Healthy body image is critical to adolescent development, and teens often diet and worry about their weight and appearance. However, for some youth these concerns become fixed and distorted, resulting in psychopathology. Eating disorders, particularly binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious, complex chronic disorders, which can be life-threatening. Differential diagnoses for eating disorders include: cardiac valvular disease, malabsorption syndromes; inflammatory bowel disease; chronic infections; thyroid disease; hypopituitarism, Addison disease; central nervous system lesions; cancer; and other psychiatric disorders including depression, obsessive-compulsive disorder, anxiety, and substance abuse. Eating disorders are difficult to treat, especially when presenting with comorbid diagnoses, and treatment depends on the severity of the illness. Primary health care providers play a critical role in assessment, monitoring of treatment progress, screening for and managing medical complications, and coordinating care with psychiatric and nutritional professionals.
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Pediatric primary care providers (P-PCPs) are involved in the primary care of children and adolescents with developmental and behavioral issues. The purpose of ongoing developmental behavioral screening in a primary care medical home is to identify problems early. These early interventions improve the long-term outcomes for children and adolescents. This chapter focuses on some of the more common neurological and psychiatric disorders that are encountered by children and adolescents in the primary care medical home setting and the ways in which the P-PCP can better identify a mental health disorder as early as possible through screening and intercept the problem with evidence-based interventions to promote better behavioral health outcomes. However, even with early intervention, some of the mental health disorders are chronic, long-term disorders requiring lifelong attention and treatment. It covers bipolar I disorder, depressive disorder, conduct disorder, obsessive-compulsive disorder, schizophrenia, and trauma- and stressor-related disorders.
The preschool child is generally 3 to 5 years of age. At 3 years old, the child is becoming a real person. The preschool years are an important time to prepare children to be successful in school. It is critical to identify and address the problem of social behavior readiness long before a child enters school. Parents need to be partners with other professionals in helping their children to succeed. They need to learn about their child’s growth and development and to be aware of unusual behavior changes and/or regressions to work with pediatric primary care providers (P-PCPs) to intercept potential behavioral problems. This chapter addresses the assessment, screening, diagnosis, and treatment of preschoolers with behavioral health problems. It also discusses assessing for school readiness and strategies to intercept potential and identified behavioral health problems in preschool-age children to help the child become ready to succeed in school.
Pediatric primary care providers (P-PCPs), who are educated about resiliency, are in the unique position to assess child and family strengths, identify behaviors indicative of stress, and offer guidance and recommend services to help build child, adolescent, and family resilience. This chapter presents the evidence for building resiliency in children and the role of P-PCPs, which includes attention to the office environment and structure, comprehensive assessment, ongoing support, and community referrals. Building resiliency in children intercepts the impact of adversity on a child’s emotional, social, and behavioral health. Analysis of the results of screening tools completed by the parents and the child, appropriate assessment questions, office-based interventions, and timely referrals to therapy in community resources are critical components of the behavioral health assessment to enable the P-PCPs to intercept problems and build child, adolescent, and family resiliency.
This chapter discusses psychotropic medications for children and adolescents. While some stimulants and psychotropic medications are prescribed by pediatric primary care providers (P-PCPs) in primary care settings, and in particular those credentialed as pediatric primary care mental health specialists (PMHSs), many are prescribed by psychiatrists and psychiatric-mental health nurse practitioners (PMHNP). This chapter provides the most current information about simulant and psychotropic medications and other medications prescribed for children with emotional or behavioral and mental health problems, with a focus on safe prescribing for behavioral management, reduction in symptoms, and the knowledge needed to intercept adverse side effects of prescribed medications. It provides P-PCPs with information about the safety and effectiveness of psychotropic medications for this population, with a focus on the privilege and responsibilities for safe prescribing practices.
Eating disorders are the most common psychiatric illnesses among adolescent women and the most lethal of all psychiatric conditions within every age group, including children and the elderly. The incidence and prevalence of anorexia nervosa, bulimia nervosa, and other eating disorders in children and adolescents continue to increase, calling for an emergent need for pediatric primary care providers (P-PCPs) to be familiar with early detection and evidence-based management of these disorders. This chapter describes eating disorders in children and adolescents, appropriate screening to assess for eating disorders in this population, the medical and psychological evaluation, the medical complications, and current treatment recommendations. P-PCPs must know how to assess and diagnose children and adolescents who present with a possible diagnosis of an eating disorder, to intercept patients from the potential long-term damage of these deadly diagnoses, and to establish a referral to a psychiatric provider as soon as identified.
Innovations in fields such as neuroscience, developmental psychology, sociology, and molecular biology have sparked a paradigm shift toward a multidisciplinary approach to health. This paradigm shift is illustrated in the concept known as the social determinants of health (SDH). This chapter provides an overview of concepts of SDH and their effects on child and adolescent development, focusing on behavioral, mental, and biological health. In addition, this chapter describes the role of pediatric primary care providers (P-PCPs) in addressing SDH at each healthcare visit with a goal of under- standing the important role of SDH in achieving or in failure to achieve positive behavioral health outcomes. By incorporating the ways environmental factors interact with biological and behavioral factors, healthcare delivery systems can deliver optimal comprehensive care to improve overall health outcomes for the U.S. pediatric population, thus leading to a medically and behaviorally healthy adult population.
This chapter discusses the case study of adolescent with a substance use disorder. Confidentiality is defined as an agreement between patient and provider that information discussed during the encounter will not be shared with other parties without patient permission. A confidentiality statement must be provided to adolescents at every healthcare visit. The confidentiality statement assures adolescents that information provided to the pediatric primary care provider (P-PCP) during the office visit is a standard of care that supports full disclosure and trust between the adolescent and the P-PCP, without punitive consequences for the adolescent. P-PCPs must be knowledgeable about the laws in the state in which they practice to provide accurate information to the adolescents with admitted substance use problems. The key to intercepting these behaviors is effective office-based screenings and an immediate intervention with prompt referral to treatment and interprofessional collaborative initiatives at the national, state, and local community levels.
Fetal alcohol spectrum disorder (FASD) is a group of disorders that can occur when the fetus experiences intrauterine exposure to alcohol. Alcohol present in a developing fetus’s bloodstream can interfere with the development of the brain and other critical organs, structures, and physiological systems. This chapter discusses FASDs, and includes strategies for prevention including early identification of maternal alcohol use during pregnancy, appropriate screenings for both the mother and child, and interventions and treatments for the child throughout adolescence. Intercepting alcohol use during pregnancy should be a major goal for all healthcare professionals, including but not limited to adult primary healthcare providers, obstetricians, dentists, and pediatric primary care providers (P-PCPs), which includes pediatricians, pediatric and family nurse practitioners, and physician assistants. Primary prevention is key to eliminating the devastating effects on the developing fetus and the adverse outcomes the child experiences throughout their lifetime.
Infancy is a wonderful time for healthy parents and healthy infants to grow together within healthy home and community environments that support the social–emotional development of infants, thus establishing the foundation for lifelong behavioral and mental health. Pediatric primary care providers (P-PCPs) must acknowledge the paradigm shift to attain behavioral health for all by viewing behavioral health as beginning at the moment of conception and existing on a continuum throughout the life span, delicately balancing between behavioral/mental health and well-being versus behavioral health disorders/mental illness and malady. This chapter examines, analyzes, and evaluates the best available evidence to identify and intercept behavioral health problems prior to conception, post-delivery, and during the first year of life. P-PCPs must assess the mother–infant bonding and attachment relationship, maternal nurturing behaviors, and maternal responses to the infant, as well as the infant’s social–emotional developmental patterns, at every primary care encounter.