Clinical Reference Systems: Pediatric Advisor 10.0

The child with a serious medical illness is at risk for developing associated psychological problems. Unlike a child with a temporary sickness such as the flu, the child with a chronic illness must cope with knowing that the disease is here to stay and may even get worse. Almost all these children at first refuse to believe they are ill. Later they feel guilt and anger.

The young child, unable to understand why the sickness has occurred, may assume it is a punishment for being bad. He or she may become angry with parents and doctors for not being able to cure the illness. The youngster may react strongly against pampering, teasing, or other attention. Uncomfortable treatments and restrictions in diet and activity may make the child bitter and withdrawn.

A teenager with a long-term illness may feel pulled in opposite directions. On the one hand, he or she must take care of the physical problem, requiring dependence on parents and doctors. On the other hand, the adolescent wants to become independent and join his or her friends in various activities. A teenager with a long-term illness may try to decrease or stop taking prescribed medication without consulting with the physician. This often shows a normal adolescent desire to take charge of one's own body.

Chronic illness may cause setbacks in school or avoidance of school. This can increase a child's loneliness and feeling of being different from or behind other youngsters. Parents who want to help their child in every way possible should respond not only to the child's illness, but also to his or her strengths. If overprotected, the child may not learn to socialize or may have difficulty separating from parents when it is time to be involved in school. It is often helpful for the child to be in contact with others who have successfully adjusted to living with a chronic illness.

In their prolonged periods of hospitalization or rest at home, children may develop excellence in a hobby or a special talent such as art, model airplanes, or a foreign language. They may also learn as much as about their illness as possible. Such activities are psychologically healthy and should be encouraged.

Children with long-term illnesses are often treated by a team of medical specialists. The team may include a child and adolescent psychiatrist or other mental health professional who can help the child and family develop psychologically healthy ways of living with the disease and its effects.