This is the 91st #WILTW

Spotting the ‘sick’ child is, by and large, a relatively simple task. My training involved developing a visual library of well and unwell children which I needed to burn into my cerebral cortex. Now as an experienced paediatrician I apply pattern recognition to the children and infants I see to make decisions on who can go home and who needs further treatment. Experience, research evidence and previous errors keep me healthily skeptical so I don’t make snap judgements and communication skills ensure I am engaging with families not dictating to them. I hope I do a relatively good job in this regard.

However the term ‘sick’ child is usually reserved for those with medical or surgical illness. The infant with sepsis, the child with appendicitis, for example. But it is easy to overlook a less overt, sometimes less socially accepted, form of illness. Mental illness. Young people especially are often put into a one size fits all category, whereby grades of illness are not recognised so even the most distressed are given no more care and attention than anyone else. I think we  probably do badly at spotting the ‘most sick’ in relation to deliberate self harm and depression. Uncomfortably what I learnt this week is I might do a further group an even greater disservice.

Max Davie is a paediatrician with a strong interest in Mental Health and writes a blog at paedspoliticsbiscuits. He posted an eye opening blog for Children’s Mental health week. Max eloquently describes the lack of appreciation for children and teenagers with conduct disorders:

In one cubicle sits Clare, a 15 year old who has cut herself, then, in panic, told her mother and has been brought in. She’s upset, and talking animatedly with her mother. Next to her is Kyle. Kyle, also 15, has been stabbed in a fight outside a youth club, and sits sullenly alone waiting to be patched up. The evidence, as far as it exists, is that, of the two, Kyle is at a far higher risk of suicide. But it is Clare who will be admitted for a psychiatric assessment, while Kyle is stitched up and sent on his way as soon as his furious mum arrives.

Conduct disorders are, to use Max’s words: persistent patterns of anti-social or defiant behaviours that really get in the way of people’s lives. There are more precise definitions but I think this is as good an explanation as anything. Children with conduct disorders can be challenging. They make people feel uncomfortable. Sometimes the more you reason with them, the more they become agitated. It is all to easy to therefore limit your interaction with them, especially those with overtly aggressive behaviours.

So am I spotting the “child with the conduct disorder” in the same way as I do with other illnesses? Well probably only when it is patently obvious. Do I treat and react to these children in the same way as I do for the child with sepsis? Shamefully I suspect not. And while the conditions are treated differently ( importantly there is a immediate threat to life for a child with severe sepsis) Max’s blog is a reminder that conduct disorders and mental health problems may be no less deserving of our care and attention than other conditions. You may even argue more so…

What have you learnt this week? #WLTW

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