Physical contact with child and adolescent patients

Although I recognise and share some of the concerns about the appropriateness of certain types of physical contact with patients, I was surprised by several aspects of the survey by Blower et al (2006) of the views of child and adolescent psychiatrists.

First, I was puzzled by the fact that 1% of respondents selected the ‘do nothing’ option in response to the clinical vignette of a distressed child running towards a busy road and that the implications of such a response were not commented on by the authors.

Second, although Blower et al referred to physical examination in their discussion, the participants do not seem to have been asked about their views on this in either the questionnaire or the telephone interviews. The authors then seemed to downplay the role of physical examination and treatment in child psychiatry, both of which are becoming increasingly important.

Physical examination is essential in the assessment and management of many psychiatric conditions, including attention-deficit hyperactivity disorder, eating disorders and severe depression. Specific syndromes associated with behavioural disorders, particularly those accompanied by learning disability, may be missed without appropriate examination (Devlin, 2003). In addition, physical examination is necessary before initiating drug treatments and in monitoring for adverse effects, particularly when using stimulant drugs or atypical antipsychotics.

Knowledge, understanding and practical experience of the use of physical treatments is required as part of specialist registrar training in child and adolescent psychiatry, alongside the use of other treatments, including the various psychotherapies (Royal College of Psychiatrists, 1999). If trainees or consultants lack confidence or skills in physical examination and treatment, or feel uneasy with the physical contact this requires, it would be appropriate for them to seek further training as part of continuing professional development.