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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 ...