The Child & Family Experiences of Illness

Question 1

How does a child’s significant illness impact the family?

Answer 1

-Systems = interactions + patterns in beh within families
-Illness enters system & get feedback (within = what family knows already/has been exposed to, & what comes out externally) affect ind’s beh - better/worse
-Way ind’s beh altered depends on perspectives + emotional state of parents (key stakeholders)
-Get changes to family dynamics - ind’s identity

Question 2

What is the impact of an illness on the child, & why?

Answer 2

-Children = identity (of who they are) not fixed
-Identity via their illness (how see themselves in future)
–> affects mental health in future
-More emotional stressors = relationships affected
-More support systems needed

Question 3

What role does support play in childhood illness?

Answer 3

-Sufficient social support for families = better clinical outcomes
–> e.g., early interventions (paed care) from diagnosis can relieve int/ext factors - stress + social surroundings (people)
-Must be balance between int/ext factors for best coping

Question 4

How can families be affected by chronic (long-term) health condition in a child?

Answer 4

-Expense & time commitment
-Confusion due to conflicting systems of health care management
-Lost opportunities (e.g., family members providing primary care to child - can’t work)
-Loss of hope for “ideal” child
-Social isolation (can’t participate in society)
-Siblings may resent extra attention ill child gets

Would this be different if child had acute/1 off illness?

Question 5

What is involved in the “ideal” child?

Answer 5

Healthy - meet milestones
-Able bodied - social stigma
-Goals, aspirations of child

Question 6

Role of healthcare professionals in chronic childhood treatment - what should/shouldn’t they do?

Answer 6

-Must be compassionate & non-judgemental:
*develop rapport
*avoid confrontation
*address any fears (will the child die?)
*subjective symptom severity - must attempt to take ind perspective of child’s symptoms
*understand child’s sit in family

Question 7

Health contact points for children & their families?

Answer 7

(just for minor illnesses)

Question 8

What may be involved in hospital stays?

Answer 8

-Admission – history, examination, investigation, management plan
-Continued observations & treatment by nurses
-Planned 3 times daily medical reviews
-Discharge explanation & plan

Question 9

What must be considered in managing child’s treatment?

Answer 9

-How child feels
-Child’s experience
-How family system reacts - feedback from within & out
-Ext/out = interactions with healthcare

Question 10

What communications may be involved in child hospital stay?

Answer 10

-Needs of child & parent reassured
-Progress reported…
-Handover of care
-Advice for parents
-W/ primary care - ongoing clinical needs - addressing parent’s concerns

Question 11

What impacts on experiences/comes back into system (int) from ext system???

Answer 11

Child’s emotional development

Question 12

What is the attachment theory?

Answer 12

Developed understanding of others - informs understanding of self & then understanding of future relationships
-at diff ages/stages of development

Question 13

What is the internal working model of attachment?

Answer 13

-Child = shaped by their interactions with the world and the people around them

Question 14

What is attachment?

Answer 14

Type of affectional bond where a person’s sense of security is bound up in the relationship

Question 15

How do people develop different attachment styles?

Answer 15

Learnt interactions w/ early care givers –> superimpose onto other relationships in future

Question 16

What are internal working models?

Answer 16

Mental representation of child’s expectation for future relationships - based on early care giver’s relationship w/ child (learnt interaction style)
-Emotionally driven system
-Occurs as emotional centres develop faster than cognitive oens

Question 17

How does the internal working model link to children’s medical care?

Answer 17

Child will have individual expectations of people based upon early learnt experience w/ care giver - will superimpose onto healthcare profs

Question 18

When might the internal working model have negative effects on child?

Answer 18

If early care giver for child doesn’t provide sufficient care for child - needs not met i.e., neglectful/abusive = child will adopt negative future expectations of people - so may feel hospital caregivers are not safe too

Question 19

What are internal working models?

Answer 19

Mental representation of child’s expectation for future relationships - based on early care giver’s relationship w/ child (learnt interaction style)
-Emotionally driven system
-Occurs as emotional centres develop faster than cognitive ones

Question 20

What are the 3 criteria for attachment development in 1st 18 months of child’s life?

Answer 20

-Stranger anxiety - response to stranger
-Separation anxiety - distress when care giver leaves & comfort when return
-Social referencing - child refers to care giver on how to respond to new situations

Question 21

What are the distinct age-related stages of attachment?

Answer 21

0-6 weeks = asocial
6 weeks - 7 months = indiscriminate attachments
7-9 months = specific attachments
10 months… = multiple attachments

Question 22

What happens in the 0-6 weeks: asocial stage?

Answer 22

Many stimuli - favour one may smile

Question 23

What happens in the 6 weeks - 7 months: indiscriminate attachments stage?

