Introduction: Child Psychiatry Is Not Only About Children

Children come with parents. This is one of first lessons that I teach my residents: you can’t work with a kid in a vacuum. Parents who do not feel some connection with a caregiver will not bring their child to treatment or follow the recommendations of the treatment team. The articles in this Special Report reinforce that lesson.

Jeremy M. Hirst, MD, reflects on the role of the child psychiatrist on a multidisciplinary pediatric palliative care team-a scenario in which the child psychiatrist must attend to the child’s death and to the parents’ quality of life.

Sandra L. Fritsch, MD, and Jerrold S. Olshan, MD, point out how the lack of family support can have a negative impact on treatment adherence and long-term health in children with type 1 diabetes mellitus. Child psychiatrists can guide struggling parents and other family members to assist their children in developmentally appropriate ways.

Amy Yule, MD, and Timothy Wilens, MD, present their study on the familial connection of substance abuse, which corroborates our suspicion that children learn what they live. It turns out that if mothers abuse drugs, then the likelihood that their daughters will abuse drugs increases.

Finally, Brian Zimnitzky, MD, reviews the role of the child psychiatrist in custody battles. It is no surprise that children are significantly affected by their divorcing or divorced parents, particularly those who remain in bitter conflict with each other.

In these areas of child psychiatry, as in many others, the job is to make an alliance with the parents to help them identify their children’s needs and respond to them with compassion and understanding. Without such an alliance, the treatment will likely fail and the child will suffer. Sometimes the parents are the patient.