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Objective: Clinical trials and inconclusive meta-analyses have investigated the effects of omega-3 supplements in children with Attention-Deficit Hyperactivity Disorder (ADHD). We performed a randomised placebo-controlled trial to evaluate the efficacy of omega-3 fatty acids., Methods: Children aged 6-15 years with established diagnosis of ADHD were randomised 1:1 to receive either supplements containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or a placebo for 3 months. Psychotropic or omega-3-containing treatments were not authorised during the study. The primary outcome was the change in the Attention-Deficit Hyperactivity Disorder Rating Scale version 4 (ADHD-RS-IV). Other outcomes included safety, lexical level (Alouette test), attention (Test of Attentional Performance for Children-KiTAP), anxiety (48-item Conners Parent Rating Scale-Revised-CPRS-R), and depression (Children's Depression Inventory-CDI)., Results: Between 2009 and 2011, 162 children were included in five French child psychiatry centres. The mean age was 9.90 (SD 2.62) years and 78.4% were boys. The inclusion ADHD-RS-IV at was 37.31 (SD 8.40). The total ADHD-RS-IV score reduction was greater in the placebo group than in the DHA-EPA group: -19 (-26, -12)  % and -9.7 (-16.6, -2.9) %, respectively, p = 0.039. The other components of the Conners score had a similar variation but the differences between groups were not significant. Two patients in the DHA-EPA group and none in the placebo group experienced a severe adverse event (hospitalisation for worsening ADHD symptoms)., Conclusion: This study did not show any beneficial effect of omega-3 supplement in children with mild ADHD symptoms.

The Groupe de Pédiatrie Générale (General Pediatrics Group), a member of the Société française de pédiatrie (French Pediatrics Society), has proposed guidelines for families and doctors regarding children's use of digital screens. A number of guidelines have already been published, in particular by the French Academy of Sciences in 2013 and the American Academy of Pediatrics in 2016. These new guidelines were preceded by an investigation into the location of digital screen use by young children in France, a survey of medical concerns on the misuse of digital devices, and a review of their documented benefits. The Conseil Supérieur de l'Audiovisuel (Higher Council on Audiovisual Technology) and the Union Nationale de Associations Familiales (National Union of Family Associations) have taken part in the preparation of this document. Five simple messages are proposed: understanding without demonizing; screen use in common living areas, but not in bedrooms; preserve time with no digital devices (morning, meals, sleep, etc.); provide parental guidance for screen use; and prevent social isolation., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background/aims: Growth failure is a difficult but key aspect of care in children with anorexia nervosa (AN). The effects of hGH therapy have not been studied. The aim was to investigate the effect of hGH treatment on height velocity (HV) in children with AN., Methods: We carried out a retrospective observational study. Ten girls diagnosed with AN at 10.0 ± 1.9 years, with prolonged severe growth failure (HV < 2.5 cm/year for at least 18 months) at the age of 13.3 ± 1.1 years and delayed puberty after nutritional rehabilitation, were treated with hGH (0.040 mg/kg/day) from a bone age of 10.9 ± 1.7 years until they reached adult height. Height and HV were measured before treatment and at 12-month intervals during treatment., Results: Mean body mass index SDS remained unchanged, but HV increased significantly, from a median of 1.0 (0.7-2.1) to 7.1 (6.0-9.5) cm/year after one year ( P  < 0.002) and 5.6 (4.8-6.2) cm/year after two years of treatment. Height SDS increased from -2.2 ± 1.3 to -1.6 ± 1.3 after one year ( P  < 0.002) and -1.1 ± 1.5 after two years of GH treatment. Adult height (-0.1 ± 1.0 SDS) was close to target height after 3.6 ± 1.4 years of GH treatment. Serum IGF-I levels increased significantly during treatment ( P  < 0.01). The treatment was well tolerated., Conclusions: This proof-of-concept study shows that hGH treatment is associated with significant improvements in linear growth in adolescents with AN and severe growth failure. A randomized placebo-controlled trial is required to determine the ultimate impact of GH treatment in patients with this severe, rare condition., (© 2017 The authors.)

