Helping Young Children Understand Illness

• Adults are key in giving reassurance, information, and handling media exposure
• A child's comprehension is reliant on their current developmental stage
• Safety is a basic psychological need; interruptions distress children
• Children are prone to misinterpreting risks

Ages 0-3

• Children in this bracket grasp ideas through tangible events like observing sneezes
• Children in this bracket struggle with abstract ideas like germs or time
• Food, sleep, play, and closeness are crucial
• Children express distress via clinginess or disrupted routines
• Aid children by using simple, brief descriptions
• Keep a consistent schedule
• Explain ideas with stories and play
• Limit exposure to adult discussions and media

Ages 4-7

• Children are focused on their immediate surroundings
• They understand illness in simple terms, such as cough = sick
• They struggle to differentiate severity or causes of illness
• They create their own explanations or blame themselves
• Utilize stories and play to fix misunderstandings
• Break down cause and effect, for instance, hand washing aids but doesn't guarantee total protection
• Repeat simple, consistent explanations
• Aid them in expressing emotions by naming feelings

Ages 7-12

• Understand different symptoms and unseen causes of illness
• Acknowledge that medical advice helps but need reminders to follow through
• Remain aware of permanence, such as death
• Encourage emotional expression via drawing or journaling
• Normalize emotions and share coping mechanisms
• Guarantee physical activity to alleviate stress
• Supply factually accurate descriptions to prevent confusion

Ages 13+

• Comprehend complex health ideas but are heavily impacted by peers and social media
• May get concerned about future uncertainties and social/moral implications
• Likely seek information independently
• Creating space to express themselves is beneficial and offer support
• Use open questions to promote conversation
• Give access to reliable sources of information
• Bolster social interactions and decision-making
• Foster safe, constructive methods to aid peers

Notes

• Mental health and physical health overlap
• Paediatric psychology referral themes relate to formulation and intervention
• Recognising the impact of personal beliefs is important

Stats on the impact of mental health on physical health

• Focus on outcomes, recovery, and QoL
• Approximately 75% of Children and Young People with a mental illness also experience a physical health issue
• Physical illness increases the likelihood of mental illness by 82%
• Chronic physical health issues affect 10-30% of children
• Consequences affect emotional, social, and cognitive development while impacting families and schools
• Children living with physical illness are more likely to develop psychological challenges

Paediatric psychology settings

• Inpatient work on wards may be required
• Outpatient services in medical clinics or separate psychology appointments
• Services may be attached to specific medical specialties or generalised roles
• A liaison with local services and schools is important
• There is potential to work with staff groups and teams
• Support includes consultation, debriefs and training
• Training includes on talking about death and dying with children and their families, self-care
• Community services may be based in Community and Mental Health Services, not hospitals

Common Referral Themes

• Education and information giving about the health condition
• Naming the condition
• Learning about life limiting/shortening aspects of condition or treatment
• Adjustment and living alongside the condition
• Uncertainty about restriction placed on young people or family by condition
• Procedural anxiety is common
• Visible difference in body image concerns

Adherence

• Estimated adherence rates across all illnesses is ~ 50%
• Paediatric Psychologists assist with “stuckness”

Social context of a health condition

• Impact on peer relationships
• Difficulty forming or maintaining relationships due to health condition, impacting social development

Cognitive Difficulties

• Cognitive or educational difficulties following cancer diagnosis
• Support to navigate cognitive challenges and provide resources for academic or learning support

A note on Functional Presentations

• Functional presentations are physical symptoms without an obvious physical cause
• Functional presentations can also be called Medically Unexplained Symptoms or Somatic Symptom Disorder
• There may also be underlying physical health conditions ("functional overlay")

How might a health condition impact a family?

• Increased stress on family system
• It may have an impact on siblings
• Missing school and peers contributes to lower rates of academic achievement and feeling disconnected
• Missing normal activities leads to feeling isolated or different from peers
• Treatment effects and regimens impacts a person's physical and emotional well-being
• Medical trauma is common
• And there is interference with developmental milestones

Formulation and intervention

• Seek the perspective of the referrer and family
• Seek their reasoning behind the problem
• What steps have already been taken?
• Has Psychology been involved previously?

Levels of Psychosocial Needs – Paediatric Psychosocial Preventative Health Model (PPPHM)

• 10-15% require clinical/treatment, this is a Consultant behavioral health specialist requirement
• 30-40% require targeted intervention and services specific to symptoms
• 40-45% requires universal general support to help at-home care and information and support

Different levels of intervention for:

• The Young person includes problem-solving skills, support to make sense of thoughts and feelings, +psychoeducation
• The family are given Narrative ideas, systemic ideas of family life cycles
• The wider system consultation and liaison with the medical team

Communication

• Facilitate communication with family and team
• Support team curiosity to make sense of difficulties

Developmental theory

• Birth through 2 is Sensorimotor
• Ages 2 through 7 is Preoperational
• Ages 7 through 12 is Concrete Operational
• 12+ is formal operational

Infant - 1 month to 1 year

• Physical: can sit up straight if propped, can roll from front to back, or raise head 90 degrees
• Cognitive: coos and opens mouth for bottle
• Psycho-social: they will smile, recognize and move to show attention
• Nursing care: hold, swaddle or pat to comfort, use soft voice

Ecology System Theory (Broffenbrenner)

• Recognise the impact of beliefs on families
• Consider gender, race, geography, religion, age, class, and culture