Vulnerable Child Syndrome

Vulnerable child syndrome (VCS) describes a phenomenon in which a child is perceived as being at higher risk for medical, behavioral, or developmental problems than is warranted by the child’s current health. It is most often thought to occur in children who have experienced a serious or life-threatening event or who have a chronic medical condition. However, VCS should be considered a maladaptive family dynamic and can also occur in families that have not experienced a significant event, particularly where parental mental health needs are unmet. Parental perception of exaggerated risk may lead to overuse of medical services, possible unnecessary interventions, and poor parenting practices, parent-child attachment, and child development.

Several factors may predispose families to develop these maladaptive relationships and perceptions of their child. Infertility, pregnancy loss or emergent pregnancy complications, and premature birth may result in VCS. While the child is in the NICU, parents of premature infants face uncertainty about their child’s health, and many premature children develop chronic medical problems, many of which require subspecialty involvement. In addition, parents of children who have experienced a life-threatening event (eg, intubation due to respiratory syncytial virus) or diagnosis (eg, cancer) may continue to fear serious illness even after the illness has resolved. Similarly, children diagnosed as having chronic medical conditions, such as asthma or type 1 diabetes, require ongoing management and can have exacerbations, increasing the risk of parental misperception of vulnerability. Last, early childhood feeding difficulty or excessive crying may predispose families to develop VCS.

Parental mental health is an important consideration in identifying risk factors for the development of VCS. Acute stress disorder or posttraumatic stress disorder in parents …