Physical Health Disorders

Question 1

6 areas you need to understand in order to properly manage a child’s chronic illness

Answer 1

1. child’s premorbid personality
2. stage of development
3. child’s perception of the illness and its management
4. nature of specific illness and its effects on child and family
5. nature of management procedures
6. potential for support of child by family and medical staff

Question 2

What are Bowlby’s 3 stages of a child’s reaction to separation?

Answer 2

1. protest
2. despair
3. detachment

Question 3

7 factors that effect adjustment in chronically ill children

Answer 3

1. Separation from parents
2. Restriction, sensory impairment, and isolation
3. Dependency and lack of consistency
4. Pain and deformity
5. Threat of imminent death
6. Medication (side effects, alertness, anxiety,
7. Absence from school (grades and peer relationships)

Question 4

How does the presence and absence of other affected siblings affect parents’ responses to a child’s chronic illness?

Answer 4

-presence of other healthy children may reduce parental
feelings of inadequacy and distress
-parents of more than one afflicted child frequently feel more than the usual guilt

Question 5

Other factors that influence families’ responses to a child’s chronic illness

Answer 5

• Pre-existing stability and strength of the marital and family unit
• Nature and effects of the illness itself
• Effects of home management program and restrictions on family life

Question 6

How can religious affiliations and active careers of parents affect parents’ responses to a child’s chronic illness?

Answer 6

• usually positive
• upward mobility at work may require frequent transfers, late hours, which can be seriously limited by the care needed by a chronically ill child

Question 7

How can illness severity and likely prognosis affect parents’ responses to a child’s chronic illness?

Answer 7

-the more debilitating the illness and the poorer the prognosis, the greater the stress

Question 8

Other factors that influence families’ responses to a child’s chronic illness

Answer 8

• Pre-existing stability and strength of the marital & family unit
• Nature and effects of the illness itself
• Effects of home management program and restrictions on family life

Question 9

Is parents’ guilt more in cases where their child’s chronic illness is congenital or acquired?

Answer 9

Congenital

Question 10

What are some common iatrogenic complications of cancer treatment?

Answer 10

• treatments for cancer can depress immunity, cause sterility or delay puberty
• interruption of developmental process can lead to psychological problems
• chemotherapy or radiation can cause growth retardation
• medical care can isolate child from peers, interfere with social development
• loss of hair and self-esteem

Question 11

How does a child’s age at the onset of their chronic illness affect their development and parent-child relationship?

Answer 11

• congenital: parents never expect child to be normal and leads to more overprotection and indulgence vs when child is seen and treated as normal as possible
• feelings of loss when illness is aquired

Question 12

How do repeated hospitalizations and surgical procedures affect parents’ responses to a child’s chronic illness?

Answer 12

-parental uncertainty and guilt may be intensified by child’s unhappiness and resentment due to many hospital visits

Question 13

Common emotional responses by parents of a chronically ill child

Answer 13

• denial
• anxiety
• guilt
• depression
• resentment/rejection

Question 14

What is the most common pediatric malignancy?

Answer 14

acute lymphoblastic leukemia (ALL)

Question 15

What is the most common genetic disease among white North Americans?

Answer 15

Cystic Fibrosis (CF)

Question 16

define; iatrogenic

Answer 16

of or relating to illness caused by medical examination or treatment

Question 17

What are some common iatrogenic complications of cancer treatment?

Answer 17

• treatments for cancer can depress immunity, cause sterility or delay puberty
• interruption of developmental process can lead to psychological problems
• chemotherapy or radiation can cause growth retardation
• medical care can isolate child from peers, interfere with social development
• loss of hair & self-esteem

Question 18

What is a common iatrogenic complication of cystic fibrosis treatment?

Answer 18

-often too ill to work full time leading to depression

Question 19

What are 3 types of ways that survivors of childhood cancer react to the uncertainty of a relapse?

Answer 19

1. preoccupied with the risk that malignancy will return and prove fatal, a lot of anxiety
2. expressed the erroneous belief that their prior cancer
   treatments provided a sort of immunity to relapse
3. survivors who were coping well adopted a stance of “not worrying about it”

Question 20

What are 3 types of ways that survivors of childhood cancer react to the uncertainty of a relapse?

