Chronic Illness Flashcards
Definition of chronic illness
Condition lasting more than 3 months
Affects child’s usual age appropriate activities
Results in extensive utilisation of health care services beyond that considered age appropriate
Causes impairment / disability / disadvantage
What proportion of children have a chronic condition
10-20%
Name 10 common conditions that can lead to chronic disease in children
Asthma
ADHD
Arthritis
ASD
AID
Epilepsy
DM
Food allergy
Sickle cell
Spina bifida
Cancer
Obesity
Cerebral Palsy
Cardio conditions
Prevalence of psychiatric comorbidities in children with chronic illness
44% CP
29% epilepsy
12% physical disorders
Blood features leading to Dx to T1DM
High blood glucose
Ketonuria
High blood ketones
Mx of insulin
Blood glucose 4 times daily at least
Multiple daily dose with daytime short acting and night time long acting doses
Insulin MDT
DM nurse specialist, dietician, psychologist and consultant
Child who is needle phobic but T1DM. Mx?
Work with child psychologist to get over needle fear
Ideal HbA1c value
<6.5%
T1DM children should also be screened for…
Coaeliac
Thyroid disease
Retinopathy
Microalbuminaemia
BP
Foot review
Injection site examination for lypodystrophy
Advice for parents of children with T1DM and viral illness
Infection can lead to increased BG levels so might need more insulin (up to 20%)
Give insulin even if not eating
Viral infections likely self resolve
Check blood ketones
Factors that affect a T1DM teenager to adjust
Academic performance at school
Level of peer acceptance and support at school
His level of control over care
Risk of T1DM if close relative has T1DM
6%
Risk of T1DM if no close relative has T1DM
0.5%
Abroad holiday with T1DM child, what extra arrangements needed?
Take a letter from Dr with infomation
Take Mx in hand luggage, but inform airline
Renal complication of DM
Renal parenchymal disease due to elevated albumin:creatinine ratio
Impact of condition on child depends on…
Age
Age condition developed
Severity of illness
Prognosis
Support - social and medical
What impact does chronic illness have on a child
Emotional problems
Low self esteem
Impaired self image
Behavioural problems
Loss of autonomy and control
Impacts on parents
Shock and disbelief
Grief
Socially isolated
Financial burden - career issues
Guilt / anger
Time management poor
Loss of control / autonomy
Holiday plans
Impacts of siblings
Guilt
Anger
Resentment
Closer bond / relationship with sibling
Carer role
Holiday plans
Impact on school and peers
Reduced vocational / educational skills
Reduced friendships
Reduced school involvement - trips / PE
Risk of underachieving
Adjustments made by school
What framework can be applied to chronic illness in children?
Bio-psycho-social
Biological impacts of chronic illness on adolescent development
Delayed / impaired puberty
Short stature
Reduced bone mass accretion - fractures
Increased caloric requirement for growth worsens disease
Hormones impact on disease parameters
Psychological impacts of chronic illness on adolescent development
Infantilised
Adoption of sick role as personal identifier
Egocentricity
Rejection of medical professionals as part of seperation from parents
Impaired development of sense of attractive self / sexual
Exploratory / risk taking behaviours
Poor adherence due to poor decision making
Social impacts of chronic illness on adolescent development
Reduced independence inc independent living ability
Choatic eating habits –> poor nutrition
Failure of peer / sexual relationships
XS ETOH, smoking, drugs
Social isolation
Health risk behaviours - sexual
Educational failure
What is transition
Purposeful and planned movement of children with chronic physical/medical conditions from child-centred to adult-orientated healthcare system
What is transfer
Single act of moving from one facility to another with ni preparation or planning ahead of time
