Medical Family Therapy in Pediatrics

Abstract

Pediatric medicine—or “pediatrics” as an umbrella term—promotes the physical, mental, and social well-being of infants, children, adolescents, and young adults (American Academy of Pediatrics, 2011). Pediatric practices are generally situated within primary and specialty care/tertiary care settings. Primary care settings—also called pediatric patient-centered medical homes (PPMH; Ader et al., 2015)—include those where annual well-baby and well-child visits, sick visits, and routine physical exams take place. They are usually led by generalist pediatricians. Specialty/tertiary care settings require additional training tailored to a specific content areas, such as pediatric endocrinology and/or obesity, pediatric pulmonary, pediatric oncology, pediatric hematology, pediatric orthopedics, pediatric intensive care, neonatology, neonatal intensive care, pediatric palliative care, pediatric nephrology, pediatric audiology and speech pathology, pediatric rheumatology, pediatric urology, pediatric gastroenterology, and other health conditions/presentations (see glossary for term definitions). Healthcare providers—and the roles that they serve—in pediatric specialty care teams are tailored to the specialty itself (e.g., a registered dietician in a pediatric endocrinology and obesity clinic).

Additional Resources

Literature

Briggs, R. D. (2016). Integrated early childhood behavioral health in primary care: A guide to implementation and evaluation. Switzerland: Springer International Publishing.

Durand, V. M. (2008). When children don’t sleep well: Interventions for pediatric sleep disorders therapist guide. New York, NY: Oxford University Press.

Hassink, S. G. (2014). Pediatric obesity: Prevention, intervention, and treatment strategies for primary care (2nd ed.). Elk Grove, IL. American Academy of Pediatrics.

Jenkins, R., & World Health Organization. (2004). WHO guide to mental and neurological health in primary care: A guide to mental and neurological ill health in adults, adolescents, and children. London, U.K.: Royal Society of Medicine Press.

Reiff, M. I. (2011). ADHD: What every parent needs to know. Expert guidance from the American Academy of Pediatrics. Elk Grove Village, IL: American Academy of Pediatrics.

Roemer, J. B. (2011). American Diabetes Association guide to raising a child with diabetes. Alexandria, VA: American Diabetes Association.

Simmonds, J. (2014). Seeing red: An anger management and anti-bullying curriculum for kids. Gabriola Island, B.C., Canada: New Society Publishers.

Welch, M. J. & American Academy of Pediatrics. (2000). American Academy of Pediatrics guide to your child’s allergies and asthma: Breathing easy and bringing up healthy, active children. Elk Grove Village, IL: American Academy of Pediatrics.

Electronic Resources

A Family Guide: Integrating Mental Health and Pediatric Primary Care. http://www.integration.samhsa.gov/integrated-care-models/FG-Integrating,_12.22.pdf

Childhood Asthma. https://www.aaaai.org/conditions-and-treatments/library/at-a-glance/childhood-asthma

Healthy Children/Healthychildren.org. https://www.healthychildren.org/English/Pages/default.aspx

Kids Health. www.kidshealth.org

Strategies to Support the Integration of Mental Health into Pediatric Primary Care. http://www.nihcm.org/pdf/PediatricMH-FINAL.pdf

Measures/Instruments

Motivation for Youth Treatment Scale. http://peabody.vanderbilt.edu/docs/pdf/cepi/ptpb_2nd_ed/PTPB_2010_AppendixB_MYTS_031212.pdf

Patient Health Questionnaire (modified for adolescents). http://www.integration.samhsa.gov/images/res/8.3.4%20Patient%20Health%20Questionnaire%20(PHQ-9)%20Adolescents.pdf

Pediatric Intake Form. https://www.brightfutures.org/mentalhealth/pdf/professionals/ped_intake_form.pdf

Pediatric Symptom Checklist. http://www.massgeneral.org/psychiatry/assets/PSC-35.pdf

Screening for Child Anxiety Related Disorders (SCARED). http://psychiatry.pitt.edu/sites/default/files/Documents/assessments/SCARED%20Child.pdf

Vanderbilt ADHD Diagnostic Parent Rating Scale. http://www.childrenshospital.vanderbilt.org/uploads/documents/DIAGNOSTIC_PARENT_RATING_SCALE(1).pdf

Organizations/Associations

American Academy of Pediatrics/Family-Centered Care. https://brightfutures.aap.org/

American Diabetes Association. http://www.diabetes.org/living-with-diabetes/parents-and-kids/

Academy of Nutrition and Dietetics. www.eatright.org

Obesity Action Coalition. www.obesityaction.org

Glossary of Important Terms for Care in Pediatrics

Anticipatory guidance

The practice of educating parents about what they can expect for their child’s development over the next few months or years. Education and recommendations are delivered at each visit and are specific to the child’s age.

Asthma

A chronic inflammatory condition that involves constriction of the airway resulting in symptoms such as coughing, wheezing, and shortness of breath. This is likely to occur when the child is engaging physical activity behaviors. Asthma can have multiple triggers (e.g., smoke, strong odors, pollen, dust mites, pet dander) that need to be identified and is most commonly treated using medication management and environmental/behavioral changes.

Cerebral Palsy

The most commonly diagnosed motor disability in children resulting in problems with movement and posture. It can be caused by either abnormal brain development or brain damage in utero. CP has no cure, but early intervention can improve quality of life .

