"This is not normal ... "--signs that make the GP question the child's well-being.
BACKGROUND
The GPs are uniquely placed to recognise children with mental problems and emotional stress that influence their well-being.


OBJECTIVE
The aim of the article is with focus on the GP's daily practice, to describe how the GP separates the healthy normal child's developmental crises from children with problems that need special attention and treatment.


METHODS
A qualitative research design is used based on material from focus-group discussions and individual interviews with 28 GPs from a Danish county. Data was analysed descriptively.


RESULTS
The GPs' attention was directed towards the contextual and relational sides. The GPs frequently became aware of a child in need during clinical work as a feeling of "this is not normal". This reaction could be triggered by the child's symptoms and problems, the parents' narrative of the child's daily life, the child's and the parents' communication and behaviour in the consultation, the family's use of the health care system and the doctor's knowledge of the family members.


CONCLUSIONS
The GP is used to observe and reflect on what happens in the consultation room. The GP might benefit from a systematic attention to the contextual issues. The GPs are frontline workers; they need a good dialogue with the experts and relevant supervision from them to meet the challenge of recognising children in need. It takes more than insight and will from the professionals, it requires a socio-political and socio-economic effort.
Research Unit of General Practice in Copenhagen, Center for Sundhed og Samfund 5, Øster Farimagsgade, PO Box 2099, DK-1014 Copenhagen, Denmark. kirstenlykke@dadlnet.dk
Kirsten
K
Lykke
Pia
P
Christensen
Susanne
S
Reventlow
D000328:Adult; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003718:Denmark; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D011584:Psychology