Volume 4 Issue 3 March, 2014
Consultation Liaison Psychiatry Focus: ‘Paediatric Surgery’
Paediatric surgeons often deal with complex congenital birth defects, complex mechanical and functional problems
involving children. The very word of “Surgery” invokes apprehension, fear in the parents (Only an experienced parent
knows how difficult it is!!!). This is because of the complex nature of surgeries that need to be done, their associated
complications and long term sequelae.
Hospitalisation increases the potential for unresolved anxiety in a child, which can produce long term psychological
trauma. It is a challenging experience for a child as it involves loss of privacy and independence, disruption of daily
routines and separation from caregivers. This can manifest behaviourally, emotionally, and psychologically as nervousness, aggression, anger, fear of mutilation, guilt, pain or rage. It may be difficult for the treating surgeons to
spend adequate time with the child or family to address all these issues. It is here that the role of a child psychiatrist or a consultation liaison psychiatrist cannot be over emphasized. They provide immense help in tackling psychiatric, psychophysiological, socio-familial or behavioural problems involved with the family.
Just to cite some examples…..
- A child with Ano-rectal malformation, having completed all stages of surgery (Usually requires 3 surgeries in High/Intermediate varieties) and still continuing to have fecal incontinence is commonly teased by his/her peers, poses a constant stress to the family. She/he gradually becomes withdrawn, may develop psychiatric issues.
- Psychiatrists need to play a great role in treatment of these children to bring them back into the society, help them lead a normal/near normal life.
- A male child, operated for Hypospadias (a condition where the urinary meatus is located on the ventral aspect of the penis rather than the tip) and had some complications is again teased by his peers for his inability to pee like others .
- A child who is having urinary incontinence due to bladder neck or sphincteric problems is always wet, smelling of urine. He may not be allowed to school, again teased by his peers with constant parental stress.
- A child with Neural tube defects like Meningomyelocoele who needs clean intermittent catheterization or daily enemas to keep him/her dry is always a burden to the family.
- Children with malignancy requiring surgery, chemotherapy, radiotherapy; complications associated may put down an entire family.
Child psychiatrists can play a major role in providing psycho-pharmacologic expertise, family interventions, grief counseling, behaviour modification and therapy to help children cope with their illnesses. In a “liaison” capacity, they
can also serve as a resource for physicians, nurses and other professionals. Finally, a team work between the treating
Surgeon, Paediatrician and Psychiatrist will help in a long way in the better treatment of these ailing children and bring
them back to the society and help them to lead a life as normal/near normal as possible.
Dr.Raghunath.B.V, MS, M.Ch., FPMIS, Assistant Professor, Department of Paediatric surgery, Rajarajeswari Medical College, Bengaluru
