Child psychiatry training for pediatricians: Japanese perspectives in infant psychiatry.

Since August 1993, child psychiatry training by a full-time child psychiatrist has become an essential component of the postgraduate training programme at the Department of Paediatrics, Keio University Hospital, Japan. Thirty trainees, 15 first-years and 15 second-years, had first-hand experience in residential child psychiatric treatment concurrently with pediatric training. With the trainees as primary care workers, 31 cases have been successfully treated, of whom seven were school refusals, 11 were anorexia nervosas and eight somatoform disorders. Consistent maternal care, such as three spoon-feeding sessions each day, were prescribed for anorexic patients, which enhanced sensitivity in the trainees to the unmet infantile needs of their patients and facilitated awareness of their chronic unhappiness since early life and to the therapeutic implications of empathic understanding based on trustful relationships. After the 2 years of training the first group of trainees showed competency in handling children's emotional problems on their own in distant affiliated hospitals. The flexible multidisciplinary style of training that has evolved over the past 2 years has proved to have enormous relevance in the changing contexts of the pediatric practice in Japan.