Concluding Comments

The major task of childhood is to achieve healthy growth and development. This process must occur not only in the biological realm but also in the psychological and social realms. Research demonstrates that these realms interact with and influence one another, so that if one is compromised, it challenges the child's functioning and development in the others. To optimize treatment of children with chronic respiratory illnesses, good medical care must attend to the full spectrum of biopsychosocial functioning (see Figure 20-2).

No proven evidence-based approaches exist for the psychosocial and psychiatric management of children (and their families) with chronic psychosomatic respiratory diseases. Nevertheless, effective collaboration among medical psychosocial practitioners, who together provide coordinated care to the patient in his or her psychosocial context, will provide the optimal setting for comprehensive and effective care.

We offer the following goals as suggestions: 1) minimize the impact of the disease on the physical and emotional development and functioning of the child; 2) achieve optimum balance between disease management and HRQOL for the child and family;

3) facilitate the integrated functioning of the chronically ill child with his or her psychosocial surround;

4) appreciate and facilitate the developmentally synchronized shift toward self-care of the illness and its social and emotional aspects; and 5) be aware of warning signs that the balance of the child's well-being may be challenged (e.g., change in functioning in any of the three realms—biological, psychological, and social; onset of stressful life events or developmental transitions). Table 20-1 lists general guidelines for psychosomatic care.

(disease activity) Biological

Figure 20-2. Balance of well-being in children with chronic respiratory illness.

Table 20-1. Establishing adaptive interactions among family, school, peer group, and health care system: a general guide for psychosomatic care

Step 1. Open channels of communication.

Family: Encourage both parents to come to appointments; if parents are divorced, obtain permission from custodial parent to keep noncustodial parent involved if possible.

School: Identify one school person to coordinate communication with family and health care provider.

Peers: Have parents communicate with parents of patient's friends, and have patient or parents (depending on age of patient) communicate with peers regarding the illness.

Step 2. Provide education regarding the illness.

Family: Provide information about the illness to all parental figures and to siblings; assist and encourage family to share information with extended family members.

School: Have meeting at school with parents, patient, and relevant school personnel (nurse, homeroom teacher, gym teacher, bus driver). Outline characteristics of the illness, specific for that child. Devise written plan for medical treatment and for what to do in the event of an illness episode.

Peers: Have family educate peers and their parents as to nature of patient's illness.

Step 3. Emphasize balance between medical management of the disease and quality of life and developmental demands.

Family: Help family not to neglect psychosocial and developmental needs in favor of child's physical well-being and growth.

School: Assist school in achieving balanced expectations of child with regard to disease management and participation in academics and extracurricular activities.

Peers: Encourage patient to be involved with informal neighborhood peer activities. Emphasize to parents the critical nature of peer relationships for psychosocial development.

Step 4. Initiate age-appropriate self-care and facilitate increases in self-care in accordance with child's development.

Family: Guide family in home care routines that maximize patient's active participation in management of the illness and its psychosocial concomitants.

School: Prepare child for self-care activities at school and obtain school's coordination.

Peers: Encourage family to inform peers and their parents as to the care the patient will need to provide for himself or herself and any assistance that might be needed from adults.

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