Child-centered medical home

An approach to pediatric healthcare endorsed by the American Academy of Pediatrics that encourages a long-term, collaborative relationship between the child’s family and a primary medical provider that is aware of the child’s health history and can serve as base for all the child’s healthcare needs.

Developmentally and age-appropriate care

Healthcare that is tailored to the needs of the child based on his/her level of physical, social, emotional, and cognitive development. This practice involves the provider shifting their focus from the parent to the child as the child becomes older, more independent, and capable of engaging in their visits.

Diabetes

Type 1 diabetes is a disease characterized by the body’s inability to make insulin , the hormone that is responsible for breaking down and storing energy from food. It needs to be treated with insulin injections, often through the use of a pump. Type 1 diabetes is typically diagnosed during childhood; it is the most common form of diabetes present in children . Type 2 diabetes is a chronic condition caused by insulin resistance, wherein the body can make insulin but does not use it effectively. Type 2 diabetes is now being diagnosed in children because of the rise in childhood obesity . It is most commonly treated with the use of medications and lifestyle changes, such as increased physical activity and improved nutrition intake.

Early intervention

A system of services that promotes helping children with developmental delays or disabilities as soon as they are discovered. Early intervention typically takes place in the first 3 years of life.

Family-based care

Healthcare practice where the intervention or treatment focuses on the child patient and at least one other family member, typically the caregiver.

Family-centered care

A collaborative approach to healthcare where the patient , the family, and the healthcare team are equally involved in the assessment of needs and development of a treatment plan.

Family-focused care

An approach where the healthcare provider assumes the role of the expert when assessing and treating. The patient and family are considered the unit of intervention, and the provider does the intervening by creating a treatment plan.

General pediatrician

A primary care physician with specialty training in pediatric care. A qualified general pediatrician, in the United States, will be board certified by the American Association of Pediatrics.

Malnutrition

A condition that occurs as a result of poor nutrition , which can include either undernutrition and overnutrition . It can lead to other conditions, including changes in weight status, behavioral and mental health problems, and inadequate immune system functioning.

Neonatal intensive care

An inpatient unit that specializes in caring for premature or severely ill newborn infants.

Neonatology

A subspecialty that focuses on providing medical care to newborn infants, especially premature and medically ill newborns.

Overweight/obesity

The most commonly diagnosed chronic childhood illness; it is diagnosed when a child weighs too much for their height, based on their age and sex, and is often characterized by excessive adipose (fat) tissue. It is often related to comorbidities such as insulin resistance and diabetes , high blood pressure, sleep apnea, and musculoskeletal pain.

Pediatric audiology and speech pathology

Evaluation, diagnosis , and treatment specialty care for children with hearing and communication disorders . These providers encourage early screening and intervention practices.

Pediatric endocrinology

The management and treatment of disorders associated with the endocrine glands, including growth disorders , puberty, sex differentiation, glucose metabolism, bone and mineral metabolism, as well as problems with the adrenal, thyroid, and pituitary glands. The most common disease treated by pediatric endocrinology is type 1 diabetes .

Pediatric gastroenterology

A specialization in the treatment of digestive system diseases, including bowel syndromes, constipation, diarrhea, vomiting, food allergies and intolerances, nutritional problems, gastroesophageal reflux disease, and liver disease.

Pediatric hematology

The study and treatment of blood disorders , which often include bleeding disorders , blood cell disorders , anemia, blood transfusions, and bone marrow and stem cell transplant. Specialists in hematology work closely with pediatric oncology.

Pediatric intensive care

An inpatient unit that specializes in caring for critically ill infants, children , and teenagers by providing continuous monitoring of symptoms .

Pediatric nephrology

A subspecialty of pediatric care responsible for the management of kidney function and kidney problems, including dialysis and transplants. The most common disease treated by pediatric nephrology is high blood pressure.

Pediatric obesity

Pediatricians who offer evidenced-based treatment on lifestyle changes aimed at reducing a child’s weight, while also managing and treating weight-related illnesses such as high blood pressure and insulin resistance.

Pediatric oncology

The treatment of research of childhood cancers, commonly including leukemia, lymphoma, brain tumors, and bone tumors. Often closely associated with hematology, and both specialties may be available in the same practice.

Pediatric orthopedics

Specialists in the musculoskeletal system. They most commonly treat limb and spine deformations, gait abnormalities, broken bones, and bone or joint diseases, infections, and tumors.

Pediatric palliative care

Healthcare focused on improving the quality of life for a child and family with serious illness. It focuses on symptom relief from and easing stressors associated with the illness. It should not be confused with end-of-life care or hospice .

Pediatric pulmonary

Specialty care in the management and treatment of breathing and lung diseases. The most common diseases treated by pediatric pulmonologists include asthma , cystic fibrosis, and apnea .

Pediatric rheumatology

Specialists in musculoskeletal and autoimmune conditions, including arthritis, chronic musculoskeletal pain or weakness, and lupus.

Pediatric urology

A surgical subspecialty in the evaluation, diagnosis , and treatment of diseases in the urinary tract and genitals. The most common diseases treated include urination and reproductive organ disorders .

Sleep apnea

A sleep disorder characterized by heavy, loud snoring, typically associated with pauses, gasps, and snorts during sleep. A child with sleep apnea may experience restless sleep, bedwetting, fatigue, and sleepiness when woken up/during the day and behavioral problems. This disorder is commonly found in children with severe obesity .