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Pediatric chronic illness

Definition of chronic illness

A chronic illness is defined widely as a disease or condition that lasts three months or longer. Commonly, these illnesses are not avoidable, even using preventative measure such as vaccines. Similarly, there is no commonplace treatment, medication, or cure for these type of illnesses

Definition of pediatrics

The field of pediatrics is diverse . The scope of ages covered in this medical field ranges from birth through twenty-one years of age . However, this range is split into three phases of life: infancy, childhood, and adolescence . Infancy is defined as birth through the first two years of life . Childhood is seen as two years of life through twelve years of life . Finally, adolescence is designated as twelve years of life through twenty one years of life . Adolescence is further divided into three age categories: (1) early (eleven through fourteen); middle (fifteen through seventeen); and late (eighteen through twenty one) . Although there are detailed outlines for what constitutes pediatrics, physicians and families are free to discuss and make exceptions to the age limit of twenty one, especially for individuals who are diagnosed with special health care demands.

Common types of pediatric chronic illnesses

Cancer

Cancer can be conceptualized as the unmaneagable and uncontrolled growth of cells that attack healthy tissue and cells. Childhood cancer tends to grow faster when compared to adult cancer. In the United States, more than 14,500 children and youth are diagnosed with cancer. Diagnosing cancer in childhood is rare, but it is the leading cause of death in children as a result of disease .

Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a psychological disorder that can appear in individuals who have either witnessed or experienced a traumatic event, such as exposure to threatened or actual death, sexual violence, serious injury, or natural disaster. In order to be diagnosed with this disorder, individuals must experience symptoms such as intrusive symptoms, avoidance of stimuli, adverse changes in cognitions and/or mood, and notable changes in both arousal and reactivity that are related to or caused by the traumatic event.

PTSD presentation in children

Children and adolescents are exposed to multiple forms of trauma, such as natural disasters, abuse, or illness. Children's reactions to trauma differ from those of adults . In order to address these differences, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), created a new set of criteria for the diagnosis of PTSD in children aged six and under. This new set of criteria acknowledged that children conceptualize and express trauma differently when compared to adults . Many of the criteria for adult PTSD depend on verbal accounts of experiences, which younger children are not developmentally equipped to understand or disclose. Although children present with some fundamental PTSD symptoms, they also present with a spectrum of symptoms not usually associated with PTSD in adults . These symptoms include psychosomatic symptoms, such as headaches or stomach aches, regression symptoms, like bed wetting or separation anxiety, increased numbers of fears, and reckless behavior that can result in increased injuries or accidents .

Pediatric medical traumatic stress

According to the National Child Traumatic Stress Network, pediatric medical traumatic stress (PTMS) can be thought of as a "set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences" . The responses to these experiences can lead to the presentation of posttraumatic stress symptoms (PTSS) . These PTSS can include symptoms such as avoidance, hyper arousal, and re-experiencing . PTMS can be conceptualized into three stages: peritrauma, early, ongoing, and evolving responses, and longer-term PMTS .

Peritrauma

The peritrauma stage incorporates the traumatic experience and the ramifications that directly follow the trauma.

Early, ongoing, and evolving responses

Following the medically traumatic event, patients and their families must learn and accept the perpetual stresses and needs that follow a medical condition and it's treatments . Patients and their families will have various psychological responses to a medical illness and the potentially traumatic events that follow. It is typical that individuals and their families experience acute stress following a diagnosis or injury of a child, but these responses differ from person to person . As more time passes from the injury or illness, those affected will begin to return to normal functioning; however, the child and their family will have to assimilate to the long lasting treatment of the illness and the complications and difficulties that accompany this .

Longer-term PMTS

Even if a pediatric illness or injury is cured, the child and their family may experience PTSS . Long-term PMTS can been seen in pediatric transplant, cancer, and diabetes survivors along with many other pediatric illnesses . There is no defined timeline for when these PTSD symptoms should disappear, instead this is individualized to each patient and family member .

PTSD symptomatology and pediatric chronic illnesses

Cancer

The patient

Children who are diagnosed, or have survived a diagnosis of cancer, exhibit trauma-related symptomatology that can be on par with a diagnosis of PTSD. These symptoms include intrusive thoughts about the illness, increased arousability and avoidant behaviors concerning illness symptoms, such as stomach aches. In order to treat the child's cancer, the child must undergo various aversive treatments and procedures. Many children describe these treatments as being more unpleasant than the effects of the cancer itself. Cancer in itself constitutes many acute and chronic stressors, not limited to a diagnosis of cancer, the severity of the diagnosis and it's prognosis, invasive treatments, and the side effects of the treatments, such as nausea, and weight and hair loss, or more severe side effects such as death. These meet the PTSD criteria for experiencing a life-threatening event, and encompasses both a single traumatic event and repeated exposure to traumatic events. As opposed to re-experiencing symptoms, one of the key diagnostic criteria in PTSD, cancer survivors tend to focus more on future events, such as relapse . As well as this, it is a daunting task to deduce which PTSD-like symptoms are caused by the traumatic experience of cancer and which symptoms are due to the side-effects or treatment of the disease.

There are several risk factors for the development of either PTSD or posttraumatic stress symptoms (PTSS) in pediatric cancer survivors, including an older age at diagnosis, living in a lower-income household, being female, having a family history of depression, anxiety, or other mental illnesses, and being Caucasian. Overall, children who have survived cancer have a higher base rate of PTSS and a diagnosis of PTSD, with the rate of PTSD diagnosis ranging between 2-20% in survivors. Interestingly, child survivors of cancer experience lower rates of PTSD or PTSS compared to both their siblings and their parents.

The patient's siblings

Sibling's of children with cancer can experience emotional and social consequences in response to their sibling's diagnosis. These siblings tend to feel neglected, isolated, and ignored within their families. Although these children do not go through the same processes as their sibling, siblings of children with cancer show cancer-related PTSD symptomatology. The level of PTSS can depend on how much time the sibling spent in the hospital and how well-informed the siblings were about cancer-related knowledge. In total, about 75% of siblings express moderate or severe levels of PTSS, while 23% meet full criteria for PTSD and 43% meet partial criteria for PTSD. Siblings of child cancer survivors tend to have higher rates of PTSS and PTSD when compared to the child who was diagnosed.

The patient's parents

The literature shows that between 10% through 30% of parents with a child survivor of cancer suffer from PTSS. A few components lend themselves to the development of PTSS in parents include the parents' beliefs about past and present threat to their child's life, general levels of anxiety, the perceived severity of the child's treatments, chaotic or distressing family functioning, and inadequate family or social support. Mothers tend to show higher rates of PTSD and PTSS compared to fathers. In both mothers and fathers, current, recent, and previous stressful life events were related to increased rates of PTSS . As well as this, low scale stressor, such as marital troubles or economic difficulties, lent themselves to the development of PTSS while high scale stressors, such as natural disasters or abuse, did not .