Despite its considerable public health importance, childhood attachment is seriously under-represented in medical training and practice. Furthermore, the current ethos of medical practice means that unless awareness increases steeply, it is destined to remain so. Consideration of the complex and long-term implications of childhood relationships does not sit comfortably in a cash-strapped, time-strapped, evidence-based, label-based, protocol-based system which selectively protects the narrow focus at the expense of the bigger picture. Children are by definition dependent, and their dependency means that the nature of their family relationships profoundly influences their experiences in both health and illness.
Attachment can be understood as being the enduring emotional closeness which binds families in order to prepare children for independence and parenthood.1 Bowlby suggested that early attachment experience creates ‘internal working models’ — life-long templates for preconceptions of the value and reliability of relationships, close and otherwise.2 Attachment allows children the ‘secure base’ necessary to explore, learn and relate, and the wellbeing, motivation, and opportunity to do so. It is important for safety, stress regulation, adaptability, and resilience. The length of childhood indicates the complexity of the task, and the breadth of the implications of dysfunctional attachment. A web of interrelating problems is characteristic, readily leading to vicious circles, of which poor self esteem is an integral part.
Children's attachment patterns are substantially influenced by those of their parents. The attachments of both child and parents affect children's physical, psychological, behavioural, and developmental wellbeing. In any illness, children behave and parents respond in ways influenced by their respective attachment patterns, colouring ‘use’ of symptoms and professional relationships. Attachment is an important consideration in numerous paediatric problems — behavioural difficulties, infant crying, feeding problems, failure to thrive, poor eye contact, toileting problems, accidents, infections, autism, and attention deficit hyperactivity disorder (ADHD), among many. Attachment …
