GPs’ strategies in exploring the preschool child’s wellbeing in the paediatric consultation

Abstract

BackgroundAlthough General Practitioners (GPs) are uniquely placed to identify children with emotional, social, and behavioural problems, they succeed in identifying only a small number of them. The aim of this article is to explore the strategies, methods, and tools employed by GPs in the assessment of the preschool child’s emotional, mental, social, and behavioural health. We look at how GPs address parental care of the child in general and in situations where GPs have a particular awareness of the child.MethodTwenty-eight Danish GPs were purposively selected to take part in a qualitative study which combined focus-group discussions, observation of child consultations, and individual interviews with GPs.ResultsAnalysis of the data suggests that GPs have developed a set of methods, and strategies to assess the preschool child and parental care of the child. They look beyond paying narrow attention to the physical health of the child and they have expanded their practice to include the relations and interactions in the consultation room. The physical examination of the child continues to play a central role in doctor-child communication.ConclusionThe participating GPs’ strategies helped them to assess the wellbeing of the preschool child but they often find it difficult to share their impressions with parents.

General practitioners’ accounts of how to facilitate consultations with toddlers – an interview study

“…They feel insecure about doing the right thing, and at the same time are anxious about their child. This does not indicate that the parents lack knowledge [ 18 ], but rather that they need reassurance, guidance [ 22 , 23 ], and to be listened to [ 6 , 22 ]. Jeyendra [ 20 ] describes that GPs working with families identify their role as one of an educator and a provider of support.…”

“…This corresponds with Crossley and Davies [ 22 ], who suggest that doctors in consultations with children need to address both the child and the parent. Also, Lykke [ 6 ] describes how GPs work from “reflection-in-action” when they need to address an issue in the consultation and how they choose to deal with it. Despite how the GP decides to deal with a raised issue, the strategy used always entails an attempt to establish a relationship with the family, to build trust and confidence [ 5 , 6 ].…”

“…Also, Lykke [ 6 ] describes how GPs work from “reflection-in-action” when they need to address an issue in the consultation and how they choose to deal with it. Despite how the GP decides to deal with a raised issue, the strategy used always entails an attempt to establish a relationship with the family, to build trust and confidence [ 5 , 6 ]. The GPs’ effort to maintain the relationship with a family affect their actions for example when facing suspected child abuse [ 25 ] and when deciding to prescribe antibiotic or not to a child [ 26 ].…”

“…Earlier research [ 5 ] speaks of GPs’ need for family-focused consultations, understood as involving the parents in the child’s consultation. The GPs describe consultations with children as triadic, or as balancing between two dyads, as their focus may move between the triad of GP–parent–child and the dyad of GP–child or GP–parent [ 6 ]. The available literature reviews focus on triadic encounters in consultations, and show that it is preferably the GP and the parent who communicate [ 7 , 8 ].…”

The Strengths and Difficulties Questionnaire is a usable way to address mental health at well-child visits in general practice - a qualitative study of feasibility

“…They report a lack of knowledge to detect and manage mental health problems in children [10][11][12]. They also seem to lack a method to involve parents in their specific observations and concerns about a child [13].…”