Comment on 'The Pediatrician as a Consultant'

Sir .—We read with interest Stickler's article "The Pediatrician as a Consultant." 1 Stickler's primary contention is that pediatricians should be able to deal effectively with a broad range of childhood diseases and/or symptoms without referral to specialists. He presents a comprehensive and exhaustive list of typical conditions for which "children do not necessarily need to see specialists," including behavioral disorders, hematologic disorders, disorders of the skin, central nervous system, ear, nose, and throat, heart, gastrointestinal tract, genitourinary tract, musculoskeletal system, and endocrine system, as well as allergies and parasitic infestations. Stickler is generally correct in his belief that most medical conditions may be treated effectively by the pediatrician, but errs when he does not allow for situations in which referral to psychological and/or psychiatric personnel, for example, are always warranted. We believe that pediatricians in general practice may treat patients with many of the disorders outlined by Stickler.