Emotional sequelae of chronic inflammatory bowel disease in children and adolescents.

It is clear that further study needs to be made of the link between emotional disorder and chronic inflammatory bowel disease in children. It is commonly accepted that such a link exists in ulcerative colitis and although there is at present no proof in either direction it seems highly probable that such a relationship is also present in Crohn's disease. We have seen that the families of children with Crohn's disease appear to find it much more than ordinarily difficult to accept such a relationship, but an objective study is projected to explore the presence of psychiatric illness in our patients and their families. Such a study will be extremely time consuming, requiring the services of a part-time research worker, and the exigencies of clinical service have so far prevented its being set in motion. We feel that our experience in St Bartholomew's Hospital during the past seven years has very clearly demonstrated the value of close liaison between the Child Psychiatry Unit and the Paediatric Inflammatory Bowel Disease Clinic, and the much greater efficacy of such a liaison as against referrals made to a separate Psychiatric Unit. It should be emphasized, however, that a liaison of this sort is time consuming, and in our experience has involved child psychiatrists, social workers, child psychotherapists and behaviour therapists. Thus the provision of such a service is expensive both in time and money. Where a new Paediatric Inflammatory Bowel Disease Clinic is being projected there must be very careful forward planning, looking particularly at financial implications if a psychiatric liaison team is to be included.