In this study, we concurrently investigated 3 possible causes of dyslexia-a phonological deficit, visual stress, and a reduced visual attention span-in a large population of 164 dyslexic and 118 control French children, aged between 8 and 13 years old. We found that most dyslexic children showed a phonological deficit, either in terms of response accuracy (92.1% of the sample), speed (84.8%), or both (79.3%). Deficits in visual attention span, as measured by partial report ability, affected 28.1% of dyslexic participants, all of which also showed a phonological deficit. Visual stress, as measured by subjective reports of visual discomfort, affected 5.5% of dyslexic participants, not more than controls (8.5%). Although phonological variables explained a large amount of variance in literacy skills, visual variables did not explain any additional variance. Finally, children with comorbid phonological and visual deficits did not show more severe reading disability than children with a pure phonological deficit. These results (a) confirm the importance of phonological deficits in dyslexia; (b) suggest that visual attention span may play a role, but a minor one, at least in this population; (c) do not support any involvement of visual stress in dyslexia. Among the factors that may explain some differences with previously published studies, the present sample is characterized by very stringent inclusion criteria, in terms of the severity of reading disability and in terms of exclusion of comorbidities. This may exacerbate the role of phonological deficits to the detriment of other factors playing a role in reading acquisition. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Gender dysphoria, originally called gender identity disorder, is characterized by the dissociation between one's expressed gender and the gender of rearing as assigned at birth, which generates significant clinical distress and social, academic, and other important forms of isolation. This state is also known as transgender or transsexualism and is recognized as a medical disease. Adults with gender dysphoria can benefit from psychological, medical, and surgical care. However, gender dysphoria rarely occurs in adulthood but rather emerges in childhood or adolescence, generating deep social and academic difficulties, especially at puberty. For the last 10years, the management of gender dysphoria in children and adolescents has developed in several countries, specifically in Europe, but remains under-recognized in France. Since 2013, several pediatric psychiatry and endocrinology departments have initiated a multidisciplinary evaluation and management approach for these patients. This article reviews the clinical criteria helping diagnose gender dysphoria and presents the different steps in the assessment and management of these patients in accordance with international guidelines., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

This new study by the Secteur français des aliments de l'enfance (SFAE) (French Agency for Children's Foods) confirms the improvement in the nutritional environment of young children, particularly in sharing family meals. Incorporating the sample of breastfed children is a new feature, although food refusal behavior in infants did not appear to differ greatly whether or not they were being breastfed, and mothers expressed a need to be informed and guided in order for their children to better accept varied foods. We still found long-term continuation of feeding bottles and in parallel excessively early introduction of adult foods and significant and inappropriate viewing of screens for age., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Cognitive remediation therapy (CRT) seems to be increasingly interesting in the treatment of anorexia nervosa for adult patients. We attempted to apply this support to a group of young inpatients, initially to assess its feasibility and acceptability, and then to improve its content for therapeutic application and future research., Methods: Ten 12- to 17-year-old inpatients with primary DSM-IV diagnosis of anorexia nervosa participated in a 10-week intervention program with a one-hour group session of CRT per week. All 10 patients were assessed before the intervention and those who completed the 10 sessions were assessed after. Assessment included a clinical examination by a psychiatrist, a battery of clinical inventories, and set-shifting tests. Moreover, each patient wrote a letter providing feedback on the intervention for subsequent analysis., Results: Only two patients completed all 10 sessions, the other eight who were discharged from the hospital in the meantime could not attend the sessions for practical reasons. After the 10 sessions, an improvement in BMI and in measured levels of some psychopathological symptoms was observed in our two patients. Most neuropsychological task performances were improved after cognitive remediation. Feedback from the 10 patients was generally positive., Conclusion and Implications for Practice: This preliminary investigation suggests that cognitive remediation therapy is acceptable and feasible in this population. Replication of these findings requires a larger sample, improvement of the trial design, more sensitive measures, and another training format to avoid loss of so many participants., (Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common of the pediatric neuropsychiatric disorders. Methylphenidate is an important element of therapeutic strategies for ADHD. Clinicians are interested in the safety of methylphenidate. Because this drug raises heart rate and blood pressure, concerns have been raised about its cardiovascular safety. Concerns were based on case reports of sudden cardiac death in methylphenidate users, plausible pharmacological pathways involving well-established stimulant effects on heart rate and blood pressure. Until recently, data were limited to a number of observational studies too small to examine serious cardiac events. In the past two years, large retrospective, population-based cohort studies were performed. These studies did not show any evidence that methylphenidate was associated with an increase in risk of myocardial infarction, sudden cardiac death, or stroke. Treatment of children with methylphenidate is not significantly associated with an increase in the short term or mid-term risk of severe cardiac events. For many, available data now will be seen as reassuring. But gaps persist in the methodical and comprehensive assessments of the safety of methylphenidate. Analyses cannot be generalized to children with long-term use of stimulants. Furthermore, long-term effects of slight increases in heart rate or blood pressure are unknown. Stimulant administration continues to have a detectable adrenergic effect even after years of treatment. In the MTA study, greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8. Although less severe, such adverse cardiac events are nonetheless alarming to patients. This adrenergic effect may have clinical implications, especially for individual patients with underlying heart abnormalities and it deserves further investigation. More research is necessary to optimize a safe use of methylphenidate regarding its cardiovascular effects. In light of the controversies surrounding the increase in the number of children being diagnosed with ADHD, the broad use of methylphenidate in these patients, and cardiovascular concerns about it, this article addresses topics of clinical significance. For ease of use by practitioners, the article summarizes the guidelines stated by the European Medicines Agency over the appropriate pretreatment evaluation and cardiovascular assessment. It advocates a thorough history and physical examination before initiating methylphenidate to treat patients with ADHD, with an emphasis on the identification of risk factors for sudden death. A cardiac sub-specialist consultation is mandatory in case of history or physical examination findings. In other cases, an electrocardiographic screening is recommended in order to check out previously unrecognized heart disease., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

