1 The Children's Hospital of Philadelphia
The experience with practice in a children's psychiatric hospital during the past 4 years has been used as the basis for some observations on the pediatric role. The evolution of this role has been related to direct care, but more and more utilized as a support resource for the staff. The application of pediatric care to the developmental potential in the child makes this use of the role possible. The need for this support derives from the fact that the heavy demands of disturbed children tax the resources of cartakers to a degree often beyond their capacity. As in private practice, the resultant anxiety of the caretaker about her capacity to nurture the child tends to appear as fears about the child's development. These concerns frequently are expressed in forms which are accessible to pediatric intervention. Several illustrations of this in children are given from daily practice. A model of care centered on child development is presented as a basis for understanding the dynamics of pediatric intervention. It is proposed that pediatric counselling is useful in providing emotional support to caretakers. Its effective use may be a factor in lessening the appearance of somatic symptoms in the child, thereby decreasing the need for direct symptomatic care.