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Pediatric psychosomatic medicine requires communication and collaboration between families and the health care team. Families bring their children for care and are responsible for implementing recommended treatment plans. An understanding of family organization and function, the role of culture, and the impact of general medical conditions is an essential knowledge base for the effective care of physically ill children (Walsh 2006a).

Families in the pediatric setting experience the vulnerability of their children and cope with their inability to protect their children from disease (De-Maso and Meyer 1996). Successful adaptation requires parents to develop a good understanding of the illness and recognize its potential complications and treatment. (In this chapter, parents refers to the child's primary caregivers, regardless of whether they are the biological or adoptive parents or legal guardians.) Parents may have fears about survival, poor outcome, and alteration of lifestyle, which may be manifested as anxiety, guilt, depression, or anger. Because of their own inability to cure their children and the necessary reliance on health care providers, parents may be obliged to surrender control and give up their traditional caregiver roles. They can become preoccupied with medical details while psychosocial factors are ignored, considered a lower priority, or deemed irrelevant. Family responses may vary from sharing control with clinicians, to entrusting clinicians without reservations, to neither ceding nor sharing control (DeMaso and Meyer 1996).

The mental health consultant should have the skills to engage family members, establish effective methods of communication, empathize with and support the family, and enlist family members in the child's treatment. The consultant should be able to intervene in family interactions to improve family functioning while recognizing situations in which referral for more formal family therapy may be indicated. This chapter reviews family resiliency, family responses to pediatric illness, and evidence-based interventions for families of children with physical illness.

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