Having a baby hospitalized in a neonatal intensive care unit (NICU) is a potentially traumatic event for parents. This article summarizes research documenting heightened symptoms of depression and post-traumatic stress in these parents and reviews studies of the relationship of parental distress with impaired infant and child development. We describe an array of validated screening devices for depression and post-traumatic stress, along with research on risk factors for elevated scores. In making recommendations for screening both mothers and fathers for emotional distress in the NICU, we (a) present commentary on the pros and cons of screening, (b) propose a timetable for screening and (c) describe both supportive interventions for parents in the NICU and a variety of referral possibilities for parents most at risk.

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems. SCOPE OF THE PROBLEM AND NEED FOR THIS REPORTBehavioral and emotional problems during childhood are common, often undetected, and frequently not treated despite being responsible for significant morbidity and mortality. By current estimates, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder at any given time. 1,2 Estimated prevalence rates are similar in young 2-to 5-year-old children. Developmental and behavioral health disorders are now the top 5 chronic pediatric conditions causing functional impairment. 3,4 Even greater numbers of children have This document is

Children and adolescents involved with child welfare, especially those who are removed from their family of origin and placed in out-of-home care, often present with complex and serious physical, mental health, developmental, and psychosocial problems rooted in childhood adversity and trauma. As such, they are designated as children with special health care needs. There are many barriers to providing high-quality comprehensive health care services to children and adolescents whose lives are characterized by transience and uncertainty. Pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services in the context of a medical home, and health care coordination and advocacy on their behalf. This technical report supports the policy statement of the same title.

Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.

A small number (11.1%) of cases of twin-twin transfusion syndrome treated with laser therapy are affected with neurologic impairment that manifests during infancy. A strict follow-up of apparently healthy neonates is warranted.