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Trouble du comportement de l'enfant : Ébauche de raisonnement clinique en médecine de famille

par Kacenelenbogen, Nadine
Référence Revue médicale de Bruxelles, 38, 4, page (218-227)
Publication Publié, 2017-09

Article révisé par les pairs

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Résumé :

Context : In Belgium 70 % of the children aged 0 - 14 years have at least one annual contact with their family doctor, while for the same period, only 6 - 12 % of them will see a neuropaediatrician and/or a child psychiatrist, despite the fact that a diagnostic of Externalizing behavior before the age of 6 to 7 years, such as various ways of aggressiveness, of anger or of stealing will very often alert the family, the staff of creches or nursery as well as the teachers. Other children are showing signs of Internalizing behavior, very often together with depression or other forms of anxiety. Objective : Considering the role and the skills of the family doctor, the target is to propose a clinical approach adapted to the first line practitioner having to face the majority of complaints about the behaviour of a child younger than 10 years. Methodology: Bibliographic research. The research equations were used on the data base TRIP DATA BASE, Cochrane Library, PUBMED and Google Scholar (EN/FR), searching, bare exception, the literature of the last five years. Moreover, the sites of the Haute Autorité Française (HAS), Société Scientifique de Médecine Générale (SSMG), Centre d'Expertise en Soins de Santé (KCE), Institut Scientifique en Santé Publique (ISSP) and of the DSM V (Diagnostic and Statistical Manual of Mental Disorders) were consulted too. Results : The age of the child, his social and family environment will guide the family doctor and in the majority of cases, he will be able to reassure the family. Moreover, when in front of any problem within the family life it should be advisable to inquire about the health of the children in question, especially from a behavioural point of view. To the opposite, when a child is showing TEC or TIC, it is important to inquire about circumstances in his environment that might potentially be at the origin of (or contributing to) the troubles. Conclusions : The challenge the family doctor is facing is to be able in a consultation of 15- 30 minutes to make the difference between serious and less serious behaviour troubles of the child. We are suggesting a first approach to a tool that would allow the front-line doctors to make an evaluation. More developed evaluation scales to be used by the family doctor will be the subject matter of future research work.