Concluding Comments

Pediatric heart disease is a complex and diverse constellation of congenital and acquired illnesses. These illnesses can vary in severity from those with few symptoms requiring little medical care to devastating diseases that require complex surgical interventions. Beyond the physical illness, heart disease has the potential for significant developmental co-morbidities. This is especially true in patients with congenital cyanotic lesions, in whom "normal" but often below average IQs have been observed. Children and families affected by heart disease must often endure extended hospital stays, social stigma, and increased emotional burden. Time spent in the intensive care unit can be especially stressful as fam-

Table 21-2. Guidelines for approaching academic needs in patients with pediatric heart disease

Treat as "children with cardiac illness," not "cardiac children"

• Others should view the child as having a pediatric heart problem rather than responding as if the illness defines the child.

• Child should be treated as "normally" as possible within the constraints of his or her illness. Clarify the specific type of heart disease

• Clinician can guide the school in providing reasonable accommodations to child's physical limitations. Remember that pediatric heart disease is different from adult heart disease

• Chest pain is an uncommon symptom of pediatric cardiac disease.

• Chest discomfort or awareness (e.g., fluttering, skipping beat, turning sensation) related to arrhythmias is a much more likely pediatric heart disease complaint and is not the symptom of a heart attack.

Be alert for potential school fear

• Occasionally, parents report that a school is afraid of having responsibility for a student with cardiac illness. Helping school staff to understand the type of heart disease is one approach to reducing this worry.

Be alert to learning problems

• Children with cyanotic heart lesions are at significant risk of motor and language problems.

• Psychological testing should be considered. Consider classroom education

• Child's classmates can benefit from educational information regarding heart illness, particularly if child needs to be hospitalized during school year.

• Parental permission and review of "what will be said" to class is critical.

• Classroom education is generally most useful for younger children. Consider support for coping

• Preparatory interventions include cognitive strategies (e.g., hospital preadmission programs) designed to provide families with educational information regarding their children's illnesses combined with modeling of and permission for adverse affective responses (e.g., fear, anger).

• Children often need graduated transitioning back into school after surgeries or hospitalizations.

• Tutoring or assistance for children who have fallen behind on schoolwork can be immensely helpful.

• Individual counseling or peer groups can be helpful for children and adolescents struggling with longer-term issues related to heart problems.

Source. DeMaso 2004.

ilies face critical treatment decisions. Despite these mounting risk factors, however, much of the contemporary research suggests an impressive level of psychiatric resiliency in this population. Although some children and adolescents display psychiatric difficulties, factors secondary to their medical condition are likely responsible. Neuropsychological deficits, maternal stress, and poor family functioning have been shown to predict psychiatric outcomes more accurately than the severity of the illness. Thus, the clinician should approach any case using a biopsychosocial model that takes all of these factors into account.

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