Concluding Comments

Many parents experience stress after their child has been seriously ill. This is especially true when illness results in CNS involvement (Whitaker et al. 2002). After a child is critically ill, many parents' everyday activities are altered. Parents experience social isolation, strained familial relationships, time demands, and economic strains related to caring for their child (Hooper et al. 2007). In addition, parents report high levels of depression resulting from their inability to control their child's behavior (Hooper et al. 2007). The degree of anxiety and/or depression experienced by parents is directly related to the severity of their child's impairments (Hooper et al. 2007).

Bacterial, viral, and fungal meningitis and encephalitis are all serious pediatric illnesses that are generally most prevalent when a child is young (e.g., younger than 12 months old) or if a child has an immune defect. These serious illnesses result in hospi-talization of the child and may also restrict appropriate stimulation early in a child's life. Restrictions of touch and contact with primary caretakers during hospitalization due to the illness as well as the parents'/caretakers' extreme worry and reaction to the child's illness may lead to altered parent-child interaction and adversely affect the child's development (Hooper et al. 2007). This likely occurs with other acute serious illnesses as well.

A portion of children with these CNS infections experience language delay and neurological sequelae of the infection. These children have slightly lower IQ scores than healthy control subjects, and it is common for children to experience marked impairment in verbal skills. Language and communication skills are particularly vulnerable to biological and environmental stress (Whitaker et al. 2002). Problems in communication skills further affect personal-social development (Whitaker et al. 2002). Overall, the physical, neurological, and psychological sequelae of CNS infection are not separate components but rather interact with and exacerbate each other.

Significant medical advancements in the detection and treatment of meningitis, Lyme disease, PANDAS, and HIV infection have dramatically increased the survival rate of children infected with these diseases. However, dissemination of the infection into the CNS as well as the fear, trauma, and overall psychological distress associated with the serious nature of these illnesses can result in significant psychiatric morbidity, affecting multiple domains of the child's and his or her family's life. Comprehensive multidisciplinary care, including psychiatric evaluation and treatment, may improve the quality of life for pediatric patients afflicted by infectious diseases by decreasing discomfort and increasing functioning. The severity and duration of psychiatric symptoms and overall level of functional impairment will determine treatment plans.

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