The Pediatrician and the "New Morbidity"

Abstract

THE CHALLENGE

A decade has passed since the American Academy of Pediatrics (AAP) defined the role of the pediatrician in providing increased attention to the prevention, early detection, and management of the various behavioral, developmental, and social functioning problems encountered in pediatric practice.¹ These problems, called the "new morbidity,"² are not really "new"; they have always affected children, but many have become more prevalent. For example, the number of children and adolescents with activity limitation caused by a chronic health condition with attendant psychological problems currently approaches 8%.³ The number of children living with divorced mothers doubled between 1970 and 1986. The suicide rate for male adolescents has doubled since 1960.⁴ Because of the prevalance of these problems, the peditrician s being asked to expand the traditional role of health supervision and management of physical illnesses to address psychosocial and behavioral problems more effectively.

THE BARRIERS

To achieve this goal, pediatricians must overcome educational, economic, and time management obstacles, despite tremendous strides in the development of an educational blueprint,⁵ an ever-increasing knowledge base, and a growing cadre of educators. Pediatric residency training is focused on major physical illness in tertiary care hospitals and to a limited degree on behavioral issues. Training in ambulatory settings has expanded, although training in behavioral pediatrics remains limited in many residency programs. In 1987, the Residency Review Committee added a requirement for behavioral teaching, although the specific time requirement for training in behavioral pediatrics is undefined. Consequently many pediatricians have completed training with limited instruction in psychosocial issues.