Developmental Concerns For the Child With a Chronic Condition

Developmental Concerns For the Child With a Chronic Condition

Developmental Concerns For the Child With a Chronic Condition

(Newborns and Infants)

• Newborns and infants who are medically fragile are at risk for chronic conditions related to brain injury, oxygen deprivation, and respiratory problems
• Newborns cared for in the NICU are exposed to an environment of bright lights and high-pitched noises that can negatively affect their development
• Promote development and parent-infant bonding by encouraging the parents to spend time with the infant and engage in face-to-face interaction. When the newborn is stable, provide opportunities for parents to touch, soothe, and care for the infant
• Provide sensory stimuli such as mobiles, soft music, and different textures for the infant to touch

(Toddlers)

• Chronic illness can interfere with the achievement of autonomy and development of self-control. Some parents are overprotective and may do simple tasks they feel the child is incapable of accomplishing, rather than encouraging the child to try to do things independently. The child can lose independence and lack opportunities to meet developmental tasks
• Nurses can promote development of toddlers with chronic conditions by offering the child choices when possible, such as which color gown to wear or which food to eat first
• Help parents recognize the toddler’s capabilities, and allow the child to take the time to practice and learn a skill. Identify the next most appropriate developmental tasks for the child to learn and give the parents some strategies they can use to offer learning opportunities

(Preschooler)

• Preschool children recognize the association between body parts and problems associated with the chronic condition. The preschooler engages in magical thinking during this stage, and the child may believe that his or her thoughts or behaviors caused the condition. The child may also think the condition is a form of punishment
• Hospitalization or implementation of a treatment plan, such as a new med, may interfere with the preschool-age child’s developing independence
• Nurses can promote development by explaining the purpose of treatments and procedures in terms the preschooler can understand, and by emphasizing that treatments and procedures are not punishment for any wrongdoing
• Look for ways to use play so the child can learn an aspect of self-care, perform an activity, and feel a sense of accomplishment. Encourage social interactions with other children when possible. Give positive feedback to the child for appropriate efforts and successes

(School-Age Children)

• Early school-age children have an increased understanding of their condition and are capable of participating in certain aspects of monitoring and care. Older school-age children begin to understand about managing their condition and the long-term needs associated with their condition. They can assume more responsibility for their care such as serum glucose monitoring, intermittent self-catheterization, or monitoring the condition of skin under braces
• Some children with chronic conditions have learning difficulties and other limitations that interfere with education and social competence. The child needs to gain social skills, interact with peers, master new information, learn to cope with stress, and acquire skills that lead to self-sufficiency in order to develop a sense of industry
• The school-age child senses that he or she is different from peers and may feel left out, especially if functional limitations affect his or her ability to participate in extracurricular activities. It is important that children with chronic health conditions be allowed to participate in extracurricular activities as much as their condition allows and their physician approves
• Nurses can promote development of school-age children by encouraging their interaction with children in the same age group. When possible, this should occur with children who have the same type of chronic condition. Link the child to a peer support group to promote social interaction and to help the child recognize that others also have the same condition. When the child has an extended absence from school because of the chronic condition, encourage contact from school peers and friends through cards and computer messages, as well as the completion of school assignments
• Begin to identify aspects of the child’s care that the child can learn to assume under the parents’ supervision. Inform families of the benefit of special camps for children with the same condition (when available) to promote recreation, social interaction, and learning skills of self-care

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Developmental Concerns For the Child With a Chronic Condition

(Adolescents)

• Numerous challenges regarding rapid changes in growth and sexual maturation, ongoing development of identity and body image. Cognitive development and abstract thinking skills are achieved at this age allowing the adolescent to develop an understanding of short term and long term consequences of the condition.
• They become more aware of differences between self and peers and some may be unable to cope with the recognizable differences between themselves and healthy peers; they may withdraw from social activities and relationships. Others may engage in risky behavior (drugs, sex, alcohol, foods that interfere with condition) that may be harmful just to be accepted by peers
• Nursing actions to promote development- client education to help them learn about the chronic condition, care needed, and problem solving or specific skills for integrating care management into daily life
• Encourage them to build safety net of friends who know enough about the condition to assist if a problem occurs such as seizure or asthma episode
• Discuss sex maturation and importance of protected sexual activity and discourage risky behaviors
• Provide them an opportunity to express concerns regarding self-management, vocational planning, and future independent living