For Some Time at the Children's Hospital of Philadelphia we have been concerned about the changing nature of pediatric practice. It seems apparent that the shifting morbidity and mortality patterns of childhood increasingly demand that the pediatrician assume an expanded responsibility in the psychosocial aspects of care. With this in mind we have focused our attention on the training needed to develop in the pediatrician the requisite skills to meet the demands of this expanded responsibility.

Many factors have contributed to changing needs of children seen in office practice. Increased knowledge of nutrition, electrolytes, immunizations and the antibiotics have influenced the entire spectrum of child hood illness. The population growth has brought increasing numbers of children to the pediatrician, and mobility of young families has led to isolation of parents from the support in child rearing formerly offered by close contact with their own families. Increasingly they turn to their physician for this support.

With the declining incidence of acute infectious disease, many children who would have died of congenital defects and metabolic disorders are now surviving. These cases are usually marked by high degrees of family disturbance and breakdown.

In addition, there has been a rising incidence of serious developmental disorders in very young children and an increasing parental concern about the supervision of emotional growth and development.

These and other factors have been well discussed by Richmond in a recent article in Pediatrics.1

Thus, the problems presenting themselves today both in office and in hospital practice, while they may be organic in symptomatology, are complicated by severe emotional components in increasing numbers.

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