If a child develops a bit of a runny nose, but seems otherwise healthy, it doesn't make a lot of sense to make a visit to the doctor, much less rush to the emergency room. If, however, the child develops a cough, then a fever, an appointment with the doctor would be prudent. Even absent additional symptoms, if the runny nose requires the consumption of box after box of tissues over several weeks time, it's a good idea to at least check in with the doc.

This came to mind upon receiving a letter from a child and adolescent psychiatrist scolding me for not recommending a psychiatric evaluation for a 10-year-old boy who used a school writing assignment — a poem — to express sadness at the state of the world. He wrote he was afraid of death, afraid of life, had scary dreams sometimes, wanted to die, and wonders how life will turn out. The rest of the poem was about things he loved and looked forward to like eating macaroni and cheese and reading imaginative books. When his mother asked him about the poem, he broke down crying, saying that life is made up of good and bad and the bad dominates. In general, his mom said, he's bright, articulate, and "cautiously happy."

What we have here is a sensitive kid who's becoming aware that life is not a plate of macaroni and cheese. He's losing his innocence and, lacking emotional maturity, feels at times overwhelmed by things he's just beginning to understand. He uses a poetry assignment to express what he hasn't felt free to express otherwise. Such is the nature of poetry as well as the upshot of losing one's innocence prematurely, which is the plight of today's kids.

I advised the child's mother to not overreact. It was obvious that this gloominess was not a regular feature of her son's personality.

Prudence should temper any consideration concerning psychiatric or psychological services for a child. So, I generally recommend bouncing the idea off someone who knows the child's history — the child's primary physician for example — an objective third party who can help the parents put their concerns into proper perspective.

Family psychologist John Rosemond answers questions at www.rosemond.com.