Object The frequency of children living in families where substance abuse exists is steadily increasing. The absence of an adequate medical and psychosocial response to this problem could lead either to underdetection or ineffective treatment. A descriptive study of children referred from a primary paediatric care (PPC) premises to a child mental health (CMH) unit is presented.

Methods CMH 3-year prevalence data (case criteria: child and adolescent psychiatric disorders multiaxial classification, ICD-10); family profile (parents, children living conditions); medical care profile (services utilisation, referrals); children medical/psychosocial problems profile (background, psychiatric diagnosis, treatment).

Results (Prevalent/Relevant Data) Parental multiple substance abuse; parents, low educational level/unemployment; broken families; extended family care giving; inefficient use of medical care; paediatric referral: behavioural disorders; school failure; child abuse/neglect; attachment disorders; parental substance (“code Z” diagnoses); psychotherapy/counselling.

Conclusions According to the severity of problems related to parental substance abuse, the cumulative impact of psychosocial factors involved and the necessity of an early detection/intervention: children in families with substance abuse backgrounds should be approached as individuals at psychosocial developmental risk; psychosocial developmental screening procedures must include bonding–attachment items; PPC and CMH should implement procedures for coordinated interventions in selected cases (referral, liaison consultation, joint follow-up).