Mental Health and Psychosocial Care
Core concepts
Pediatric mental health includes developmental, emotional, and behavioral concerns. Recognize anxiety, depression, ADHD, autism spectrum disorder, and trauma responses. Use developmentally appropriate communication and validated screening tools. Assess for safety-suicidal ideation, self-harm, and abuse-and know when to escalate.
Therapeutic milieu: structure, safety, consistency, and positive reinforcement. Family involvement is key; teach caregivers behavior management and coping strategies. Understand the impact of hospitalization on children by age (separation anxiety in toddlers, fear of body intrusion in preschoolers, loss of control in school-age children, privacy and autonomy in adolescents).
Psychosocial care includes supporting siblings, addressing stigma, and coordinating with schools and mental health professionals. Recognize that behavior is communication.
Traps
- Dismissing behavioral changes as "just a phase" when red flags exist.
- Missing suicidal ideation because the child was not directly asked.
- Using adult therapy approaches without developmental adaptation.
- Ignoring family and school context.
- Forgetting confidentiality and assent in adolescents.
Rule of thumb
Ask directly about safety ("Have you had thoughts of hurting yourself?"). Direct questions do not plant ideas and are essential for risk assessment.
Worked example
A 14-year-old with declining grades and withdrawal is noted to have cuts on the forearm. Approach calmly and privately, ask directly about self-harm and suicidal thoughts, ensure safety, involve appropriate mental health services, and follow confidentiality and reporting policies.