Answer 20

1. preoccupied with the risk that malignancy will return and prove fatal, a lot of anxiety
2. expressed the erroneous belief that their prior cancer
   treatments provided a sort of immunity to relapse
3. survivors who were coping well adopted a stance of “not worrying about it”

Question 21

What are some psychological interventions available to help terminally ill children with pain management?

Answer 21

• in psychotherapy many children are reluctant to express their anger or frustrations too directly to those on whom they must rely for medical care, ex. fear doctors will become angry or inattentive
• various forms of behaviour therapy are also helpful

Question 22

T/F: Prior to the 1970s, doctors did not usually tell the truth or discuss issues of possible death with children.

Answer 22

True. They thought it would add to their stress, but in reality there is an inverse relationship between a child’s open discussion of illness and level of depression.

Question 23

Describe some of the issues parents of children who’ve survived cancer face during their child’s process of reentry?

Answer 23

• they often need reinforcement regarding their own competence
• stress of daily regimen of outpatient care: time-consuming, costly, exhausting
• need to actively redirect attention to other sibs, marital relationship

Question 24

Is it better to for adults to be open or secretive with terminally ill children about possible concerns? Why?

Answer 24

Open

• children have many unknown fears & fantasies which cannot be adequately expressed in a climate of secrecy
• open communication, where any question can be asked or answered, provides an opportunity to dispel fears
• concentrates on stimulating the adjustment required for treatment

Question 25

define/explain; anniversary phenomena

Answer 25

• related to the survival/remission stage of terminal illness
• where children may get anxious around significant life marker events, even if possible, eg birthdays, graduations, date of diagnosis

Question 26

What are the predictable stages that people progress through when facing death?

Answer 26

• there is virtually no empirical data or controlled studies to prove that predictable stages exist
• writings tend to be anecdotal and little of it deals with children

Question 27

What are the 2 main facotors that people should consider when administering psychological care to families of the dying child?

Answer 27

• the comfort of the child

- the aftermath for the surviving family members

Question 28

Describe some of the issues children who’ve survived cancer face during the process reentry to school?

Answer 28

• child may risk becoming withdrawn and isolated from peers at school, may regress to dependent, infantile behaviour
• hair and loss and amputations, self-esteem issues
• teachers should be prepared to treat child as normally as possible and to retain similar expectations of him as are held for other students

Question 29

What are 4 common approaches that parents take to handle their child with diabetes?

Answer 29

1. constant warnings and threats re dangers of the disease, leads to a frightened child who is dependent and passive
2. overprotective, may be so suffocating that in sheer self
   defence, child may rebel and consciously avoid health maintenance duties: results in poor chemical balance
3. perfectionistic, controlling, punitive: child’s life is excessively regimented often mirrored in child by pattern of compulsive behaviour: chemically balanced, but child can’t deal flexibly with life stresses
4. angry and resentful, both parents and child may deny feelings, as well as necessity for control of diet, insulin, exercise urine/blood testing: results in a chronic state of chemical imbalance

Question 30

What is the period of greatest stress for families of the dying child?

Answer 30

• after initial loss is period of greatest stress

- families may be reluctant to recontact professionals, and support is not as available from friends

Question 31

define/explain; insulin shock

Answer 31

• occurs when child receives too much insulin compared with his food intake and exercise
• anxious children especially susceptible
• stress is also involved in high blood sugar

Question 32

define; the postictal state

Answer 32

• the altered state of consciousness after an epileptic seizure
• headaches and weakness, shame over unacceptable behaviour

Question 33

What are some common responses by parents of children with diabetes?

Answer 33

• often feel guilty and become excessively permissive
• overindulge child in material ways as well as behaviourally
• often leads to a child who takes advantage of parents, who is lax in re-testing, diet, insulin, and generally behaves badly

Question 34

Describe some of the issues parents of children who’ve survived cancer face during their child’s process of reentry?

Answer 34

• they often need reinforcement regarding their own competence
• stress of daily regimen of outpatient care: time-consuming, costly, exhausting
• need to actively redirect attention to other sibs, marital relationship

Question 35

Describe some of the issues siblings of children who’ve survived cancer face during their sibling’s process of reentry?

