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  • Title: Child mental health in the Americas: a public health approach.
    Author: Eisenberg L.
    Journal: Bull Pan Am Health Organ; 1992; 26(3):230-41. PubMed ID: 1382773.
    Abstract:
    The systematic, population-wide application of preventive measures based on what is known about the causes and outcomes of psychiatric disorders can markedly reduce morbidity from mental ill health among children in the Americas. The actions proposed here rely partly upon increasing access for all women and their children to thoroughly tested obstetric and pediatric care; in part they depend on improving nutrition and opportunities for cognitive stimulation; and in part they call for enhancing the mental health skills of primary care practitioners by appropriate in-service training. There are limits to our knowledge and to the effectiveness of some of our interventions; nonetheless, the greatest barrier to better child mental health is failure to muster the political will to apply what is known to the care of mothers and children in all sectors of society. A professor proposes a populationwide system to reduce the prevalence of mental disorders among children in the Americas. He bases his proposal on experience in the US, but the US is a heterogeneous society with some people living in poverty similar to conditions in developing countries and others having a relatively high living standard. Even though the emphasis on each component varies from country to country, any national plan should consist of the following components: family planning; prenatal care; immunization; optical nutrition; child safety; home visiting and day care; school based, health and family life education programs; and development of mental health awareness and skills in primary care facilities. Countries with highly developed health services should also include newborn screening of congenital metabolic abnormalities such as the correctable conditions of phenylketonuria, galactosemia, and congenital disorders of thyroid function. These screening programs should not exist without an extensive follow up program. Primary health care workers in clinical settings can also contribute to the prevention of mental disorders among children by prescribing to appropriate clinical practices. They must undergo training to recognize and manage these disorders. Health workers and school teachers must be trained to identify child neglect and abuse and to refer cases to the appropriate community agencies. Foster care should be only a temporary solution. If the neglect and abuse are chronic, the child should be become available for adoption. Improved obstetric care, better effective accident prevention, and timely treatment of central nervous system infections are needed to prevent epilepsy. Certain drugs are secondary prevention techniques to control schizophrenia and affective disorders.
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