6/22- Emotions and Illness- Developmental Perspective Flashcards
What is chronic illness?
A health problem that lats > 3 months, affects daily activities, requires frequent hospitalizations, home health care, and/or extensive medical care
___ million children (under 18) suffer from a chronic illness
15-18 million children (under 18) suffer from a chronic illness
What is a common feature of children who have to undergo surgery?
Pre-operative anxiety (50-65%)
- Crying
- Agitation
- Increase in heart rate and secretion of cortisol
Most anxiety-provoking part is anesthesia induction
What are risk factors for pre-operative anxiety?
- Age under 5 yrs (6 mo- 4yrs)
- Temperament (Behavioral Inhibition)
- Passive coping style (e.g. doesn’t want to talk to anyone about disease; just take it as it comes; part of temperament)
- Negative past medical encounters
- Parents with increased levels of anxiety
What is the range for the start of separation anxiety (start/peak)?
- Experienced as early as 9 mo
- Peaks at 1 yr
What are post-op concerns of children following surgery?
- Post-operative pain
- Emergence of delirium
- Behavioral changes (nightmares, separation anxiety, eating/feeding problems/ increased fear of doctors)
What is associated with kids with high levels of pre-operative anxiety?
Negative behavioral changes
- Children with high levels of preoperative anxiety are 3x as likely to develop negative behavioral changes
What is the time course of post-op behavioral changes?
- 40-55% at 2 weeks
- 19% at 6 months
- 65 at 1 year
A child’s perspective changes greatly with what?
Age (especially cognitive development)
How do children interact with illness in the Sensorimotor stage (0-2 yrs)?
- Rely on senses to understand illness and bodies
- Mainly pre-verbal and cannot establish narratives to convey thoughts/feelings
How do children interact with illness in the Preoperational stage (2-7 yrs)?
- “Egocentric” thinking reliant on personal encounters with limited capacity to generalize in other experiences
- Empirical rather than logical thought (i.e. may fear phlebotomist not b/c of pain but distress over losing all blood) [Band-aid obsessions!]
- Concept of immanent justice: belief that a form of natural justice exists, leading to guilt and shame (got cancer b/c lied to parents)
- Belief that events connected temporally are causally related (I fell down and got a cough)
- Over-extension of the concept of contagion, applying it to conditions without an infectious etiology
- Prior to adolescence, difficult to conceive that unrelated symptoms can belong to one illness (e.g. rash and headache as part of the same syndrome)
How do children interact with illness in the Concrete Operations stage (7-11 yrs)?
- Concrete thinking processes with limited ability to abstract (e.g. don’t understand how medicine taken by mouth could help a hurt ankle)
- Continued difficulty recognizing that apparently unrelated symptoms are part of same disease process
- Capacity to use logic to comprehend their perceptions
- increasing ability to differentiate self from others; ability to distinguish one’s own wishes, needs, and thoughts
How do children interact with illness in the Formal Operations stage (>12 yrs)?
- Multiple etiologies are considered for source of illness
- Capacity to understand two unrelated symptoms can manifest from one condition (e.g. migraine headaches and emesis)
What are risk and protective factors in relation to illness/hospitalization (broadly)
- Onset
- Etiology
- Diagnosis
- Deformity/disability
- Prognosis
Risk factors: Age of Onset?
Age of Onset:
- Onset (6 mo- 5 yrs) and early adolescence
- Other stressors: losses, school problems
- Issues of attachment, independence, and autonomy for 1-4 yr olds (challenging all of these if a child gets a disease at this time)
- Issues of privacy for early/mid teens
- Painful, frightening symptoms are the most difficult for preschoolers
- Younger children lack understanding of causality/concept of justice
- Immanent justice
- Younger children lack ability to understand treatment rationale
