A mental health presence in hospital paediatrics adds an extra player to the medical partnership with patients and families. Now there are two contrasting kinds of opinion about children and their health disorders, and they are not always compatible. The tension created may cause divisions between staff, but it can also lead to a more three-dimensional view of the patient’s predicament. The ability to take part in triangular relationships is an emotional and intellectual achievement for the developing mind. As the psychoanalyst Ronald Britton put it ‘a third position comes into existence [that] provides us with a capacity for seeing ourselves in interaction with others and for entertaining another point of view while retaining our own’ (Britton, 1989, p. 87).1 Likewise it is an enrichment of child health practice when necessary differences between paediatrics and child mental health add depth and perspective to the clinical picture. Alex is 11 and has asthma. He keeps getting admitted to the paediatric hospital ward from the emergency department (A&E) with dangerous attacks of wheezing.
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