WHAT CAN THE PHYSICIAN TELL THE PARENTS EARLY ON?

Parents are naturally concerned when their newborn child has problems, and physicians need to

evaluate the child's condition and prognosis as well as they can. For example, evidence of a bleed in the child's brain should be discussed with parents, although the outcome of such a bleed cannot be predicted. As we've discussed, the diagnosis of cerebral palsy cannot be made at birth and, most assuredly, the extent and severity of involvement that an individual child might eventually have is

impossible to assess at birth. Many neonatologists, aware of the interaction that generally occurs between the newborn and parents, avoid discussing the child's problems in detail because they want to permit this interaction to take place. The presumption of a bleak future for a child sometimes causes parents to withdraw from the child and this can have a significant negative effect on the child. Physicians usually communicate their concerns in terms of the child's symptoms, such as muscle problems, and prepare parents for the possibility of neurologic damage. Clearly, it is part of the physician's role to inform parents, but the variability of outcome makes it virtually impossible for the physician to predict the future, and so the physician must weigh the need to inform (and the imprecision of information) against the need for the parents to have hope for, and to become close to their child.