Not long ago, a friend asked me what was the most common question parents ask about the emotional development of children. Initially, I was uncertain about the answer. Was it, "Is my child's behavior normal?" or "What can I do to make sure I am doing the right thing?" But, on reflection, I decided it was often something else. When parents are concerned about their child, they frequently ask, "Could you recommend something I can read?"

The good news is that by asking such a question, parents demonstrate that they are being reflective about a particular problem and that they want to do something about it. It may also show that they trust the pediatrician by asking for help, if only to recommend something to read.

But the bad news with recommending something to read is that many problems are better handled by talking them out, face-to-face. When parents ask, "Could you recommend something for me to read?" perhaps they are really saying that they don't expect the doctor to take the time to discuss their issues, face-to-face.

The family pediatrician has a unique advantage with helping parents address the emotional problems of children. He has known the family over time, has been available to address serious health issues, has observed the child's growth and development, and is often present at periods of transition and stress. Nevertheless, it is true that pediatricians and parents have often not capitalized on this advantage. Too often, parents are either prematurely reassured or referred too quickly. If parents and pediatricians could discuss the possibility of thoughtful, empathic listening, not looking at the clock, both might discover that many problems could at least be better understood, and possibly even solved, just by taking the time to talk. It does require, however, that the pediatrician really listens, striving to understand how the whole family is coping.

The following suggestions are offered with the hope that they might help parents create such a relationship with their physician. If they could, it might be a step toward solving their child's problem. For example, parents might:

* Ask if the physician is willing to help with an emotional problem. At their earliest meeting, parents should consider asking if the doctor is willing to help with behavior concerns. If she is not, then parents should ask for a recommendation for another professional who can assist them with their child's problem.

* Question the physician if he tells you that your child "will grow out of it." Parents need to feel certain that they have been given adequate opportunity to describe the problem or to have their child assessed.

* Review the issue of confidentiality with the physician. Parents may wish to ask the physician how their child's medical record and the private information that the parent may be sharing will be protected. Physicians need to listen and reassure parents that details are protected from being shared with anyone who might misuse the information.

Understanding what is involved in an adequate assessment of your child's problem is also important. An adequate assessment may take an hour or longer and may include a history of the family as well as the child. It is helpful for parents to describe if their child's problem coincided with some event or if it is chronic, when it occurs, the duration, if there is a family history of this type of concern, and what the parents have done to help the child. Perhaps the parents view the problem differently. What are their worst fears if it continues? While these types of question may make a parent feel uncomfortable, they are important for a full assessment of the child's situation. Finally, a good assessment should include a discussion of the child's and the family's strengths.

If the physician views the parent as a teacher, the doctor-patient relationship could evolve into a very special partnership. Furthermore, if doctor and parent could accomplish such a meeting of minds and feelings, then it is reasonable to hope that the parent, in turn, might move on to helping his or her child become similarly competent. However, how can parents judge the quality of their child's evaluation? Parents should feel that:

* the physician is profoundly interested in them as people,

* they have shared their thoughts and feelings,

* they feel a renewed sense of competence in addressing the problems of their child,

* they see that they have choices in confronting these problems and that they have the capacity for making good decisions.

While it is painful for parents to confront developmental issues in their children, such problems could also be viewed as an opportunity to assess how they and their child are doing. The earlier this assessment is accomplished, the better. If parents can find an empathic listener, they may discover the problem has been bubbling under the surface for some time. By working with the pediatrician to consider how their family is doing, parents may find constructive interventions that could help their family become stronger.

For more information on patient-physician partnerships or health-related concerns, please consult the following:

American Academy of Pediatrics
Department of Maternal, Child, and Adolescent Health
141 Northwest Point Blvd.
P.O. Box 927
Elk Grove Village, IL 60009-0927
Telephone: 800-433-9016

Touchpoints Project
1295 Boylston St.
Boston, MA 02115

Telephone: 617-355-8158

Shelov, Steven. (1994). Caring for your baby and young child: Birth to age 5. Bantam Books, 1540 Broadway, New York, NY 10036.

Schor, Edward L. (1995). Caring for your school-age child: Ages 5 to 12. Bantam Books, 1540 Broadway, New York, NY 10036.

Greydanus, Donald E. (1991). Caring for your adolescent: Ages 12 to 21. Bantam Books, 1540 Broadway, New York, NY 10036.