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In 1964, Green and Solnit1 described
a group of 25 children ages 17 months to 14 years old with a history
of a condition perceived, and oftentimes physician-endorsed, as
life-threatening (eg, prematurity, seizures, congenital cardiac
disease, pneumonia, diabetes mellitus, head trauma). Despite recovery,
these children were then inappropriately considered by their parents
to be at heightened ongoing risk for premature death. Although the
majority of the precipitating illnesses occurred within the first 2
years of life, the parent–child relationship was persistently
altered, generating in later years maladaptive behaviors such as
separation difficulties, infantilization, bodily overconcerns, and school
underachievement. Vulnerable child syndrome (VCS) is currently viewed
as an extreme manifestation of persistent and unfounded parental
expectations of medical vulnerability after a real or perceived
health threat to a child. The high parental perception of child
vulnerability (PPCV) significantly increases use of acute medical
care, attention to behavioral and developmental problems, and parental
distress.
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The prevalence of vulnerable child syndrome is unknown and is
difficult to measure. However, studies2,3 have
documented that approximately 10% of children seeking care
in pediatric ambulatory settings may be inappropriately perceived
by their parents as vulnerable. Among 750 parents seeking medical
care at four pediatric primary care sites and at a children’s
hospital emergency department, 27% expressed concerns during
an on-site interview that their child was especially “vulnerable.” However, for
40% of these “vulnerable” children (10.8% of
the entire sample), there was no clinical evidence in the medical
records of any health vulnerability.2 In another
community-based sample of 1095 children visiting pediatrician offices,
10.1% were perceived as vulnerable by their mothers.3
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Predisposing factors to high parental perception of child vulnerability
may include parent factors (eg, history of infertility or miscarriage, postpartum
depression, unresolved grief from the death of a close family member,
hereditary disorder in the family, maternal psychological factors,
limited social support), child factors (eg, prematurity,4,5 a
congenital anomaly, difficult temperament, chronic illness), and
threat of fetal or maternal death during pregnancy or delivery.1,6
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In 1986, Green described variants of vulnerable child syndrome
that included (1) the “illness-prone child” who
has no underlying disorder to account for the numerous illnesses and
injuries that result in medical attention7; (2) a
parent who watches a child vigilantly for the earliest signs of
a specific medical or behavioral disorder that affects relatives;
and (3) a parent misconstruing a normal variation on a physical
examination, a false-positive screening test result, or an apparently “abnormal” test result
as indicating a serious problem with the child.6,8-10 Parents
of children with chronic medical conditions who have an incomplete
understanding of their child’s disease may overestimate
the child’s true vulnerability. All these variants have
in common the frequent use of health care services.
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Boyce11conceptualized a “taxonomy
of childhood vulnerability” in an epidemiological framework.
The normal child has a low objective ...