Dr. Chandrasekhar Dabhadkar*, M.D. (Ped.), D.C.H.**
Consultant Pediatrician Mahad (Dist. Raigad), Maharashtra.*, Consultant Pediatrician Mahad (Dist. Raigad), Maharashtra.**
12 years old female child was brought to hospital with vague complaints of pain in chest, tingling and numbness, headache, vomiting and blurring of vision. Detail clinical examination didn't reveal anything abnormal, hence child was admitted and subjected to many tests including funduscopy, lumbar puncture etc. Child was sent to city hospital for CT scan & MRI. However every result was normal. We were confused with plethora of symptoms, lack of signs and normal laboratory results. Finally our hospital staff interviewed the child in absence of her parents and we were shocked to know the results. She was the only child of very famous and academically successful parents, who were serving in one reputed research institute. Both parents were busy in their field and the child was brought up in a highly lonely atmosphere by a caretaker. The child was alone without friends, grandparents or relatives. She developed depression, tried to commit suicide after some academic failures, however was saved by a neighbour and on the top of it, parents were unaware of her suicide attempt.
How miserable! We were not only shocked and shaken but were ashamed of our profession. The child was in need of love, appreciation, affection, and we were loading her with so many medicines! The child was in perfectly normal 'physical' health and we were busy in detecting some 'illness' or 'syndrome' in this child !

No doubt, giving birth to children is a natural instinct but their upbringing is an art, which demands active efforts, concern, sensitivity and skill of parents. Unfortunately, we spend lot of money and energy providing a child with best possible food, best possible immunization, best possible education, clothes and toys. However, we fail to provide them best possible environment for their natural psychosocial development. In fact, we neglect this important aspect of child development. Almost all of us know details of modern gadgets like TV, computers, radio, etc; we train ourselves in maintenance and repair of these gadgets but unfortunately we are least aware of our own children and their psychological needs! As Penn said " Men are more careful of the breed of their horses and dogs than that of their own children".

We, medical professionals in general and pediatricians in particular discuss a lot about child health problems in our routine practice. We do extensive research in childhood illness and present our data to medical fraternity in national and international conferences, but neither we are serious regarding psychosocial needs of our own children, nor regarding their behavioral problems. Though we say 'children are jewels dropped unstained from heaven' we are least concerned regarding their psychological needs!

Of course, rapid industrialization, urbanization and rapid modernization have arranged our lifestyle. In addition, nuclear family set up, both working parents leave the child at the mercy of servants and in this situation child may fall prey to the problems of neglect. Disturbed interpersonal relationship, overprotection of rejection, family discipline, undesirable parental model, over expectations etc do play important role in personality of a child and may lead to 'Problem Child'. In fact, as said, 'there is no problem child but Problem Parents'.

Apart from interaction with parents, other factor influencing child's psychosocial development is his interrelation with his teachers, friends, close relatives and people coming in contact with him. Conflict between child's developing personality and that of his parents, teachers, siblings and other children lead to abnormal psychosocial development and may manifest in the form of behavioral a problem.

These psychosocial problems are classified and grouped by many scientists in different ways. This classification can be simplified and grouped as:
  • Problems of feeling (e.g. depression, anxiety, etc.)
  • Problems of bodily functions (e.g. psychosomatic disorder)
  • Problems of behavior (e.g. conduct disturbances, passive-aggressive behavior etc.)
  • Problems of performance (e.g. learning disorder, etc.)

The etiology of these psychosocial disorders is multifactorial as stated above, but most important causes are physical or emotional stresses like birth defects, physical injury, inconsistent and contradictory child rearing practices, marital conflicts, child abuse, neglect, overindulgence, chronic illness, etc.

Manifestation of these psychosocial problems depend on many factors and particular problem do not produce specific symptom of disorder. Broadly, these manifestations depend on variables like temperament, developmental level, nature and duration of stress, past experiences and coping ability of the child as well as family.

It is observed that chronic stress or series of stressful events are much more difficult for a child to tackle than single acute stressful event. They may manifest in many ways like thumb sucking, nail biting, mud eating, hair plucking, anger spasms, temper tantrums, hyperactivity, habit spasms, bed wetting, faecal soiling, stammering and other speech and sleep disorders.

Children who have abnormal psychosocial development, and are neglected for a long time may develop anti-social behavior and different psychiatric illnesses and then it will take very little time for these cases to blow up into juvenile delinquency at a very rapid rate.

In short, it can be said that so many behavioral problems manifest in early childhood. Causes are multifactorial like adverse family circumstances or frustration, over pampering or significant neglect from teachers or parents, overconfidence or lack of confidence etc. These problems may pip-up during development of a child. It is duty of every parent and pediatrician to recognize these problems at a very primary stage. For this one needs a high index of suspicion.

On this great occasion, let us (parents, teachers⁷, pediatricians) pledge to study, identify and treat these problems at earliest. Let us dedicate and devote some time for this priority problem in childhood development. Let us discuss this 'neglected problem in pediatrics in every zonal, state and national conference for perfectly healthy (physically and mentally) future generations.

Let me conclude this important (but neglected) topic with few lines from my collection.
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