Dr. Parmanand Kulhara's Response

Close on the heels of the ^ IPS presidential address, exhorting one and all to integrate our speciality with other branches of medicine it is indeed a welcome study. In the course of our consultation liaison work, we too have noted significant burden in families, where a child has chronic medical/surgical illness. Highlighting this as a necessary focus of management plans and facilitating such plans dq form a key role for child psychiatrists in the general hospital setting and we congratulate the authors on their effort. We, have certain comments on the study. A child psychiatric control would have placed the situation in some perspective. Regression analysis using the global burden scores (we appreciate that total burden is not possible with the instrument used) would have been interesting. We are intrigued by the use of the FBS, an instrument which was basically devised to measure burden in families of patients with chronic mental illness. It would be useful to know the authors experience of using the FBS in this vastly different sample. Also information on number of other children in the families would have been of clinical value, as the families are faced with issues like death of the ailing children and so on. Sir, My response to the observations of Raman and Ashok are as follows : 1. We are thankful to the writers for the encouraging comments about our paper. 2. The point about a child psychiatric control is debatable because one is immediately faced with the problem of nature and the purpose of the control. 3. It is acknowledged that the Family Burden Scale is an instrument which is basically designed to measure burden in a family with chronic mental illness. However, we in this department' have used this instrument successfully to measure burden in patients other than mental disorders and our present study on family burden is one such explore. Our expertise suggests that there is nothing very specific psychiatric about the scale and if one is measuring burden then our expertise shows that this scale can be used relatively easily in various disease category patients.