Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians

Book Preface

Mental health (MH), including all its psychosocial and emotional aspects, is an intrinsic part of overall health and well-being. Pediatric primary care clinicians (PCCs) (pediatricians, family physicians, internists, nurse practitioners, and physician assistants who provide frontline, longitudinal health care to children and adolescents) have an important role to play in influencing the intentional pursuit of optimal MH as part of each child’s or adolescent’s development. Good MH has been described as “the reasonable, regular experience and effective practice of

▶▶Confidence and courage
▶▶Adaptability
▶▶Cheerfulness
▶▶Attention/concentration
▶▶Harmony
▶▶Hardiness
▶▶Social connectedness”1

The foundation of MH begins before birth, with the parents’ and caregivers’ own well-being and with preparations they make for the physical and emotional care of the child. Caregivers continue to build on this foundation after the child’s birth by providing their attention and love in a safe and nurturing environment. Interaction between the child’s biological makeup and his or her environment—particularly the relational experiences—affect the architecture of the child’s brain.

The environment expands from the child’s home to include the child care setting, school, and community, ultimately affecting his or her biological reactivity to stress, psychological resilience, and immunologic resistance throughout life. Box 1-1 provides examples of the skills needed by caregivers in all settings to nurture social-emotional competence in a young child. Each stage of childhood provides PCCs and other members of the medical home team with unique opportunities to promote MH during regular contacts with the child or adolescent and his or her caregivers. These