There has been an explosion of public interest and concern about children and adolescents who show an interest in changing their gender. And it is an emerging problem for pediatricians, which brings many inquiries about what to do? Both the diagnosis and treatment of gender identity disorder are controversial. But there are a new early treatment using puberty blocking hormones., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

With the rapid growth in the number of children and adolescents having access to videogames, there is a risk of addictive behavior, especially among those with underlying mental illnesses. Yet there is no consensual definition of videogame addiction. Depression, anxiety disorders and hostility are all associated with overuse, but attention-deficit hyperactivity disorder (ADHD) is the most significant predictor.

Using social media web sites is a common activity for children, and any site that allows social interaction (social network, games, virtual worlds...) is a social media site. Pediatricians are in a position to help families understand the benefits and the risks of these sites, and to diagnose problems in children and adolescents as cyberbullying, depression, and post traumatic disorder., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Food refusal is a frequent symptom in infants and toddlers. Many difficulties resolve with pediatric treatment. In some cases of feeding disorders it is necessary to involve child psychiatrist intervention. This indication depends of child characteristics (medical and psychiatric diagnosis, failure to thrive, psycho-affective development) and also of family functioning and parental psychopathology., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Dangerous games inside or outside school are a serious social phenomenon, but unfortunately underrecognized. Aggressive games are a part of school bullying, which is in expansion. Choking games are very dangerous, with many deaths or serious neurologic complications. Pediatricians should be knowledgeable about risky behaviors encountered by their patients, and provide guidance about its dangers., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: The aim of this study was to investigate the use of psychotropic medications for both labeled and off-labeled indications in a French paediatric teaching hospital., Methods: A prospective analysis of all psychotropic drug prescriptions was conducted during a 6-month interval. Details were recorded from the computerized prescription order entry system. They included demographic data (sex, age and weight) and psychotropic medications (name, dosage, schedule, route of administration and indication). The physicians specified the indication when prescribing the psychotropic medication. All prescriptions were assessed for off-label use. Off-label prescriptions were defined as: use of a different dose or dose schedule, use for an indication not included in the license or approved for adults only, drug use outside the age range of the product license, use of medicines for which no paediatric information was available, use when the product was contraindicated, use of drug preparations that were manufactured by the hospital pharmacy, use of licensed drugs that were modified by the hospital pharmacy and use of new drugs available under a special manufacturing license. Each prescription was compared with data available in the National French Formulary., Results: A total of 1629 drug prescriptions were written for 472 patients. Sixty-eight percent of all drug prescriptions were for off-label uses: indication not included in the license or approved for adults only in 40%, no paediatric information available in 37%, different dose or dose schedule in 7%, licensed drugs that were modified by the hospital pharmacy in 5%, administration to children outside the age range of the product license in 4%, drug preparations that were manufactured by the hospital pharmacy in 4%, contraindication in 2% and new drugs available under a special manufacturing license in 1%. Sixty-six percent of the patients were prescribed a psychotropic drug in an off-label manner. Over half of the off-label prescriptions were given to adolescents (62%), followed by children (29%), infants (8%) and neonates (1%). The percentage of off-label prescriptions by age was: neonates 91%; adolescents 74%; children 59% and infants 58%. The percentage of off-label prescriptions by medication class are presented in decreasing order of prescription frequency: anxiolytics 65%; antipsychotics 69%; antidepressants 92%; antiepileptics 51%; stimulants 30%; antiparkinsonians 100% and hypnotics 100%. The 5 drugs most commonly prescribed off label were risperidone (12%), clobazam (12%), amitriptyline (11%), hydroxyzine (10%) and diazepam (7%). Nearly half (47%) of all off-label prescriptions were associated with 3 indications: anxiety (24%), disruptive behaviour (12%) and pain (11%)., Conclusion: The high rates of off-label prescription documented here and elsewhere highlight the need for further controlled clinical trials to evaluate the risks and benefits of psychotropic medication in children and adolescents.

