Ostensible versus actual reasons for seeking pediatric attention: another look at the parental ticket of admission.

The presentation of parental anxiety that appears excessive in view of the nature of the child's "chief complaint" is a frequent occurrence in pediatric practice. This study reviews 370 sick-patient visits in one pediatric office during a three-month period. Additional questioning in the area of parental anxieties concerning these symptoms revealed that in 125 instances (33.8%), the parent was entertaining unverbalized fears that something much more serious was wrong with the child than could be anticipated from the ostensible reason for seeking assistance. An analysis of the "actual reason for coming" reveals that the child's presenting complaint has become associated for the parent with (1) family history of serious life-threatening illness; (2) fears of loss and separation; (3) death; (4) the fears of another family member who is pressing for "answers" about the problem; (5) fears of loss of vital functions and a variety of other thought processes that have somehow become linked to the child's symptom. Techniques for recognizing and ameliorating this parenting difficulty are discussed.