Children are still seen but not heard

Editor—Kroenke and Gask and Underwood describe in some detail the multiplicity of psychological presentations in patients.¹,² No mention is made, however, of the many children seen in general practice and by paediatricians who have primarily mental health problems, psychological factors associated with their physical illness (such as diabetes management), or medically unexplained symptoms (such as recurrent abdominal pain). The best estimate of the prevalence of psychiatric disorders in young people in the United Kingdom is the Office for National Statistics figure of 10% of all children.³ This figure increases appreciably in inner cities and when chronic ill health, and particularly neurological disorders, are present. But only one in five of these attend mental health services for children and adolescents. Some evidence exists that family doctors can provide effective treatment for this group.⁴

Children are in the unique position of being presented to their family doctors by parents, rather than seeking help themselves. They are therefore vulnerable in “the consultation” to the effects of mental illness and personality disturbance in their parents, which can range from the genuinely (over-) anxious to the homicidal.

Quite apart from the genetic transmission, the psychosocial impact of parental mental illness, separation, and divorce is considerable and may well present as psychosomatic symptoms in vulnerable children. At the other end of the scale, a few parents and carers actively harm children and then seek help for their illness.

Patterns of help seeking behaviour are established in childhood. Practising psychological medicine in children may well reduce undesirable adult patterns of health care use. If it is to truly encompass the whole person, child and adult, psychological medicine must consider all members of the family, not only adult patients.