1. The Long-stay Paediatric Inpatient and Consultation-liaison Psychiatry Dr Zanda Jaquire MBChB FCPsych Senior Registrar Child Psychiatry Dept. Child Psychiatry, UCT & Red Cross Hospital

2. What is a Long-stay Patient? Definition: 6 days or more = long stay Every hospitalised child: psychological reaction Degree varies - developmental level - pre-morbid emotional - chronic / serious condition - reaction of the family

3. Models of Interaction with Paediatrics Emergency response Anticipatory Case finding Continuous care and collaboration Education and support

4. Risk-factors for Emotional Problems: Child younger age pre-morbid emotionally vulnerable sudden / unprepared admission prolonged hospitalisation Physical factors chronic / more severe conditions invasive / painful procedure immobilisation, disfigurement Parents emotions (understanding, expectations, guilt…) marital stress / disruption financial drain

5. Why you become concerned: Anxiety Depression Behaviour problems Parent

6. Psychiatry Assessment: Time and flexibility Knowledge of normal development Emotional defence or regression Child as an individual in current context Relationships: parent-staff-outside Knowledge of medical illness and potential role of neuro-active medication

7. Abigail and Guillian-Barrè S. Physically extremely ill, urban ? clinically depressed Regular assessment impossible Focus on support structure identity autonomy Input from everyone associated Medication