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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.

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

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

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.

Boyce11conceptualized a “taxonomy of childhood vulnerability” in an epidemiological framework. The normal child has a low objective ...

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