When Do Child Behaviour Problems Warrant Paediatric Management, and What Is Needed to Do This Successfully? Results of a Delphi Study

AIM: Developmental-Behavioural problems represent the most common reason for referral in Australian outpatient paediatric practice. While paediatricians consider behaviour a part of developmental assessment, it is unclear to what extent they then go on to manage problem behaviours themselves. To clarify this question, this study examines (1) properties of child behaviour that warrant ongoing medical care, (2) supports considered necessary to do this work effectively and (3) whether these supports are available in current practice. METHODS: These questions were examined by expert consensus (Delphi) methodology, comprising two rounds of surveys. The survey population was members of the Australasian Society for Developmental Paediatrics (ASDP). RESULTS: A total of 228 completed responses were received to the first survey round, with a high level of consensus achieved. Behaviours considered appropriate for medical assessment and intervention were those potentially causing either direct or indirect harm for the child and/or others. There was strong agreement regarding support services considered necessary for good clinical practice both from within and outside of health services. In current clinical practice, these supports were commonly not available. In the public health system compared to private practice, needed supports were less available. CONCLUSIONS: Management of behaviour is part of Developmental Paediatrics. Paediatricians have a clear understanding regarding behavioural properties that justify active intervention. There is agreement regarding supports needed to do this work successfully. These supports are not often available in clinical practice, most notably within the public health system. This is problematic for the well-being of the children seen.