a psychology professor at Columbia University who says Christophersen's call for increased communication between parent and physician has some merit. However, he'd rather see more training for pediatricians in behavioral problems.

"It's an admirable goal, but you're probably better off training a pediatrician who is skilled about childhood behavior to pick up things to talk to the child or make a referral," Silvan says.

What To Do

If you have RealPlayer on your computer, check the video "Begin with Love," narrated by Oprah Winfrey, at the American Academy of Pediatrics. For an outline of more significant childhood disorders, visit Wisconsin Family Ties.

SOURCES: Edward Christophersen, Ph.D., professor, pediatrics, Children's Mercy Hospital, Kansas City, Mo.; Matthew Silvan, Ph.D., professor, psychology, Columbia University, New York City; Oct. 20, 2002, presentation, American Academy of Pediatrics' 2002 National Conference and Exhibition, Boston
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