Cozzi and Barbi: Continuous positive support for parents

Children who are seldom really ill, but seldom really well, are repeatedly brought to their paediatricians’ attention for a variety of reasons, and may undergo a series of changing diagnoses and treatments. [1]

Epidemiological studies show that the prevalence of mental health and behavioural disorders is increasing in childhood and adolescence, and that these conditions frequently hide behind physical symptoms. [2] There is also evidence to suggest that parental anxiety, catastrophising, and overprotection impact on the development and outcome of these conditions. [3,4,5]

In these days of low natality, older parents, and only children, and with the availability of a wide range of sophisticated diagnostic tests and the constant fear of legal arguments, some paediatricians may become reluctant in making decisions without performing blood or other tests, without relying on specialist consults, or without prescribing medication for symptoms which are relatively minor and most likely self limiting. Because of this, repeated medical evaluation and diagnostic testing is often prominent in these children’s histories. [6]

Some physicians’ and parents’ behaviours may foster and perpetuate a certain perception of sickness, which can contribute to the loss of physical and mental growth opportunities in children.

To protect children and support families paediatricians need confidence to remain a continuous positive referral for these families, highlighting children’s and families’ strengths, and paying particular attention to family characteristics that could influence symptom presentation and exacerbation, such as family perception of illness, mechanisms for coping with stress, or any relevant family medical history. [7]

Scheduling frequent visits, sharing hypotheses, and involving community colleagues can reassure parents, limit reinforcement of familial anxieties, and discourage “doctor shopping” and excessive medicalisation. [7]

Dedicating time to offering explanations plays a pivotal role in reassuring parents and is constructive when deciding upon a shared way forward.

Giorgio Cozzi is a paediatrician at the Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy

Conflict of interest: None declared



Egidio Barbi is a professor of Paediatrics at the University of Trieste, Italy

Conflict of interest: None declared




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