[Definite contact with the outer world as a factor in hospitalism prophylaxis--on education and learning in pediatric hospitals (author's transl)]

Being a useful means against negative psychic consequences of hospitalization, the "walk" in the near or distant surroundings of the hospital is analysed and methodically described. The immanent playing and occupation therapy as well as the stock of experience additionally acquired are integrating educational and learning aids. By the example of the observation of nature the use of the so-called "creative moment" in learning processes is demonstrated.

[Adaptation of children to hospitalization]

Infants especially of about 1 to 4 years of age are opposed to an unknown environment and to unusual demands when they are admissed to hospital. Literature informes about some characteristic troubles during the first time of adaptation. In addition to those kinds of transitory adaptional difficulties, physical and mental retardation of development may appear when infants become long-time patients. The socalled psychic hospitalism has to be valued as a sign of underprotection and differs from adaptional troubles as a symptom of full strain. The survey shows adequate measures how physicians and nurses may deal with both of the problems in order to ease adaptation and to prevent psychic hospitalism.

Clinical observations of play of hospitalized suicidal children

This paper emphasizes the usefulness of play observation for diagnosis, treatment, and understanding suicidal behavior of children. Predictive indicators of play for potential suicidal behavior are themes of separation and loss, repetition of dangerous and reckless behavior, misuse and destruction of toys, and repetitive acting out of omnipotent fantasies. The selection of a suicidal method is partly derived from unconscious motivations that are illustrated in play themes. This study revealed a characteristic suicidal technique of latency age children seems to be jumping from heights.

Who gets referred? Child psychiatric consultation in a pediatric hospital

The authors approach the question, "Who receives a child psychiatry consultation?" in several ways. First, by reviewing the consultation patterns in a pediatric hospital over a five year period as a new array of liaison services were being provided, they found the overall consultation rate decreased. Yet in absolute numbers the referral rate for consultation around diagnostic issues remained relatively constant. This underlines the core importance of the child psychiatry consultant as diagnostician. Second, in matching a group of children receiving a psychiatric consultation against a group of children who did not, the authors found somewhat more psychosocial information recorded in the charts of the former group. However, it is doubtful that this played any direct role in the generation of the referral per se. The authors stress the finding that the pediatric hospital is a medical setting and unless the child's psychological problems impinge directly on that system, such problems are likely to remain hidden and beyond the scope of the consultation process.