Developmental Trends: Chronic Health Conditions in Children and Adolescents

Diversity:

• Some genetic conditions, such as cystic fibrosis, may be diagnosed during infancy.
• Some infants initially show normal developmental advances, such as making eye contact, babbling, and smiling, and then slow down in their physical growth as illnesses progress.

Implications:

• Provide emotional support to families when they struggle with the news that their children have a chronic or serious illness.
• Determine the kinds of physical care that infants find comforting and soothing.

Early Childhood (2-6)

What You Might Observe:

• Eating problems
• Regular medication schedule
• Some toileting problems
• Susceptibility to other illnesses, such as the common cold
• Belief that “being bad” is the cause of getting sick

Diversity:

• Children may have special nutritional needs.
• Some children may need to take dietary supplements.
• Children may fail to take prescribed medicines when their parents believe medication is unnecessary or cannot afford to purchase it.

Implications:

• Encourage children to adhere to diets advised by medical personnel.
• Allow children to use the toilet whenever necessary.
• Safeguard small children from environmental substances that exacerbate their symptoms (e.g., shield children with asthma from secondhand smoke).

Middle Childhood (6-10)

What You Might Observe:

• Frequent teasing and inappropriately personal questions from other children
• Periods of health followed by flare-ups of the condition
• Some efforts by the child to manage symptoms at school (e.g., a child with asthma monitors his or her lung function with a peak flow meter)
• Greater than average number of absences from school

Diversity:

• The nature of the illness will affect the child’s ability to manage it and other children’s reactions to it.
• Absences from school vary depending on the child’s illness, frequency of flare-ups, and the family’s anxiety about the illness.
• Some children are hospitalized occasionally or regularly.
• Many children show some adverse reactions to particular treatments (e.g., becoming nervous or jittery after taking asthma medicine).

Implications:

• Ask families for ideas about how you can support the child’s physical well-being.
• Advise family members of significant changes in the child’s symptoms and health-management routines.
• Insist that other children show understanding of children with chronic illnesses while also preserving sick children’s right to privacy.
• When children are absent due to hospitalizations, keep in touch through phone calls, e-mail, and notes from classmates.
• Allow children (particularly those with diabetes) to eat nutritious snacks regularly throughout the school day.

Early Adolescence (10-14)

What You Might Observe:

• Heightened concern about physical appearance
• Some self-consciousness about being different due to illness
• Growing knowledge of how to monitor health conditions
• Transition from family care to self-care of chronic illnesses
• Some feeling of being invincible to threats to health

Diversity:

• Some adolescents who were previously conscientious about their treatment regimens now become inconsistent in adhering to good medical routines.
• Some adolescents with chronic health conditions may need accommodations at school or in particular classes, such as physical education.
• Some adolescents show irregular physical features that reflect the progression of their disease (e.g., adolescents with cystic fibrosis may develop enlarged and rounded fingertips).
• Adolescents with diabetes may have an increase in symptoms when they are growing rapidly.

Implications:

• Offer reassurance that all adolescents are valued members of the class and school.
• Advise adolescents about the supportive services of school counselors.
• Continue to encourage contact with classmates and teachers when adolescents are hospitalized or recuperating at home.
• Talk privately with adolescents about seeing the school nurse as needed (e.g., to take inhaled medications).

Late Adolescence (14-18)

What You Might Observe:

• Growing knowledge of health conditions and their optimal management
• Some difficulties in physical education classes (e.g., breathing problems, fatigue, and weakness with heat)
• Some negative feelings when illness necessitates continued dependence on parents (e.g., being unable to obtain a driver’s license because of a seizure disorder)

Diversity:

• Some adolescents who regularly miss school due to illness feel isolated and lonely at school.
• Some adolescents face declining health as well as the prospect of dying in early adulthood.
• Some adolescents manage their health conditions effectively and make plans that realistically address their conditions.
• Adolescents who engage in risky behaviors or follow chaotic lifestyles may fail to take prescribed medicines.
• Adolescents with some serious health conditions are vulnerable to depression.

Implications:

• At the beginning of the year, develop a plan for dealing with school absences and making up missed academic work.
• Consult with a school counselor to learn appropriate ways to help if an adolescent is terminally ill.
• Encourage adolescents to assume increasing responsibility for management and treatment of their condition.