- The Washington Times - Sunday, April 20, 2008

If a child develops a bit of a runny nose but seems otherwise healthy, it doesn’t make a lot of sense to visit the doctor, much less rush to the emergency room. If, however, the child develops a cough and then a fever, an appointment with the doctor would be prudent. Even absent additional symptoms, if the runny nose requires the consumption of box after box of tissues, it’s a good idea at least to check in with the doc.

This came to mind when I received a letter from a psychiatrist specializing in child and adolescent care who scolded me for not recommending a psychiatric evaluation for a 10-year-old boy who used a school writing assignment — a poem, actually — to express sadness at the state of the world.

The boy wrote that he was afraid of death, afraid of life, had scary dreams sometimes, wanted to die and wondered how life would turn out. The rest of the poem was about things he loved and looked forward to, like eating macaroni and cheese and reading imaginative books. When his mother asked him about the poem, he broke down crying, saying that life is made up of good and bad and the bad dominates. In general, his mom said, he’s bright, articulate and “cautiously happy.”

What we have here is a sensitive boy who is becoming aware that life is not a plate of macaroni and cheese. He’s losing his innocence, which is too bad, and, lacking emotional maturity, feels overwhelmed at times by things he is just beginning to understand. He used a poetry assignment to express what he hasn’t felt free to express otherwise. Such is the nature of poetry as well as the upshot of losing one’s innocence prematurely, which is the plight of today’s children.

I advised the child’s mother not to overreact. It was obvious from her letter that this gloominess was not a regular feature of her son’s personality. The last thing he needs at this time in his life, I said, is a mom who is anxious about him. A parent who worries unnecessarily about a child can cause the child to begin worrying that perhaps something is wrong with him. The child’s anxiety causes the parent to worry even more, and before you know it, there’s a problem where there might never have been one otherwise.

The psychiatrist said I was being “irresponsible” and that the mother should take the child to a psychiatrist for a “face-to-face evaluation.” With all due respect, I think it might completely unnerve this child for his mom to take him to talk to a professional because he seized upon the license of a poetry assignment to purge himself of certain feelings.

It could cause the child to resolve never to talk to his parents about anything other than macaroni and cheese again. Keep in mind, too, that the overall tone of his poem was upbeat, concerning things he liked to do. All in all, this child had the equivalent of a runny nose, not symptoms of a life-threatening illness.

Yes, the child wrote that he sometimes felt he wanted to die, but that is not the equivalent of “I feel like killing myself.” Besides, one incident does not a diagnosis make, nor does it necessarily justify seeking professional help. If this were part of a pessimistic pattern, professional help certainly would be warranted, and I certainly would have recommended it.

What alarmed the mother was that the child was usually a “cautiously happy” boy, not given to pathos. What about that word “cautiously”? I took that to mean that although this little guy isn’t exactly happy-go-lucky, he’s generally in good spirits — happy enough, in other words.

Speaking of caution, common sense should tell us that prudence should temper any consideration of psychiatric or psychological services for a child. In that regard, I generally recommend bouncing the idea off someone who knows the child’s history — the child’s primary physician, for example — an objective third party who can help the parents put their concerns into proper perspective.

Taken out of context, molehills sometimes can look an awful lot like mountains.

Family psychologist John Rosemond answers parents’ questions on his Web site (www.rosemond.com).

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