Answer 23

Enjoy any human company equally - upset if someone won’t interact
3 months = smile @ familiar faces more - more comfort from familiar care giver

Question 24

What happens in the 7-9 months: specific attachments stage?

Answer 24

-Prefer single care giver = attachment figure
–> look to them for security, comfort, protection - separation anxiety if leave
-Stranger fear

Question 25

What happens in the 10 months…: multiple attachments stage?

Answer 25

-Build attachment w/ other family members & more (more care givers)
18 months = more independent & makes many more attachments

Question 26

Role of attachment

Answer 26

–>Provide safety - so child develops sense of prox w./ others

To increase prox w/ attachment figures
-Proximity = regulated by attachment behs
-Smiling, vocalising = interest in interaction
-Crying = disliked beh - draws attachment figure in to stop
-If child approaches/follows = seeking proximity

*Biologically = for survival –> seek proximity when danger/stressed - gather understanding of people who let them seek proximity - are they helpful/unhelpful = adaptive mechanism (can be maladaptive if primary attachment figure = -ve)

Question 27

What type of development is attachment?

Answer 27

Emotional development

Question 28

What are Piaget’s 4 stages of cognitive development & why is it clinically important?

Answer 28

-Informs how communicate with children as patients - based on their capacity

-Explains how child views everything based on their current stage

Question 29

What does the sensorimotor stage (birth-2 years) involve?

Answer 29

-Understand world by what can see, smell, touch, taste (movements & sensations)
–> learn by touching, sucking, listening
-Learn things exist even when not seen = object permanence - still learning
-Know are separate beings from people, objs around
-Begin to see their actions have outcomes

Question 30

What does the preoccupation stage (2-7 years) involve?

Answer 30

-Start symbolically thinking - use of words, pics to represent objs
-Often egocentric - own perspective only seen (if good for them = good for all)
-Lang & thinking develops - have ‘concrete’ processes
-Skills develop - pretent play

Question 31

What does the concrete operational stage (7-11 years) involve?

Answer 31

-Logical, organised thinking - on ‘concrete’ events
-Concept conservation begins = things staying the same even though other elements change
-Inductive logic starts = inference - can extrapolate info from general principle (but not metaphors)

Question 32

What does the formal operational stage (12 years…) involve?

Answer 32

-Abstract thinking about hypothetical issues starts
-Moral, philosophical, ethical, social, political considerations start (use theoretical + abstract reasoning)
-Deductive logic starts = reasoning from general principle to specific info
-Development of personal identity

Question 33

How are children viewed by Piaget?

Answer 33

As scientists = have active role in learning - observations, experiments - to learn about world - gain/build on knowledge

Question 34

What is needed for +ve health outcomes for children (as patients)?

Answer 34

-Health profs = source of new info/learning to child - need +ve experience for engagement by:
*Knowledge
*Skills
*Age-appropriate Language
*Attitudes

Question 35

Knowledge & skills role in healthcare?

Answer 35

-How is info given - to have various effects - how is info communicated - MUST calm feedback in int/ext system - for +ve clinical outcomes
-Can be didactic/empowering - but should each be used? - based on child & family understanding
-Info MUST be effectively communicated

Question 36

Language & attitude role in healthcare?

Answer 36

-Must engage @ child’s level of devlopment
–> based on what language used (not above/below)

Question 37

Problems caused by communicating at wrong level of child’s cognitive development?

Answer 37

Feelings of…
-distrust
-disengagement
-resentment
and these feeling may cause –> poor clinical management, lack of adherence, follow up, engagement w/ healthcare services, -ve healthcare outcomes

Question 38

Outcomes (+ve) by communicating at correct level of child’s cognitive development?

Answer 38

Feelings of…
-being listened to
-being trusted
-being respected

Question 39

What is influenced by how Heathcare profs communicate?

Answer 39

Influence our feelings –> impacting on engagement, adherence & clinical outcomes

Question 40

Differences between treating 18-month-old vs 13-year-old?

Answer 40

-Older child = more understanding of world & so worry of what is wrong w/ them - can communicate how they feel more effectively
-Parent of younger child = more worried as child cannot say exactly how feel - more based on observation - & may be new parent - still learning
-Doctors - must tailor communication to child & parents @ correct level - whilst remaining compassionate & informative

Question 41

What is meant by treating the person 1st then condition after?

Answer 41

Building effective relationship w/ child & family - to then allow for more +ve clinical outcomes - effective treatment & management

Question 42

Why might treating patient 1st then condition after be useful when child has a chronic illness?

Answer 42

-So not faced w/ anger, doubt, cynicism
–> so parents do not disengage (would put child at risk = -ve clinical outcome)