Answer 35

• difficult transition, as parents may still treat patient as special
• they need extra attention, can miss school: guilt, jealousy, resentment in sibs
• they are often repressed, frequent psychosomatic complaints

Question 36

Describe some of the issues parents of children who’ve survived cancer face during their sibling’s process of reentry?

Answer 36

• they often need reinforcement regarding their own competence
• stress of daily regimen of outpatient care: time-consuming, costly, exhausting
• need to actively redirect attention to other sibs, marital relationship

Question 37

define; enuresis

Answer 37

involuntary urination, especially by children at night

Question 38

What is the most prevalent neurological disorder of childhood?

Answer 38

epilepsy

Question 39

What are 4 common approaches that parents take to handle their child with diabetes?

Answer 39

1. constant warnings & threats re dangers of the disease, leads to a frightened child who is dependent & passive
2. overprotective, may be so suffocating that in sheer self
   defence, child may rebel and consciously avoid health maintenance duties: results in poor chemical balance
3. perfectionistic, controlling, punitive: child’s life is excessively regimented often mirrored in child by pattern of compulsive behaviour: chemically balanced, but child can’t deal flexibly with life stresses
4. angry & resentful, both parents & child may deny feelings, as well as necessity for control of diet, insulin, exercise urine/blood testing: results in a chronic state of chemical imbalance

Question 40

define; the postictal state

Answer 40

• the altered state of consciousness after an epileptic seizure
• headaches and weakness, shame over unacceptable behaviour

Question 41

define; grand mal seizures

Answer 41

a type of generalized seizure that affects the entire brain, a sense of stigma, hereditary guilt and preoccupation

Question 42

define; petit mal seizures

Answer 42

• absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy
• 20-30% of the time
• school performance may suffer

Question 43

explain; aura (pre seizure)

Answer 43

child is abruptly seized with a sense of imminent doom

Question 44

define; the postictal state

Answer 44

the altered state of consciousness after an epileptic seizure
-headaches and weakness, shame over unacceptable behaviour

Question 45

define; the postictal state

Answer 45

the altered state of consciousness after an epileptic seizure
-headaches and weakness, shame over unacceptable behaviour

Question 46

What are the 2 most common psychiatric problems faced by children with epilepsy?

Answer 46

1. conduct disorders

2. ADHD

Question 47

explain; aura (pre-seizure)

Answer 47

child is abruptly seized with a sense of imminent doom

Question 48

define; the postictal state

Answer 48

• the altered state of consciousness after an epileptic seizure
• headaches and weakness, shame over unacceptable behaviour

Question 49

define/explain; Inflammatory Bowel Disease

Answer 49

• includes 2 conditions of unknown etiology:
• in both: psychosomatic relationships extensively studied, strong familial associations
• may begin at any age but more frequently in adolescence
• characterized by bloody diarrhea, pain, fever, and variable degrees of delayed growth

Question 50

define/explain; Inflammatory Bowel Disease

Answer 50

• includes 2 conditions of unknown etiology:
• in both: psychosomatic relationships extensively studied, strong familial associations
• may begin at any age but more frequently in adolescence
• characterized by bloody diarrhea, pain, fever, and variable degrees of delayed growth

Question 51

What are some psychological differences in children with IBD?

Answer 51

-serious difficulties in their relationships with their mothers
-children have been described as unusually passive &
compliant, with difficulty expressing their feelings verbally
-conflicts over aggression particularly noted

Question 52

define; extrinsic asthma

Answer 52

-bronchial asthma resulting from an allergic reaction to foreign substances

Question 53

define/explain; bronchial asthma

Answer 53

• diverse disease characterized by reversible airway obstruction
• extremely common in childhood, has a strong familial component, exact cause unknown
• more common in children of families where one or both parents smoke
• psychological factors play a prominent role
• asthmatics have more expectation of being able to avoid disease symptoms

Question 54

What similar psychological effects do children with IBD and asthma share?

Answer 54

• conflicts over dependency
• wish to be protected by mother
• difficulties expressing emotions verbally