Late Consequences of Chronic Pediatric Illness

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With the advent of new treatments for pediatric disorders, more chronically ill children and adolescents are surviving into adulthood than ever before. This article is aimed at helping psychiatric consultants understand how medical, developmental, and psychosocial needs are altered in adults who have grown up chronically ill as children. Congenital heart disease, cystic fibrosis, and rheumatologic disorders are discussed in detail as models to illustrate the impact of congenital malformations, genetic disorders, and typically adult disorders occurring in the pediatric age group.

Section snippets

Evaluating Chronically Ill Children and Adolescents

Three aspects of psychiatric consultation in the medically and surgically ill that are specific to working with youth are (1) an awareness of the cognitive and emotional developmental levels of the patient, (2) the essential role of the family, and (3) a focus on facilitating coping and adjustment to illness to follow an optimal developmental trajectory, rather than a focus on psychopathology. Clinicians must be familiar with normal physical, motor, language, cognitive, sexual, and emotional

Impaired Growth and Development and Impact of Chronic Steroid Use

Physical growth is a dynamic process that starts at conception and ends after full pubertal development [12]. Chronic illness may lead to growth retardation, either because of the illness itself or because of treatments required for it. Short stature commonly is perceived to be associated with social and psychologic disadvantage [13]. Parents often attribute behavioral disorders, anxiety, depression, social, and attentional problems to short stature and are concerned that their children are

Psychosocial Considerations

Normative developmental tasks throughout childhood center on developing a sense of self and acquiring autonomy in all areas of life. When compared with their cohort in the general population, however, young adults who are chronically ill with a wide variety of disorders have lower academic and employment achievement, receive less vocational education and have less permanent employment [45], are more likely to be single [46], and have delayed independence [3]. Cohorts have not been followed long

Psychiatric Consequences

Investigations of psychiatric disorders in pediatric conditions have been limited by small and varied demographic samples, lack of consistent testing measurements, frequent subthreshold Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnoses, and lack of appropriate control groups. The full range of developmental and childhood psychiatric disorders, including adjustment disorder, major depression, anxiety, and delirium, are seen in children and adolescents who

Transition to Adult Care

Adolescence is a complex period of transition from childhood to adulthood. Having a chronic illness adds to the complexity (Table 1). Issues of puberty, autonomy, personal identity, sexuality, education, and vocational choices become more difficult for an adolescent who also is coping with chronic illness. This period may be complicated further by medical setbacks, impaired physical or mental abilities, forced dependence, and perceived poor prognosis [76]. For adolescents who have a chronic

Summary

There are many challenges in coping with and adapting to life with a chronic disease, and increased survival cannot be assumed to be associated with increased quality of life. A recent systematic review shows there is wide variation in outcomes depending on the definitions and measurements used to estimate the prevalence of chronic health conditions, making the impact of disability on children's health and social functioning difficult to assess; various authors have called for an international

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    This research was supported in part by the National Institute of Mental Health. Dr. Pao's views are her own and do not necessarily reflect the opinions of the United States government.

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