Objective. The aim of this study was to investigate the use of "as needed" (pro re nata or prn) psychotropic medication in a child and adolescent psychiatric inpatient population. The study was carried out on the psychiatry ward of a paediatric teaching hospital in Paris, France. Methods. A prospective analysis of prn psychotropic drug prescriptions and administrations was conducted for all patients hospitalised over a period of 4 months. The study group consisted of 187 patients. Results. In total, 93 prn prescriptions were written, for 27% of the patients (51) but only 14% (26) received a total of 76 administrations. Antipsychotic drugs accounted for 54% of the prescriptions, anxiolytics for 33%, antiepileptic drugs for 8%, antiparkinsonian drugs for 4% and hypnotic drugs for 1%. Anxiety was the reason given for 67% of the prn administrations, with hydroxyzine used in 69% of these cases. Disruptive behaviour accounted for 22% of prn administrations, with antipsychotic drugs accounting for 88% of these administrations. Insomnia accounted for 8% of prn administrations, and antipsychotic drug-induced dystonia accounted for 3% of such administrations. Conclusion. Controlled studies are required to assess the efficacy and safety of prn medication and the conditions in which its use is indicated.

Objective: The aim of this study was to investigate the use of psychotropic medication in children and adolescents hospitalised in a psychiatric ward., Methods: A prospective analysis of psychotropic drug prescriptions was conducted for all patients hospitalised in two acute psychiatric hospitalisation units of a paediatric teaching hospital in Paris, France. The study group consisted of 187 patients and was characterised in terms of age, sex, prior psychiatric hospitalisation and DSM-IV-Tr diagnosis. All prescriptions were assessed for off-label use., Results: Overall, 46% of patients received at least one dose of psychotropic medication. Antipsychotic drugs were the most frequently prescribed drugs (44%), regardless of diagnosis. Ninety percent of patients who received antipsychotic drugs did not have psychosis. We found that 69% of the 421 prescriptions written were for off-label uses. The percentage distribution of off-label prescriptions by medication class was as follows: antipsychotic drugs, 90%; anxiolytics, 28%; stimulants, 26%; antidepressants, 89%; antiepileptic drugs, 89% and antiparkinsonian drugs, 91%., Conclusion: The extensive use of drugs for off-label indications in children and adolescents suggests that prospective post-marketing studies should be carried out to evaluate efficacy and safety.

This article presents a review of the treatments for children suffering from attention deficit hyperactivity available in France. Multimodal treatment of French hyperactive child includes psycho stimulant medication (short and long acting methylphenidate) and parent training, speech therapy, psychomotor therapy and academic training.

The scope of the concept of school phobia, associated with anxiety disorders, is now broadened to include other underlying disorders such depression, conduct disorders and behaviors such as school truancy. The term "school refusal" is now preferred in the literature. This article reviews the main clinical and terapeutical dimensions of school refusal. Its aim is to increase practionners' awareness of this disorder and to describe a treatment plan centred on school attendance.

