Parents of a handicapped child need an ongoing relationship with someone who understands both their struggles and their child's. The pediatrician is the professional most familiar with the child and family, including their full range of needs. With proper knowledge of childhood development, neurological maturation, and emotional growth, the pediatrician can serve as a longitudinal supervisor. A child is not simply a small adult. As he grows, his environment changes significantly, and the meaning of his handicap shifts across different stages of life.
It is the developmental physician who can periodically review and revise the treatment plan in response to the changing, dynamic problems that emerge with growth. Of course, he must work with other healthcare and social professionals, as well as educators, coordinating their efforts and directing the team's work as needed.
The necessity of this multidisciplinary collaboration becomes clear when we consider how often psychomotor handicaps have multiple causes, and how profoundly they affect school integration and social participation.
In every case of psychomotor handicap, parents expect the pediatrician to take two patients into care: the child and the family. The pediatrician's first essential role is early detection of handicap. Diagnosis must be confirmed through subsequent evaluation by a team of specialists—pediatrician, neurologist, orthopedic surgeon, and others.
This collaboration serves another crucial purpose: to prevent the typical parental denial of diagnosis, the subsequent visits to other specialists that so often follow, and the resulting delay in beginning treatment.
Once diagnosis is made, treatment becomes the question. I emphasize treatment rather than therapy, because treatment encompasses everything possible—from medical to human perspectives—to ease the child's difficulties and improve life for both patient and family.
Treatment, then, is the sum of all therapies addressing the child's different dimensions: physical, intellectual, social, and more.
The pediatrician's essential role in treating the psychomotor handicapped child involves:
- first, directing the patient toward appropriate specialists or rehabilitation centers;
- second, identifying and treating every clinical condition that contributes to developmental delay and social adaptation difficulties, while maintaining constant vigilance over the child's overall health;
- third, supporting and guiding the family through clarification, education, and practical advice about the condition and what can be done.
The pediatrician has another task, equally important: intelligent collaboration with social and educational services in programs for the handicapped.
The fundamental principle of adequate treatment is that it must be centered on the child's family and their needs.
It bears remembering that the birth of any child—beyond positive reactions—brings parents worries and problems tied to the new family situation, which inevitably worsen when the child is not normal.
Additional objective difficulties arise: the frustrating reality of living in a society that prizes efficiency and competition; the shattering of parental hopes for their child; the risk of initial rejection—of the diagnosis or even the child itself—and conscious or unconscious guilt. The physician must be alert to these problems and intervene to address them. What the pediatrician tells parents about their child, and the manner in which he speaks and acts with them and the child, can profoundly shape the parents' relationship to their son or daughter. There may be times when the pediatrician calls upon a psychologist or social worker to support the family through crisis.
The first phase of treatment consists in clarifying the diagnosis to the parents and establishing the most appropriate treatment plan with the family.
Both parents should be present. This reduces misunderstanding and fosters early collaboration in facing the repeated stresses of raising a handicapped child. In the diagnostic conclusion, the child must be considered as a whole—attention drawn not only to his deficits but to his strengths and capacities.
The pediatrician thus bears responsibility not only for medical care and the general health monitoring that any child requires, but above all for guiding the entire psychological treatment of the handicapped child and his family.
This privileged role continues as long as the child improves and grows, until more time is devoted to educational work.
Then parents come to understand that the child's school success depends on his autonomy, and the guiding role passes to the teacher.
Dr. Antonio Comito, 1979