User:Jvb26/Childhood chronic illness

Management

Taking care of a child with a chronic illness will require a team of providers that may include medical providers, therapists, educators, and other caregivers.

Psychological

Coping with a chronic illness can challenge many aspects of life, and some therapies can help children and their families adjust to their condition.

Psychological Management in Children

Children with chronic illnesses have a higher risk of developing mental health disturbances than their healthy counterparts. Many evidence-based interventions exist to treat children with mental health issues; however, these interventions often have not been validated for children with chronic physical illnesses, and their efficacy on this population is not fully understood. Nevertheless, psychological management in children with chronic diseases should be prioritized similarly to the management of physical symptoms because it can impact the child's quality of life, behavior, and functioning.

Behavior therapy and cognitive behavioral therapy can help children improve their condition and manage the stress associated with a chronic illness. Behavior therapy in the setting of chronic illnesses aims to change problematic learned behaviors 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. Additionally, systematic desensitization can be used to decrease children's fear associated with some medical treatments, such as imaging or invasive procedures.

One of the more studied interventions for the psychological management of chronic physical illness in children is Cognitive Behavioral Therapy (CBT). CBT is used to build resilience in children with chronic diseases. It includes breathing exercises, relaxation training, imagery, distraction methods, coping models, cognitive coping skills, reinforcement for compliance, behavioral rehearsal, role-play, and direct coaching. CBT has positive effects in specifically treating anxiety and depression in this population; when treatment includes both parents and child, it can improve physical symptoms associated with the child's condition.

Psychological Management in Parents

Parents of children with chronic conditions often experience higher stress levels, maladaptive behaviors, and mental health issues due to challenges associated with balancing their child's care and other obligations. The adverse effects of chronic childhood illness in parents are critical to address because the child's well-being depends on the parents' ability to deal with the situation and maintain healthy family dynamics. Treatments aim to improve parents' distress, adaptive behaviors, family dynamics, and the sick child's well-being.

Currently, there is a lot of debate about what interventions are the most effective for parents, and often the efficacy of therapy appears to depend on the child's condition. For example, psychotherapy has helped improve parental adaptive behaviors in parents of children with cancer but not in others. Additionally, some therapies may work for some targeted outcomes but not others. Treatments can include psychotherapy, CBT, problem-solving therapy (PST), family therapy (FT), and multi-systemic therapy (MST). Of these, PST has shown to improve parents' adaptive behavior, mental health, and stress level post-treatment.

Diet

Nutrition is a crucial part of managing many chronic conditions in children. Many chronic illnesses increase children's risk of developing growth complications due to increased inflammation and other pathological processes specific to each disease. Inflammation is one of the main drivers of growth failure and malnutrition in children with chronic illnesses because it decreases caloric intake and increases both energy demands and energy losses.. Consequently, children can experience food aversion, intolerance, malabsorption, and loss of lean muscle and fat.

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 needs and to supplement nutrient deficiencies. General guidelines for treatment include regular monitoring of growth and development, checking nutritional status, addressing issues with food intake, reviewing medications and supplements, referral to a specialist and assessment of food insecurity . Nutrition management is essential for many children with chronic diseases because poor nutrition is associated with worse treatment responses, development of comorbidities, and lowered survival in some cases.  

Transition to Adult Care

The transition from pediatric and family-centered care to adult-centered care is an area of management that has recently gained importance due to the increased prevalence of chronic diseases and lengthened 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 models of transition.

The transition process is multifactorial and depends on patients' goals, family preferences, cultural differences, and the patient's condition. Guidelines on conducting this process vary amongst countries and healthcare institutions. Most guidelines from countries where western medicine is practiced have similar characteristics. First, early planning is often desirable to allow enough time for the transition and to decrease potential adverse outcomes and the need for acute care. For example, the National Institute of Health and Care Excellence sets transition guidelines in the UK and recommends that planning starts as early as when the child is thirteen or fourteen. Second, a systematic approach that provides good communication between providers, patients, and families is preferred. A dedicated transition coordinator is appointed to manage this process sometimes. Lastly, providers and parents should encourage self-managing of care as the child develops a stronger desire for autonomy and independence . Methods used to achieve self-management will likely depend on the child's capacity and understanding. Plans can include educating the child about their condition, providing different communication tools to reach providers, referring them to peer support or advocacy groups, and encouraging them to be involved in decision-making.