Merck Manual

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Children with Chronic Health Conditions


Deborah M. Consolini

, MD, Thomas Jefferson University Hospital

Reviewed/Revised Jul 2022

Chronic health conditions (both chronic illnesses and chronic physical disabilities) are generally defined as those conditions that last > 12 months and are severe enough to create some limitations in usual activity. It has been estimated that chronic health conditions affect 10 to 30% of children, depending on the criteria. Examples of chronic illnesses include asthma Wheezing and Asthma in Infants and Young Children Wheezing is a relatively high-pitched whistling noise produced by movement of air through narrowed or compressed small airways. It is common in the first few years of life and is typically caused... read more , cystic fibrosis Cystic Fibrosis Cystic fibrosis is an inherited disease of the exocrine glands affecting primarily the gastrointestinal and respiratory systems. It leads to chronic lung disease, exocrine pancreatic insufficiency... read more Cystic Fibrosis , congenital heart disease Overview of Congenital Cardiovascular Anomalies Congenital heart disease is the most common congenital anomaly, occurring in almost 1% of live births ( 1). Among birth defects, congenital heart disease is the leading cause of infant mortality... read more Overview of Congenital Cardiovascular Anomalies , diabetes mellitus Diabetes Mellitus in Children and Adolescents Diabetes mellitus involves absence of insulin secretion (type 1) or peripheral insulin resistance (type 2), causing hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) Attention-deficit/hyperactivity disorder (ADHD) is a syndrome of inattention, hyperactivity, and impulsivity. The 3 types of ADHD are predominantly inattentive, predominantly hyperactive/impulsive... read more , and depression Depressive Disorders in Children and Adolescents Depressive disorders are characterized by sadness or irritability that is severe or persistent enough to interfere with functioning or cause considerable distress. Diagnosis is by clinical criteria... read more . Examples of chronic physical disabilities include meningomyelocele Spina Bifida Spina bifida is defective closure of the vertebral column. Although the cause is often unknown, low folate levels during pregnancy increase risk. Some children are asymptomatic, and others have... read more , hearing impairments Hearing Impairment in Children Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children... read more Hearing Impairment in Children or visual impairments, cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or... read more , and loss of limb function.

Effects on the children

Children with chronic health conditions may have some activity limitations, frequent pain or discomfort, abnormal growth and development, and more hospitalizations, outpatient visits, and medical treatments. Children with severe disabilities may be unable at times to participate in school and peer activities.

Children’s response to a chronic health condition largely depends on their developmental stage when the condition occurs. Children with chronic conditions that appear in infancy will respond differently than children who develop conditions during adolescence. School-aged children may be most affected by the inability to attend school and form relationships with peers. Adolescents may struggle with their inability to achieve independence if they require assistance from parents and others for many of their daily needs; parents should encourage self-reliance within the adolescent’s capability and avoid overprotection. Adolescents are going through a time when being similar to peers is very important, so they find it particularly difficult to be viewed as different (1 General references Chronic health conditions (both chronic illnesses and chronic physical disabilities) are generally defined as those conditions that last > 12 months and are severe enough to create some limitations... read more ).

Health care practitioners can be advocates for appropriate hospital services for children with chronic health conditions. Age-appropriate playrooms can be set up and a school program can be initiated with the oversight of a trained child life specialist. Children can be encouraged to interact with peers whenever possible. All procedures and plans should be explained to families and children whenever possible so the families know what to expect during the hospitalization, thus relieving the anxiety that can be created by uncertainty.

Effects on the family

For families, having a child who has a chronic health condition can lead to loss of their hope for an “ideal” child, neglected siblings, major expense and time commitment, confusion caused by conflicting systems of health care management, lost opportunities (eg, family members providing primary care to the child are therefore unable to return to work), and social isolation. Siblings may resent the extra attention the ill child receives. Such stress may cause family breakup, especially when there are preexisting difficulties with family function.

Conditions that affect the physical appearance of an infant (eg, cleft lip and palate Cleft Lip and Cleft Palate An oral-facial cleft is a birth defect in which the lip, the roof of the mouth, or both do not close in the midline and remain open, creating a cleft lip and/or cleft palate. These defects are... read more Cleft Lip and Cleft Palate , hydrocephalus Hydrocephalus Hydrocephalus is accumulation of excessive amounts of cerebrospinal fluid, causing cerebral ventricular enlargement and/or increased intracranial pressure. Manifestations can include enlarged... read more Hydrocephalus ) can affect the bond between the infant and family members or caretakers. Once the diagnosis of abnormality is made, parents may react with shock, denial, anger, sadness or depression, guilt, and anxiety. These reactions may occur at any time in the child’s development, and each parent may be at a different stage of acceptance, making communication between them difficult. Parents may express their anger at the health care practitioner, or their denial may cause them to seek many opinions about their child’s condition.

Care coordination

Without coordination of services, care is crisis-oriented. Some services will be duplicated, whereas others will be neglected. Care coordination requires knowledge of the children’s condition, their family and support systems, and the community in which they function.

All professionals who care for children with chronic health conditions must ensure that someone is coordinating care. Sometimes the coordinator can be the child’s parent. However, the systems that must be negotiated are often so complex that even the most capable parents need assistance. Other possible coordinators include the primary care physician, the subspecialty program staff, the community health nurse, and staff of the 3rd-party payer. Regardless of who coordinates services, families and children must be partners in the process. In general, children from low-income families who have chronic conditions fare worse than others, in part because of lack of access to health care and care coordination services. Primary care practices may coordinate care services for children with medical complexity, a concept known as the patient-centered medical home (2 General references Chronic health conditions (both chronic illnesses and chronic physical disabilities) are generally defined as those conditions that last > 12 months and are severe enough to create some limitations... read more ). Some children with terminal illness benefit from hospice care Hospice Dying patients can have needs that differ from those of other patients. So that their needs can be met, dying patients must first be identified. Before death, patients tend to follow 1 of 3... read more .

General references

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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