The Transdisciplinary Approach: A Commentary on “A Case of Pediatric Undernutrition”

The case presented in this journal by Dr. Marion Birch is an important one. It illustrates how easy it is to be led down the narrow path of biomedicine (as distinct from the biopsychosocial approach suggested by Dr. George L. Engel 1977, 1980) in a restricted search for causation without due consideration of the child's and family's life circumstances and mental-health needs. With the common practice of mental-health carve-outs and the continuing lack of parity between physical and behavioral health needs, it is certain to me that cases such as the one presented so eloquently by Dr. Birch are much more common than one might expect. The concern is how rarely such families find their way to practitioners as helpful as Dr. Birch and how infrequently their medical colleagues refer them.

We see many families whose primary care providers and medical specialists unwittingly add to the problem of children with pediatric undernutrition with vague threats of disastrous consequences if children aren't somehow gotten to eat more than they are. More commonly, physicians are simply failing to provide adequate information or assistance to allow parents to do what really needs to be done. Physicians and other members of the health care team need to assist parents in understanding how to allow (better than “encourage” or “force”) their children to increase their caloric intake (Satter 1999). This needs to be done in an age-appropriate manner with full understanding of the social and emotional needs of young children and the real-life challenges often facing their parents. Medical providers often fail to provide for this, not out of malice but ignorance. Most practitioners in our health care system, even under managed care (with its euphemistic emphasis on “health maintenance”) continue to act like the “cartoon-version M.D., the all-head-no-heart formalist who, when presented