For several years, a growing number of children raised in lesbian families have been noticed. Even if this number is not really known, it appears clearly that more and more psychiatrists will have to care for children which will present this family configuration. The problem then is to know if this type of education has an incident on the psychopathology of children or not. The purpose of this article is not to give answer or to take side but just to help physicians to make a point of what is known about this subject in international literature.

Münchhausen syndrome by proxy is a factitious disorder, a disease produced or simulated by a parent, the mother in most cases. Clinical presentation is miscellaneous (factitious bleeding, epilepsy, apnea are frequent) and unusual. Physicians participate in the abuse by their therapeutic and diagnostical measures. It is very important to think about this diagnostic in any ambiguous situation in order to evaluate and protect the child.

This article shows the second part of results from the "Behaviour" chapter of fourth edition of Feeding in French infants and young children Survey conducted by SFAE, in 2005, concerning mothers of 713 infants and young children from the age of 1 to 36 months. This survey, conducted every 8 years since 1981, shows that feeding behaviour of young children has improved, especially since 1997, with meals taken in family, postponement of diversification. It confirms that mothers need counselling for feeding their child, and especially from the medical profession. On the other hand, the transition to adult feeding is too fast since 1 year old; an early introduction of certain food as French fries, and cooked pork meat, early television viewing, a lack of sports are observed.

The SFAE conducts every eight years since 1981 a national survey on feeding behavior and consumption in children under 3 years old. In 2005, the authors noticed a great improvement of milk feeding behaviour in infants compared to 1982, 1989, and 1997. Infant formulas get more importance compared to cow milk before the age of 1 year, and growth milk takes more and more cow milk's place since 13-18 months old. Feeding diversification is postponed between 5 and 6 months old.

Objectives: The onset of anorexia nervosa (AN) during childhood can affect the timing of puberty and adult height. The aim of the study was to evaluate the determinants of late menarche and adult height in children with AN., Patients and Methods: We carried out a retrospective, longitudinal, university hospital-based study. All prepubertal or early pubertal girls diagnosed with AN between 1998 and 2002 were selected for the study. Participants (n = 33) were studied at a median age of 21 (19.8-24.3) years. AN was diagnosed at 11.8 (10.7-12.3) years., Results: Patients with AN reached menarche at significantly greater ages than their mothers [15.4 (13.5-16.8) vs. 13.2 (12.0-14.5) years, P < 0.01]. Chronological age at onset of AN and lowest body mass index (BMI) were important independent predictive factors for delayed menarche (P < 0.01). Adult height was 165.0 (163.0-172.0) cm, 2.5 (-1.5 to 5.0) cm above target height. Twelve patients (36%) did not reach their target height and had a median height deficit of -3.9 cm with respect to their target height. The duration of hospitalization, a marker of disease severity and chronicity, was an independent predictor of the difference between adult height and target height for a given individual (beta coefficient = -0.07; P = 0.01). The other factors studied (i.e. age at onset of AN, pubertal stage at diagnosis of AN, lowest BMI reached, associated comorbidity if any, type of AN, age at menarche) had no significant effect on adult height., Conclusion: The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth.

Conduct disorder is a repetitive and persistent pattern of behaviour in which the basic rights of others or societal rules are violated. It is at the junction of psychiatry, social field and law. The early diagnosis of this disorder and the identification of risk factors must go to preventive programs and psycho-educational treatments, to prevent juvenile delinquency.

Multimodal treatment of hyperactive child includes psychostimulant medication, methylphenidate (MPH) marketed in France in its short-acting form since about ten years. We report our clinical experience about the first fifty methylphenidate responders who received one of the two sustained-release forms available since summer 2004, tablets of oros-methyphenidate (Concerta LP) or microgranule-filled capsules (Ritaline LP).

Talking is normal and not talking is not. In case of developmental language delay, "wait and see" is not a good medical practice. In many cases, this delay is secondary to conditions such as hearing loss, mental retardation, brain damage, pervasive developmental disorder, environmental deprivation... In other cases, it is a specific language delay or a specific language disorder (dysphasia). Specific speech assessment and speech therapy are indicated to prevent behavioural problems, and learning disabilities.

