Consultation with the Specialist

Historical Perspective In 1964, Green and Solnit first described a constellation of clinical features comprising a "vulnerable child syndrome" based on a cohort of 25 families. Each of the families had a child who had suffered a life-threatening illness in infancy. The authors observed that the parents, particularly the mothers, shared a continuing and unfounded anxiety concerning their children's health. Green and Solnit hypothesized that the parents persisted in fearing that their child was destined to die in childhood. The parents' perception of their child as uniquely vulnerable led to myriad maladaptive behaviors and difficulties in parent-child interactions (Tables 1 and 2). The parents overprotected the child, were unable to set age-appropriate limits, and displayed excessive concerns in medical settings about their children's health. The children, responding to their parents' expectations of vulnerability, evidenced exaggerated separation anxiety, out-of-control behavior, school underachievement, and distorted perceptions of their own health. Interestingly, these behaviors were not noted in the parents' interaction with their other children. As clinicians began to identify families that had this constellation of clinical features, additional details about the vulnerable child syndrome were elucidated. Parental perception of their child as medically vulnerable was not a universal legacy of severe illness in infancy, but more likely a reflection of how an individual family responded to an illness in their child.