CHRONIC DISORDERS in children have been of increasing importance over the past century, in association with the decline of acute illnesses, particularly those associated with infectious agents. Childhood survival has increased because of the improvement in standard of living (for example, sanitation, housing) and advances in medical care, such as the management of infectious diseases using antibiotics.
Medical advances have, however, also resulted in an increase in chronic medical disorders in children. Children with conditions such as congenital heart disease, chronic renal disease and babies born with very low birth weight are now surviving for longer periods. Children with chronic conditions suffer not only from physical problems associated with their condition, but may also experience developmental and behavioural problems.
Generally the prevalence of chronic conditions varies widely, depending on the definition used, from a low of 15 per cent to a high of 35 per cent. However, the prevalence of chronic conditions associated with limitation of activity remains fairly constant at five per cent.
Chronic illnesses impact children's development and behaviour in many ways - there is the limitation of normal age related activity; frequent investigation, medications and therapy; hospitalisation and separation from family; multiple health providers (doctors, nurses, others); they experience pain and discomfort; there is the feeling of being "different" from their peers; there is the loss of school time; isolation and loneliness; dependency and loss of control and anxiety about the future.
But the children's parents and siblings are also affected by their chronic illnesses. Parents might feel guilt, anger, shame and loneliness; they have to attend hospitals and clinics frequently (putting their jobs at risk, getting in transportation problems); they have to interact with multiple health providers; have limited social networks; may experience child care difficulties, financial strain, and special school requirements. They might also feel an uncertainty about the future of the child and how he will be cared for.
The siblings may experience isolation because of poor communication to them about their sick sibling; they might be fearful of contracting the illness; have more work at home; increased responsibility to care for their sick sibling if parents are not at home. Siblings might also become angry and resentful perhaps because they see a diversion of parental resources and attention to their sick sibling; they might be teased by their peers and have an altered sibling relationship (for example, the normal sibling rivalry might be absent).
Dr. Maureen Samms-Vaughan. Proceedings of the Paediatric Association of Jamaica 13th Biennial Conference.
