Working with your Pediatrician

What Should Parents Expect of Their Pediatrician When They Are Worried about a Child's Emotional Health?

When you have concerns about your child’s mental health, turning to a trusted professional can be supportive and helpful. Pediatricians or other health care providers know your child and family well, and could be important allies in finding guidance and resources around mental health assessment and treatment. The following document may be helpful for you if you are concerned about your child’s mental health. It provides information regarding what expectations you might have from your pediatrician when talking about your child’s mental health, as well as how to establish successful working relationships with such important figures in your child’s mental life.

Basic principles

  • Confidentiality — Parents should expect that information shared in the context of an office visit will be strictly confidential and will be shared with no one (e.g. a schoolteacher or a therapist) without explicit permission. There are two exceptions to this rule. First, if a child is a danger to himself or others (e.g., suicidal or homicidal) the safety of the child or others is of utmost importance and confidentiality must be broken. Second, if the pediatrician or health care provider learns that the child is a victim of abuse, this must be reported in order to protect the child.

    Parents may wish to consider allowing the pediatrician to share limited mental health information to specific school personnel staff (e.g., school nurse, guidance counselor, in- school mental health clinician). As emotional or behavioral problems may significantly impact a child’s school performance, communication between the pediatrician and a school liaison will be important in providing prompt and relevant treatment recommendations. (Sample: Information Release Form)
  • The nature of the visit — Parents should expect to be listened to in a caring and compassionate way, with a respectful and non-judgmental attitude on the part of the doctor. Mental health concerns may be present in any family, regardless of composition, education, or background.
  • The role of “stigma” — Parents may be fearful of experiencing a sense of shame when sharing their worries about possible mental illness in their children. They may ask themselves, “Why is this happening to me, where did I go wrong, or am I to blame?” The answer is that there is no one to blame. There are a host of possible reasons, which may cause emotional distress in children. The most effective way to seek help is to establish open, honest communication and to expect that stigma should not play a role in the relationship with your pediatrician, or in the quality of care your child will receive.
  • Answering the question “Why?” — Obtaining an exact reason for why a problem has developed may not always be possible. Families experience different circumstances and stressors, and it is unlikely that the explanation for current predicaments will be achieved as easily as a throat culture can rule out a strep infection. However, discussing the current concerns is an important step in identifying those factors, which may potentially contribute to your child’s distress. The result of this act of sharing may be the beginning of a plan to move ahead with a potential solution.

Frequently Asked Questions(FAQs)

How might you and your pediatrician work together when the focus of the visit is to share concerns about your child’s mental health?

While each provider will have his or her own unique style of interaction, there are several resources that provide parents with an idea to the nature of information gathered during the visit. Internet sites that are helpful in this regard include the Children's Emotional Health Link. At that site, there are two relevant articles. One is entitled, Taking a History. Another is entitled Is There a Problem? Deciding When to Assess the Emotional Health of the Child. Resources also exist on the American Academy of Pediatrics web site and at the web site representing the American Academy of Child and Adolescent Psychiatry.

Regardless of how the information is gathered, the primary consideration is that the pediatrician should help you know what to expect. For example, a visit to discuss a child’s mental health may take more time than routine appointments. Additionally, you should be informed that some questions might be of a sensitive nature. In this regard, you and the pediatrician should discuss, prior to the visit, whether including your child in the discussion would be beneficial.

Finally, you should also know that you may choose to share initial concerns with the pediatrician, but may prefer to discuss more detailed or in-depth information with a different kind of professional, such as a mental health clinician. You should feel that you are able to have choices regarding every step of the process.

What is at the heart of successful parent–pediatrician collaboration?

You need to feel a sense of trust in the pediatrician. Indeed, all good primary care medicine relies on this fundamental issue. However, there may be times when families discuss the more personal issues of psychosocial distress, that the relationship may feel quite different to both patients and physician. You need to feel that your doctor cares, that he (or she) is not rushed, that he sees this kind of interview as an important professional task, that he is comfortable doing so, and, in particular, that he will respect the many choices and decisions families may make in the course of seeking assessment or treatment. The pediatrician should encourage parents not to rush into making a decision, assessing the strengths of different ways in going about things, and even encourage them to seek a second opinion in order to help them develop new insights.

Pediatricians are responsible for communicating with the parent. It is very important that you should be encouraged to repeat any questions for which you feel you still do not have clear answers.

Finally, you know your child better than anyone else. Pediatricians and other pertinent professionals are encouraged to ask the parents to review the child’s strengths, interests, and goals. Professionals should not assume to understand the child completely based on a set of questions, but rather use information obtained through evaluation questions to complement the parents’ global opinions and impressions.

What kind of information should you consider sharing with the school staff?

Please see the form titled Information To Consider Sharing With School Personnel at the end of this guide.

What if the school suggests an evaluation be done?

Members of the school staff observe children on a daily basis within different contexts, and are often very good at identifying a change in children’s mood or demeanor. Therefore, their recommendation of an evaluation may be confirmation of your own concerns about your child’s emotional functioning.

What if my the child needs counseling?

You and the pediatrician may come to the conclusion that counseling, or ongoing treatment may be useful. The pediatrician may recommend a child psychiatrist, psychologist, social worker or a similar counselor within the school. Taking a proactive, preventive approach is often helpful. For example, even if your child’s distress may not be significantly impairing all aspects of his/her functioning, obtaining counseling to deal with the present stress to prevent a more serious crisis may be beneficial.

What if the child only needs “medication”?

When a child is experiencing emotional distress, it is rare that therapeutic intervention will consist of medication only. Typically, an evaluation by a mental health practitioner will facilitate an understanding of which treatment components may be most successful for the child. If medication is recommended, the pediatrician and mental health provider should discuss who would prescribe and monitor the medication.

How active a participant should you be in your child’s ongoing psychosocial treatment?

Starting from finding the right provider, to participating in ongoing treatment, you should be active members of your child’s treatment team. That is, you should be key figures in obtaining updates on your child’s progress, you should be made aware of particular treatment recommendations to follow through at home, and you should be able to ask questions about the goals of treatment. If at any time you feel uncomfortable with the provider, if you have concerns about how treatment is progressing, or if you just have questions that you would like the provider to address, it is your right to meet with the provider to ask for clarification. The provider should be able to maintain and respect your child’s confidentiality while being attentive to your questions about how to best support your child during treatment.

When first calling a mental health provider, it is important for you to interview the provider to increase the likelihood of a good match for your child and his/her treatment needs. Sample questions may include:

  • Are you a licensed mental health practitioner?
  • What is your experience in working with children ages ____?
  • What are your areas of clinical expertise?
  • Are you affiliated with a hospital or clinic?
  • What is your policy in terms of communicating with parents and schools?
  • Who provides coverage for you if there is an emergency?

Further Information:

Disclaimer: Material on the MSPP INTERFACE® Referral Service website is intended as general information. It is not a recommendation for treatment, nor should it be considered medical or mental health advice. The MSPP INTERFACE® Referral Service urges families to discuss all information and questions related to medical or mental health care with a health care professional.