Treatment of hyperactive child is multimodal, a combination of behaviour therapy and medication. Stimulant drugs are the most often prescribed medications. In France, we use methylphenidate (Ritaline); its efficacy was demonstrated with mild side effects. New formulations of methylphenidate with prolonged action, and non-psychostimulant treatment (atomoxetine) are available in some countries, but not yet in France.

The cyclic vomiting syndrome is defined by episodes of vomiting lasting from hours to days with free intervals between episodes. Various symptoms can be associated with vomiting: nausea, abdominal pain, photophobia, fever, pallor, dehydratation, excess salivation, social withdrawal. Some factors often precipitate the crisis: infection, psychological stresses, menstruation. Excluding a medical condition, especially a gastro-intestinal or a neurological disease is compulsory for the diagnostic of cyclic vomiting syndrome. The cyclic vomiting syndrome shares many common features with migraine including treatment. Due to negative paraclinical testing, a psychiatric disease is often suspected in these children. Pathophysiology of cyclic vomiting syndrome is unknown. As for migraine, mitochondrial and ionic channels abnormalities are thought to play a role. Overactivation of hypothalamic-pituitary-adrenal axis and autonomic dysfunction seem to be involved too. Three clinical vignets will illustrate these aspects.

Objective: To report on observations of 6 adolescents treated with electroconvulsive therapy (ECT) and to compare the data with literature data., Method: We conducted a retrospective study of our division charts of adolescents treated with ECT and hospitalized in the last 20 years. We also undertook a computer search in several databases (including Medline) to identify the reported observations on this treatment., Results: We studied the charts of 6 adolescents aged 14 to 16 years. There were 3 cases of major depressive disorder (including 1 case of delusion of negation), 2 cases of neuroleptic malignant syndrome, and 1 case of schizoaffective disorder with catatonic characteristics. Four adolescents received ECT as a first-line treatment. They were given an average of 9 ECT, which was judged to be efficacious. Tolerance was adequate, and in this series, ECT does not seem to have caused alterations to long-term cognitive functions. No relapse was noted after a minimum of one-year follow-up., Conclusions: For some severe psychiatric disorders in adolescents, ECT could be a treatment with a good efficacy and tolerance profile.

The safety and efficacity of atypical antipsychotics in comparison with conventional neuroleptics allow their prescription in children and adolescents who are particularly at risk for developing neurological or cardiac side-effects. Hematological complications of new antipsychotics are less known, except for clozapine treatment in which blood monitoring strategy is well established. We report on a case of risperidone-associated leucopenia in an african adolescent treated for schizophrenia. He developed leucopenia 10 days after starting risperidone therapy (4 mg/day). The cessation of treatment was followed by a normalization of the white blood cell differential count and the rechallenge was positive (2 mg/day). No hematological abnormalities were observed with olanzapine therapy in this patient. Therefore olanzapine may represent a safe therapeutic alternative. We concluded that risperidone therapy may create a risk for leucopenia especially in patients who present a risk of leucopenia for ethnic reasons. We propose hematological monitoring during risperidone treatment.

Classical therapeutic recommendations requires that girls with anorexia nervosa be separated from their parents. Refeeding, and later individual psychodynamic approaches were also emphasized. These guidelines are now broadened towards psychotherapeutic approaches (psychodynamic, familial, cognitive-behavioral) associated with psychoeducational and dietetic strategies. In the Child and Adolescent Psychopathology Unit of Robert-Debre Hospital in Paris, individual therapeutic programs are applied to young anorectic girls and their families. These programs are implemented within an inpatient (full-time, part-time) or outpatient (consultations, weekly day-therapeutic program) framework. In order to forge a therapeutic alliance with parents and restore "parental competences" feelings, we do not separate any longer anorectic girls from their parents during hospitalization, and we have developed an alternative therapeutic model to full-time hospitalization.

Post traumatic stress disorder occurs in children as well as in adults following a stressful traumatic event, either unique and exceptionally severe, or recurrent as in abused children. The main symptoms are repetition, avoidance and neurovegetative activation. Prevention and recognition of this disorder are important. Parents must be sensitized to the necessity of an early management.