Talking with children

Professional conversations with children have certain rules:

1. Don’t talk to children in a condescending manner but as a physician talks with any patient.

2. Don’t convey to the child your thought that his or her feelings, concerns, of ideas are “childish”.

3. Don’t laugh at what a child says unless you are quite sure the child intends to be humorous.

4. Don’t try always to be funny or amusing to children. Such efforts are best saved for few occasions only and for children you know and who know you very well. Children know the difference between doctors and funny people.

5. Never tease a child unless you know him or her very well and the child knows that he or she has permission to tease you in return.

6. Initial or casual encounters with young children are often made easier when introduced in a whisper, which young children may find more personal, private, and reassuring than jollity; they commonly whisper in response.

7. When children are old enough, at 4-5 yr, from the habit of discussing with them their symptoms, diagnoses, and treatments in terms they can understand. The use of drawings to illustrate and explain medical problems can be very useful.

8. Never discuss the illness of treatment of a hospitalized child who has acquired receptive language functions in the child’s presence unless you are discussing it with him or her as well.

9. When a child fails to cooperate in his or her care in office or hospital, the first assumption should be that negativism or struggling meant that he or she is frightened and reacting to fear in a customary personal manner; such behavior is often erroneously perceived as immature and irritating, embarrassing, provocative, or frightening by parents and other adults.

Chronic illness in childhood

The epidemiology of chronic illness in childhood differs in important ways from the epidemiology of long-term illness in adults. Adults face a relatively small number of common chronic conditions (e.g., diabetes, osteoarthritis, and coronary artery disease) and few rare diseases. Children, in contrast, face a wide variety of mainly quite rare diseases. Only two groups of chronic physical conditions in childhood are common: allergic disorders (mainly asthma, eczema, and hayfever) and neurologic disorders (mainly seizure disorders and neuromuscular conditions such as cerebral palsy). Other conditions often though to be common, such as childhood diabetes, occur only in about 1 in 1,000 children younger than 16 yr of age, a much lower rate than that seen in adults.

At least 10-20 % of American and British children have some chronic condition, and some studies indicate that the number may be even higher. This percent-age translates into at least 10 million or more children in the United States with some kind of chronic health condition. Most chronic conditions are mild, such as acne, hayfever, or mild congenital deformity causing a slight limp. Only about 2-4 % of children (1-2 million children) have diseases of such physiologic severity that they interfere with a child’s usual daily activities on a regular basis.

Severity, a notion simple in concept, is difficult to measure, in most chronic illnesses. Few illnesses have a clear biologic marker that is independent of environmental influences and treatment (the factor VIII level in hemophilia is an exception to this rule). Physiologic measures of severity (e. g. asthma, rating scales or hemoglobin A_1C in diabetes) reflect the interaction of biologic susceptibility, treatment, and other environmental factors. The impact of the condition on the child’s functioning with friends or in school or on his or her psychologic status are other aspects of severity.

The percentage of children with severe long-term illnesses has more than doubled in the past 2 decades. This change partly reflects major advances in the technology of medical and surgical care. Current estimates are that, even among severely ill children, at least 90 % survive to young adulthood, although often with significant physical morbidity and physiologic disturbance. Most adolescents with chronic conditions, however, make the transition to adulthood well, with little interference in their finishing education, becoming employed, and entering into significant interpersonal relationships. Conditions that may show major changes in incidence, thereby affecting the size of the total population of children with severe illnesses, include AIDS, the aftereffects of fetal substance exposure, and major pulmonary or neurologic disease in children leaving neonatal intensive care units. Alternatively, new genetic techniques allow the prenatal and preconception diagnosis of increasing numbers of health conditions, and genetic counseling and other interventions may diminish the incidence of several diseases.