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Children frequently experience minor illnesses; during their first year alone, children experience an average of five to seven respiratory or gastrointestinal illnesses. Many children also have a long-term illness that may be associated with restrictions in daily activities; physical disabilities; and repetitive, often painful, treatments and hospitalizations. Estimates of the prevalence of chronic illness range from 17% to 20% of children, with estimates even higher if less serious conditions are included. Approximately 2% of children from birth to 21 years of age have a chronic condition that is severe enough to significantly alter their daily lives; approximately 200 children per 10,000 require intensive care hospitalization each year.1

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Illnesses and their treatment are predictably upsetting experiences for children and their families. They represent potential stressors that can interfere with normal development, but they also provide an opportunity for mastery, which can enhance self-esteem and promote development. It is important to appreciate how children of various ages typically interpret and react to physical illness and its treatment to identify ways of minimizing the negative impact of such experiences and of maximizing their positive potential.2 This section reviews the developmental process by which children come to understand physical illness and its treatment; children’s reactions to acute and chronic illness; children’s normal reactions to the treatment process, including medical procedures and hospitalization; and guidelines for assisting children to understand and cope with illness and treatment.

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Children develop an increasingly sophisticated understanding of physical illness and its treatment as the result of both biological maturation and the accumulation of relevant experiences.3 Developmental theorists (such as Piaget) describe important qualitative differences in the basic ways that children at different developmental stages see, interpret, and come to understand various phenomena, including physical illness and its treatment.4 Effective support and assistance during the illness is enhanced by an appreciation of this developmental process.5

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Very young children often rely on magical thinking and phenomenistic explanations and may attribute the cause of illness to immanent justice, the belief that good is naturally rewarded and misdeeds are punished. This leads to a child believing illness is caused from personal guilt or causes guilt in others. Children may persist in using immanent justice explanations if they have had less personal experience with illness and if more adequate explanations have not been provided. Children as young as 4 years old can respond to educational efforts to improve their understanding both of specific diseases and of illness in general.6

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As young children develop a more accurate understanding about the causes of illness, the concept of contagion appears in their explanations of illness. Initially, such explanations are often overextended to include even noninfectious conditions. By about 9 or 10 years of age, children believe that germs must be internalized to cause illness, but they usually cannot elaborate on the process or mechanism by which illness results. By 12 or 13 years of age, children ...

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