[A psychiatric consultation service at a pediatric hospital. Definitions, nomenclature, perspectives]

A psychiatric consultation service has been implanted for the last 15 years at the Children's Hospital of Tours. It co-ordinates pediatric psychiatric activities on the various wards of this large pediatric center (200 beds). All pediatric psychiatry personnel belong to this autonomous unit which plans their work: clinical care and liaisons, teaching and research activities. This unit manages 1,000 cases a year: 20% of children are aged 0 to 2 years, 40% are under 5 years of age. This type of structure in a university pediatric hospital fosters considerably an early diagnosis and the prompt triaging of children to the services available in their home districts for appropriate care. Furthermore, it facilitates a comprehensive approach with appropriate integration of the somatic and of the psychodynamic dimensions of the child. This type of implantation constitutes a significant step forward in the field. However, its professional activities are handicapped because of the discrepancy between resources made available to psychiatry and pediatrics due to the failure to take into account the type of interventions required of the pediatric psychiatrist. In the hope of remedying these problems of evaluating the services distributed by psychiatry to young children hospitalized in clinical units, we present a specific nomenclature, elaborated after several years of experience. It classifies services in four large categories: Consultation and liaison in in-patient care units; chronic care carried out on a part time basis; admissions to the Pediatric Psychiatry Unit in beds belonging to various pediatric services; complete workups in day care beds.