LONG-TERM PHYSICAL ILLNESS IN CHILDHOOD: A CHALLENGE TO PSYCHOSOCIAL ADAPTATION

Abstract

Pediatricians and psychiatrists long have recognized that many psychosocial problems facing children with long-term physical disorders can lead to social disability far more serious to an individual than the direct effects of his physical ailment. The physician who provides comprehensive care to a chronically ill child and his family wants to promote realistic and normal child-rearing attitudes, so that the child can develop a self-image as a socially competent and productive citizen. In meeting this task, the physician may be helped by knowledge of the major causes for emotional stress in serious illness and by familiarity with the child's and the parents' various means of coping with their burden. This paper reviews long-term disorders in childhood from the standpoint of the attendant psychologic stresses and the related adaptational techniques used by the child and his parents in their attempt to master their negative and distressing emotions. Such techniques include the use of cognitive functions, motor activity, emotional expression, and certain psychologic defenses. Clinical examples illustrate how these coping mechanisms can support or hinder good psychosocial adaptation due to the degree of their employment and the nature of the parent-child relationship. Children with chronic illness as well as their parents show a rather predictable sequential pattern in adapting to their difficult situation. The parents' early acceptance of their child's disability and its impact on the family is crucial in promoting a healthy personality development of the child.