User:Jvb26/Childhood chronic illness
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Management
Taking care of a child with a chronic illness will require not one provider, but a team that may include medical providers, therapists and educators, and other caregivers.
Psychosocial
Coping with a chronic illness can challenge many aspects of life, and there are some therapies that can help children and their families adjust to their condition. Programs that focus specifically on parenting include increasing positive interaction between parent and child, and better communication about emotions.[1] Therapies that can help children improve their condition and manage the stress associated with having a chronic illness are behavioral therapy and cognitive behavior therapy.
Behavior therapy in the setting of chronic illnesses aims to change learned behaviors that are problematic using classical conditioning and operant techniques. Some examples of behavioral therapy for children with asthma include stress management techniques and contingency coping exercises. In one study, the asthma patients randomized to such therapies demonstrated fewer behavioral adjustment problems.[2] Additionally, systematic desensitization can be applied to children with illness to decrease the fear associated with some medical treatments that could be required of their condition such as imaging or invasive procedures.[3]
Cognitive Behavioral Therapy (CBT) is one of the most common techniques used to build resilience in children with chronic illnesses. CBT includes the practice of breathing exercises, relaxation training, imagery, distraction methods, coping models, cognitive coping skills, reinforcement for compliance, behavioral rehearsal, role-play and direct coaching.[4] Another intervention that is gaining popularity is the PASS Theory of Intelligence. The PASS Model combines a multitude of interventions to create a well-rounded program to foster resiliency in not only the children but the families affected as well. The goals of the pass model are to minimize trauma symptoms, develop adaptive coping skills, strengthen resiliency, and connect families to support networks.[5]
Diet
Nutrition is often a crucial part of managing many chronic conditions in children. Many chronic illnesses increase children's risk of developing complications such as growth failure due to increased inflammation and other pathological processes specific to each disease[6][7]. Inflammation is one of the main drivers of growth failure and malnutrition in children with chronic illnesses because it increases energy demands, increases energy losses, and decreases caloric intake[6][7]. Consequently, children can experience food aversion, intolerance, malabsorption, and loss of lean muscle and fat[6][7].
The specific management of nutrition varies depending on the patient and their disease. The goal of treatment is to increase energy intake to match the increased energy and protein needs and to supplement nutrient deficiencies[6]. General guidelines for treatment include regular monitoring of growth, development and nutritional status, addressing issues with food intake, review of medications, supplements and associated side effects of either, referral to a nutrition specialist and assessment of food insecurity and access to other services[7]. Nutrition management is essential for many children with chronic diseases because poor nutrition is often associated with worse treatment responses, development of comorbidities, and decreased survival in some cases[7].
Transition to Adult Care
The transition from pediatric and family-centered care to adult-centered care is an area of management that has more recently gained importance due to the increased prevalence of chronic diseases and life expectancy in children with chronic conditions. This transition is an ongoing area of research, and better data is still needed to assess the effectiveness of different interventions[8].
The specific details regarding the transition process often depend on individual goals, family preferences, cultural differences, and the patient's condition. Guidelines on conducting this process mainly vary amongst countries and healthcare institutions. Most guidelines from countries where western medicine is practiced have similarities. For example, early planning is often desirable to allow enough time for the transition and to decrease potential adverse outcomes and the need for acute care[8]. Also, a systematic approach that provides good communication between providers, patients, and families is preferred[8]. Lastly, providers and parents should encourage self-managing of care as the child develops a stronger desire for autonomy and independence[8].
References
- ^ Kaminski, Jennifer Wyatt; Valle, Linda Anne; Filene, Jill H.; Boyle, Cynthia L. (2008). "A meta-analytic review of components associated with parent training program effectiveness". Journal of Abnormal Child Psychology. 36 (4): 567–589. doi:10.1007/s10802-007-9201-9. ISSN 0091-0627. PMID 18205039. S2CID 207155947.
- ^ Perrin, J. M.; MacLean, W. E.; Gortmaker, S. L.; Asher, K. N. (1992). "Improving the psychological status of children with asthma: a randomized controlled trial". Journal of Developmental and Behavioral Pediatrics. 13 (4): 241–247. doi:10.1097/00004703-199208000-00001. ISSN 0196-206X. PMID 1506461. S2CID 9618651.
- ^ Harbeck-Weber, Cynthia (2003). Promoting Coping and Enhancing Adaptation to Illness. The Guilford Press. pp. 99–118. ISBN 978-1572309067.
- ^ Wenar, Charles, 1922- (2011). Developmental psychopathology : from infancy through adolescence. Kerig, Patricia. (5th ed.). Maidenhead, Berkshire: McGraw Hill. ISBN 978-0-07-713745-8. OCLC 756486438.
{{cite book}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link) - ^ Morison, Jillian E.; Bromfield, Leah M.; Cameron, Heather J. (2003). "A Therapeutic Model for Supporting Families of Children with a Chronic Illness or Disability". Child and Adolescent Mental Health. 8 (3): 125–130. doi:10.1111/1475-3588.00058. ISSN 1475-357X. PMID 32797558.
- ^ a b c d Kyle, Ursula G.; Shekerdemian, Lara S.; Coss-Bu, Jorge A. (2015-04). "Growth Failure and Nutrition Considerations in Chronic Childhood Wasting Diseases". Nutrition in Clinical Practice. 30 (2): 227–238. doi:10.1177/0884533614555234. ISSN 0884-5336.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c d e Sevilla, Wednesday Marie A. (2017-08). "Nutritional Considerations in Pediatric Chronic Disease". Pediatrics in Review. 38 (8): 343–352. doi:10.1542/pir.2016-0030. ISSN 0191-9601.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c d Samarasinghe, Shehani C.; Medlow, Sharon; Ho, Jane; Steinbeck, Katharine (2020-01-01). "Chronic illness and transition from paediatric to adult care: a systematic review of illness specific clinical guidelines for transition in chronic illnesses that require specialist to specialist transfer". Journal of Transition Medicine. 2 (1). doi:10.1515/jtm-2020-0001. ISSN 2568-2407.