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Child & Adolescent Psychiatry

Starting School: Tips for Parents
When To Seek Help For Your Child
Hospitalization

What does a child and adolescent psychiatrist actually do?
What training programs are available?

Parents, teachers and other caring adults can help reduce the anxiety associated with starting school. The following specific suggestions may help facilitate this process:

* Spend time talking to kids about school before they actually begin. Describe what school will be like and what will happen throughout the day.

* Bring kids to visit the school in advance. If possible, show them their classroom and other important landmarks such as the playground, the lunchroom and the bathroom.

* Let kids know that it's OK to feel nervous or worried when starting school. Reassure them that everyone feels a little anxious when they do things for the first time.

* Help kids establish a regular routine to get ready for school. Let them participate in making choices about what to wear, what to have for breakfast or what to bring for lunch.

* If kids are particularly anxious, consider sending a small reminder of home, such as a photograph of the family or a picture of a favorite pet.

* Arrange for kids to spend time with classmates out of school. Having friends always reduces anxiety.

* Spend time talking to kids about what happened in school. Chances are they'll have lots of stories.

* Give them plenty of positive feedback for all the new experiences.

Anxiety about starting school usually passes within the first few days or weeks. However, if kids are having excessive difficulties (e.g., problems sleeping, frequent temper tantrums, reluctance or refusal to go to school, etc.), further evaluation and/or consultation may be indicated. Talk to your child's teacher and/or family doctor. If difficulties persist, consider a referral to a trained and qualified mental health professional.

When To Seek Help For Your Child

Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

YOUNGER CHILDREN

* Marked fall in school performance
* Poor grades in school despite trying very hard
* Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age
* Frequent physical complaints
* Hyperactivity; fidgeting; constant movement beyond regular playing with or without difficulty paying attention
* Persistent nightmares
* Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures
* Frequent, unexplainable temper tantrums
* Threatens to harm or kill oneself

PRE-ADOLESCENTS AND ADOLESCENTS

* Marked decline in school performance
* Inability to cope with problems and daily activities
* Marked changes in sleeping and/or eating habits
* Extreme difficulties in concentrating that get in the way at school or at home
* Sexual acting out
* Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death
* Severe mood swings
* Strong worries or anxieties that get in the way of daily life, such as at school or socializing
* Repeated use of alcohol and/or drugs
* Intense fear of becoming obese with no relationship to actual body weight, excessive dieting, throwing up or using laxatives to loose weight
* Persistent nightmares
* Threats of self-harm or harm to others
* Self-injury or self destructive behavior
* Frequent outbursts of anger, aggression
* Repeated threats to run away
* Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism
* Strange thoughts, beliefs, feelings, or unusual behaviors

If problems persist over an extended period of time or if others involved in the child's life are concerned, consider speaking with your seeking a consultation with a child and adolescent psychiatrist or a trained mental health professional.

Hospitalization in a psychiatric facility is one of a range of available treatment options when a child or adolescent is mentally ill. Parents are naturally concerned and may be frightened and confused when inpatient treatment is recommended for their child. By asking the following questions, parents will gain a better understanding of the care proposed by admission to an inpatient facility:

1. Why is psychiatric inpatient treatment being recommended for our child, and how will it help our child?
2. What are the other treatment alternatives to hospital treatment, and how do they compare?
3. Is a child and adolescent psychiatrist admitting our child to the hospital?
4. What does the inpatient treatment include, and how will our child be able to keep up with school work?
5. What are the responsibilities of the child and adolescent psychiatrist and other people on the treatment team?
6. How long will our child be in the hospital, how much will it cost, and how do we pay for these services?
7. What will happen if we can no longer afford to keep our child in this hospital or if the insurance company denies coverage and inpatient treatment is still necessary?
8. __________________________
9. How will we as parents be involved in our child's hospital treatment, including the decision for discharge and after-care treatment?
10. How will the decision be made to discharge our child from the hospital?
11. Once our child is discharged, what are the plans for continuing or follow-up treatment?