Q: I have heard that some parents tend to worry more easily over their child's health; and, as a result, make the child sick. Is that true and what kind of parents fit into this category of worrying excessively?
A: There is indeed a medical diagnosis, first described in 1964 by Dr Green from the Indianapolis Children's Hospital, called the "Vulnerable Child Syndrome" (VCS).
VCS refers to a physically healthy child who is viewed by a parent as being at a greater risk for behavioral, physical and developmental diseases than what is actually likely. Usually Vulnerable Child Syndrome develops when a parent has experienced their child’s serious illness (i.e. a bad asthma attack), hospitalization for jaundice or dehydration or a "near miss sudden death" (the child survives a life threatening event and survival was not expected).
Risk factors for the development of VCS include:
- Previous serious injury or illness in the child
- Problems with conception, miscarriages, still births
- Acquired infertility in subsequent situations due to sterilization or even a hysterectomy
- Preterm delivery
- Birth defects
- Heart disease
- Jaundice in the newborn
- Feeding problems in the first few years of life
- A high risk of hereditary disorders
The above list includes only a few, but common, examples. Sometimes there is a spectrum of VCS. For example, innocent heart-murmurs are relatively common in children. Yet, a study showed that 40% of parents who were told that their child had an innocent murmur, continued to restrict that child's athletic activity into early adolescence (NEJM 1967;276:1008-1013).
If one of the risk factors occurs in a family predisposed to worrying and depression then the stage can be set for many years of struggle. These parents are excessively concerned about their child, despite re-assurances that the child is healthy. Unfortunately, perception is more important than reality to these parents; and, they frequently have to resist the urge to see a doctor or visit the emergency room, because they’re hoping to catch an illusionary problem before it deteriorates into something more dangerous.
The doctor has to work hard at reassuring the family that the child is well. Even after a thorough history and examination, clear, specific communication and anticipatory teaching, some doctors feel insecure, starting to worry that they may be missing a rare diagnosis. It definitely takes a doctor with the Wisdom of Solomon and the Patience of Job to help these families.
Excessive parental concerns and high frequency use of health care are very typical in the Vulnerable Child Syndrome. If this kind of behavior and belief system continues over a long period of time, it may cause these so-called illness prone children to become more vulnerable to mental and physical health problems and it may actually make them sick. Illness begets illness. Children are very sensitive; so, it should not be surprising that they sense the unwarranted parental anxiety and it has an impact on them.
Parents of vulnerable children have difficulty being apart from the child; they frequently overindulge the child; they’re often overprotective; the child is less likely to receive appropriate discipline; and some parents even tolerate physical abuse from the vulnerable child.
The scale that is used to measure Vulnerable Child Syndrome was devised by Forsyth and Canny (it can be seen in more detail by accessing the Journal of Pediatric Psychology 1996:21:89-101). Following are a few features on the scale. A "yes" response to these questions may indicate that you have a vulnerable child:
- Does your child seem to be less healthy than other children of the same age?
- Do you often think about calling the doctor about your child?
- Does your child usually catch whatever is going around?
- Is your child more accident prone?
- Do you get concerned that your child does not look as healthy as he or she should be?
- Does the child usually get stomach pains and other sorts of pains?
- Does your child have less energy compared to other children?
- Do you often keep your child indoors because of health reasons?
- Do you often check your child at night to make sure he or she is okay?
- Do you feel anxious about leaving your child with a baby sitter?
- Do you feel guilty when you have to punish your child?
It is unfortunate that parenting, a joyful journey for most, becomes a constant worry for others; especially when there is no real reason for that concern and those fears are seldom realized. Family therapy may be helpful, but even that frequently fails to reassure parents of a vulnerable child.
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An informed parent is ... an empowered parent.