Sandra L. Fritsch, MD, Guest Editor

Harsh K. Trivedi, MD, Guest Editor

There has long been a struggle, both in the medical profession and in the general public, about the interplay between the mind and the body. The notion that one’s mental health can be so inextricably linked to one’s physical health is often discounted or overlooked. Take, for example, the patient with asthma who is on prednisone and develops an altered mental status with hallucinations. A critical corollary to this is the notion that one’s mental health care provider needs to work collaboratively with one’s primary care provider. Indeed, this is all too often not the case and as the saying goes “never the twain shall meet.” This phenomenon is also present in the healthcare industry as mental health carve-outs are used to manage mental health and substance abuse benefits. With the recent passage of mental health parity legislation and health care reform, integration of mental health and physical health will be key. The Mental Health Parity and Addiction Equity Act passed by the US Congress ensures that coverage for mental health and substance abuse benefits will be equitable to medical and surgical benefits for group health plans with more than 50 employees. The Patient Protection and Affordable Care Act establishes accountable care organizations and creates a substrate for better integration of all care. The opportunity to improve children’s health at this critical juncture should not be missed. —From Harsh K. Trivedi, MD, Consulting Editor, Child and Adolescent Pyschiatric Clinics of North America “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” —World Health Organization, 1948

As we enter the era of health care reform, “accountable care” organizations, and patient- and family-centered medical home models, never has the interface of pediatric health care and child mental health needs been more necessary. This edition was originally published in the Child and Adolescent Psychiatry Clinics of North America to help child and adolescent psychiatrists gain basic understanding of common pediatric illnesses, both to understand the health care challenges of their own patient in the office and to have a common language with primary care clinicians. The goal of this issue is to provide the reader a basic understanding of common chronic illnesses beginning in childhood (even at the time of conception); an understanding of the role of development, the family, and mental health issues, and how they may affect treatment adherence; and challenges faced when transitioning to adulthood.

The issue begins with an overview on the Pediatric Medical Home. Drs Trivedi’s, Pattison’s, and Neto’s article provides a historical overview and defines basic concepts, constructs, and credentialing issues to become a Medical Home. Professor Garralda’s article on unexplained physical complaints greatly underscores the need for a Pediatric Medical Home and the expertise of child mental health providers. She also reports on two chronic health conditions: recurrent abdominal pain and chronic fatigue syndrome; recent advances in evidence-based treatments for the conditions and mixed findings on the etiology of chronic fatigue syndrome.

The next series of articles focuses on the psychosocial challenges of the very premature infant, behavioral and psychiatric concerns for the neurodevelopmentally challenged child, and the developmental perspective of the child and family with cystic fibrosis. Drs Vanderbilt and Gleason address the mental health concerns of the very premature infant throughout the lifespan from attachment concerns in infancy, to attentional and learning issues in the school-age child, to risk for psychopathology in the teen and young adult. My colleagues, Drs Siegel and Smith, have written a concise, yet thorough article on phenotypic and behavioral manifestations of major genetically based syndromes. In addition they provide a primer on basic genetic testing. Our colleagues from Cincinnati Children’s Hospital have written an elegant article addressing the developmental and psychosocial issues of the newborn to the transitioning young adult with cystic fibrosis. Their article could serve as a treatise on normal development and the impact of a chronic illness in the context of development. In addition the authors note the increasing social isolation for children and teens with cystic fibrosis, social isolation that is required to prevent/lessen infectious disease complications and novel Internet programs to address that isolation. One potential sequelae of cystic fibrosis is organ transplantation and our next article in the series is Dr Stuber’s article on Psychiatric Issues in Pediatric Transplant. Included are a historical overview, family and psychological considerations pretransplant, pregnancy following transplant, and a brief note on the emerging field of face and hand transplants.

The next group of articles in the series includes potentially lifelong chronic illnesses including inflammatory bowel disease, asthma, diabetes mellitus, obesity, and epilepsy. Szigethy and colleagues educate us about the rapid advances in defining the genetics and development of treatments for the two major conditions of inflammatory bowel disease: Crohn’s disease and ulcerative colitis. In addition, they underscore quality-of-life issues and comorbid mental health considerations lending to further treatment challenges. Peters and Fritz provide an overview of the medical and treatment aspects of asthma, linkages of psychosocial stressors and exacerbation of illness, the mental health conditions associated with asthma, and the essential work with the patient and family on symptom perception. The next article in the series focuses on diabetes mellitus, predominately insulin-dependent diabetes mellitus, but makes note of the increasing incidence of type 2 diabetes and metabolic syndrome. In addition to focusing on neuropsychological consequences of hypo- and hyperglycemia, the article also broadens our understanding of family factors, comorbid psychiatric conditions, and the notion of “assent” for treatment of the developing child. An overview of pediatric obesity is provided by Dr Maloney, which underscores the public health crisis and the need for policy reform and education to address this crisis. Our colleagues from Children’s Hospital of Boston advance understanding of pediatric epilepsy and psychiatric concerns. They underscore the need for collaborative care models, involvement with schools, and factors to promote resiliency.

The final portion of the issue addresses potential life-threatening illnesses, including HIV and oncologic illnesses, and finishes with an article on palliative care. Dr Benton’s article on pediatric HIV reports a chilling trend of increasing cases of HIV infection in teens, a preventable illness! She underscores the need to address mental health issues, which may lead to increased risk for infection as well as treatment adherence challenges of the HIV-infected person. Kurtz and Abrams write about the psychiatric issues associated with pediatric cancer, including the impact of the developmental level of the child and family at the time of diagnosis, the changing landscape, with an increasing number of children surviving cancer and factors aiding successful transition to adulthood, and the overall role of child mental health providers working with children, adolescents, and family members receiving treatment for pediatric cancer. Our issue ends with an informative overview of palliative care issues for children and families. Knapp and colleagues describe two innovative programs in Florida and provide a roadmap for mental health collaboration in pediatric palliative care.

The authors in this issue are to be commended for the valued contribution they each made under a deadline that was challenging. I must personally thank Sarah Barth at Elsevier for her support, guidance, and clear thinking during times of potential chaos or disaster and her recommendation to consider publishing the complete original edition in Pediatric Clinics of North America . Thanks must also be given to Kerry Holland at Elsevier for publishing the “Interface between Pediatrics and Children’s Mental Health” in this issue of the Pediatric Clinics of North America . Thank you.