Something was wrong. Even though this was the first time I met Thuy and her four-year old son Vu, I could see from the mother’s tight smile and furrowed brow that she was stressed and worried. The child, meanwhile, circled the clinic exam room, making only fleeting eye contact with me. He hardly seemed to notice when I, his new pediatrician, sat down in the chair closest to his mother and began discussing Thuy’s concerns. 


I learned Vu was an only child. He spoke his first word at age 2, much later than other children. At first, Thuy attributed this to her son hearing Vietnamese at home, while enjoying English language cartoons on television. However, as the young boy aged, the language difference was not the only concern. At the park, he preferred to play alone and was more interested in stacking stones or wood chips than playing tag with others. After attending preschool for four months, Thuy realized that her son’s differences were more than just preferences. He was having trouble participating in group activities such as circle time. By the time I met his mother, Vu was refusing to go into the classroom entirely.


I was surprised to learn Vu’s previous pediatrician was unaware of these issues, as Thuy never discussed them.

“Vu is a strong boy who eats well and hardly ever gets sick,” she replied, when I asked. Looking down at the floor, she added, “And I was embarrassed that he was different than other children. I didn’t want his doctor to think that he was a bad child or poorly raised.”

She had not voiced her concerns to his preschool teacher, either, for the same reasons.


Thuy’s reluctance to seek treatment for her son’s developmental and behavioral health symptoms is a story I hear too often. While Massachusetts’ Rosie D. regulations increased rates of routine developmental and behavioral screenings for children, the social stigma of mental illness remains the biggest obstacle in engaging parents.

Mental illness is more common than many believe. According to the Centers for Disease Control (CDC), an estimated 1 in 5 children aged 3 to 17 years old have a diagnosable mental or addictive disorder. Early diagnosis and connecting with appropriate health professional and educational resources is central in helping prevent problems at home, in school, and in forming relationships throughout the child’s life.

Thuy’s story also illustrates how our mental health is central to overall well being. Locally, the Boston Public Health Commission (BPHC) is working to reduce the social stigma of mental illness and encourage early family engagement in behavioral health services.

At seven community health centers in Boston, BPHC has worked with others to establish teams of early childhood mental health clinicians and family partners that have real-world experience in caring for children with special needs.  These teams consult with pediatricians and connect families of young children to prevention and intervention services in an environment where they already feel at home. Working closely with Partners HealthCare, BPHC introduced a social and emotional learning curriculum in 23 Boston Public elementary and K-8 schools, helping children develop positive relationships and conflict resolution skills. 

In partnership with the Massachusetts Executive Office of Health and Human Services and the Department of Public Health, BPHC launched a new awareness campaign that educates the public on the importance emotional health. The campaign aims to encourage parents, like Thuy, to discuss any concerns they may have with their pediatrician.

BPHC has also produced a toolkit containing flashcards and other materials, in multiple languages, that will be in all 23 Boston community health centers. These toolkits are a parental guide for having conversations about a child’s social and behavioral development.
Knowing I understood her concerns and could offer advice, tears welled up in Thuy’s eyes as she voiced her worries.

“You did the right thing for Vu by talking about these challenges with me today.  I can see that you love him,” I said. “I don’t have all of the answers yet, but there are many things we can do to help him to get to that bright future you envisioned for him. Let’s take the first step together.”

Dr. Huy Nguyen is the Medical Director at the Boston Public Health Commission and a pediatrician at the Dorchester House Multi-Service Center.