Pediatric Psychiatrists in Children's Hospital

Gregory K. Fritz, M.D.

Consultation liaison psychiatry, or pediatric psychiatry, as it is more commonly known, involves child and adolescent psychiatrists' diagnostic and treatment work at the interface of psychiatry and pediatrics. Usually based in children's hospitals or general hospitals with a large pediatric service, the pediatric psychiatrist provides consultation to pediatricians, ambulatory pediatricians, pediatric specialists, and pediatric surgeons regarding a broad range of issues. These include, psychiatric, psychophysiological, socio-familial or behavioral problems affecting their medical or surgical patients. Pediatric psychiatrists are involved in everything from puzzling diagnostic problems (Why won't the toddler gain weight?) to behavior management (How can the scratching be controlled?) to systems' issues involving other professionals in the hospital (How can parents get consistent, timely information when many staff are working on a case?). They provide psychopharmacologic expertise, family interventions, grief counseling, behavior modification and therapy to help children cope with their illnesses. In a "liaison" capacity, they also serve as a resource for physicians, nurses and other professionals. They provide guidance around difficult aspects of pediatric care. For example, a pediatric psychiatrist provides staff support and leadership after a particularly difficult patient death, dealing with a psychiatrically impaired parent, and in clarifying ethical issues associated with potentially dangerous treatment.

Many children's hospitals have "ped-psych" inpatient units or day treatment programs directed by pediatric psychiatrists. These units provide intensive treatment for children and adolescents with such problems as eating disorders, pain syndromes, brittle diabetes, morbid obesity, difficult rehabilitation, or other chronic illnesses complicated by a large psychosocial component. Pediatric psychiatrists, on an outpatient basis, work with children who have disabling headaches, conversion disorders, enuresis or encopresis, difficulty adhering to their medical regimen, functional gastrointestinal symptoms, anxiety or depression associated with a serious chronic illness, and similar problems that involve both the "psyche" and the "soma."

Few pediatric psychiatrists work in isolation. Ideally, the mental health professionals in a children's hospital - psychiatrists, psychologists, social workers, psychiatric nurses - are organized as a multidisciplinary team to make the most effective use of their diverse areas of expertise. A child with cystic fibrosis, for example, may need an antidepressant and therapy for depression that is worsening the course of the illness, a behavioral program to ensure medication adherence, and family therapy to help divorced parents deal effectively with the child's medical and emotional needs. A coordinated team effort can have a major positive impact on such a case. Teaching is always an important aspect of the pediatric psychiatrist's role, both at the bedside and in didactic conferences. Pediatric psychiatrists teach medical students, pediatric residents, psychology interns and postdoctoral fellows, attendings in other specialties, as well as, trainees in their own discipline. Many exciting research opportunities for pediatric psychiatrists exist. Increasingly, research projects are being undertaken in the psychosocial/psychophysiological realm within children's hospitals. Child and adolescent psychiatrists with a strong medical orientation like the variety and fast pace of work at children's hospitals and find pediatric psychiatry to be an ideal professional career path.