Behavioral Pediatrics

Question 1

Behavioral Pediatrics

Answer 1

Branch of behavioral medicine that is concerned with the psychological aspects of children’s medical illnesses.

compliance with medical regimes and coping with painful medical procedures.

1. Disclosure: open communication is encouraged to child about the illness. Children told earlier about their diagnosis cope better. Use developmentally appropriate language.
2. Medical Procedure: Multicomponent cognitive-behavioral interventions have been found to reduce children’s anxiety about medical procedures and the pain they cause.
   
   1. Meichenbaum’s stress inoculation model: provide information about the procedure and help the child cope with anxiety and stress.
   2. filmed modeling, reinforcement, breathing exercises, emotive imagery/distraction, and behavioral rehearsal.
3. Hospitalization: hospitalized kids are at increased risk for emotional and behavioral problems like increased dependency or mildly disruptive bx to anxiety, depression or severe withdrawal.
   
   1. those hospitalized between 1-4yo have the most negative reactions to hospitalizations and that is mainly due to separation from family.
   2. increased visitation hours and rooming-in (parents can stay with child the whole time).
4. Physical Disabilities: linked to a higher risk for emotional and behavioral disorders, risk for psychopathology being greatest for children and adolescents with a major neurological disorder.
   
   1. one study found 3 times higher rate of psychiatric problems in children with hemiplegic cerebral palsy.
5. School Adjustment: Youth with chronic medical conditions have higher rates of school-related problems. In some cases these difficulties are the direct result of the illness itself; others are caused by the treatment or the frequent absences from school.
   
   1. CNS irradiation and intrathecal chemotherapy (injected in spinal cord), common of leukemia, are both associated with impaired neurocognitive functioning and a higher-than-normal rate of Learning Disabilities.
6. Compliance: Lack of compliance with medical regimens is common problem among the chronically-ill children/adolescents and linked to lack of knowledge or skill, parent-child conflicts/communication difficulties, and developmental issues.
   
   1. compliance is particularly difficult in adolescence as they are concerned with conformity to rules, questioning the credibility of the doctors and/or reduced parental supervision.