Today, in the evaluation of diseases of children and adolescents, not only the biological dimension but also the psychological and social dimensions are considered, and efforts are made to provide both biological, psychological and social support by approaching the disease from a biopsychosocial perspective. Because today, it is better known that children and adolescents experience psychological, social and/or behavioral problems during their illnesses. Not forgetting the biopsychosocial perspective in sick children and adolescents will contribute greatly to a more comfortable diagnosis and treatment process.
In this section, how children and adolescents with acute or chronic diseases react psychologically and behaviorally, and what plays a role in these reactions. It is aimed to include some questions that families of children and adolescents with the disease may want to know:
AT WHAT AGE AND HOW DO SICK CHILDREN AND ADOLESCENTS RESPOND MOST COMMON?
0-6 age group
-Separation anxiety (experiencing intense distress when being separated from the mother or close caregivers, crying,…); It is a situation that is frequently encountered, especially in the first 3 years of age.
-Regression (regression, infantilization): It is the situation of the child not being able to perform most of the skills he has acquired at his current age. Such as starting to pee again after being toilet trained, wanting the mother to feed him while he can eat on his own, baby talk, thumb sucking.
-Changes in eating and sleeping patterns: Not being able to sleep at the usual sleeping time, waking up frequently at night, having nightmares, such as decreased appetite, being picky about eating.
-Fear of medical procedures performed by the healthcare team. Such as injection, drug administration.
-Withdrawal,…
6-11 years (school period) )
-School problems: Failure in classes, absence from school, being ridiculed by peers, being underestimated, ostracized, stigmatized.
-Fears and anxieties: Not being able to sleep alone, darkness. such as fear of death, fear of death, anxiety of losing one's parents.
-Feelings of boredom and loneliness.
-Problems such as sleeping and eating problems may be experienced.
Adolescence
-E During adolescence; As a characteristic of the developmental period, adolescents may experience problems arising from body shape changes because they are very busy with their appearance (such as skin color changes that may develop due to the current disease, accidental missing of arms and legs, gait disorders).
-In a period when they need to gain their independence. Being dependent on the healthcare team and parents again may make the adolescent uneasy.
-They may experience problems at school.
-Sometimes they may become depressed due to the disease they have, they may attempt suicide,…
WHY ARE DIFFERENT SPIRITUAL AND BEHAVIORAL REACTIONS OBSERVED IN THE DISEASES OF CHILDREN AND ADOLESCENTS?
Psychological and behavioral reactions of children and adolescents to the disease It depends on many factors:
1. FACTORS RELATED TO THE CHILD
1.a. age,
1.b.Characteristics of the child's psychological and social development stages,
1.c.Child's temperament,
1.d.Children's diseases The defense mechanisms they use against.
2. FACTORS RELATED TO THE DISEASE
2.a. Form of occurrence,
2.b.Course of the disease,
2.c.Treatment method and hospitalizations,
2.d.Period of the disease.
2.c.Treatment method and hospitalizations. p>
3.FAMILY-RELATED FACTORS
4.ENVIRONMENTAL FACTORS
1. FACTORS ABOUT THE CHILD
1.a. Age of the child
The way children perceive events varies depending on their age and cognitive development level. For example; Children between the ages of 2 and 7 rely on their own experiences and act accordingly. Their ability to generalize the situation is weak and they cannot think logically in the face of the disease. Since the autonomy of a child between the ages of 2 and 7 who is sick or hospitalized is controlled to various degrees (eating, dressing, playing style, etc.), a feeling of uselessness and helplessness develops. In addition, at this age, children may experience illness due to wrong behavior. They think it is a punishment given to them. Therefore, care should be taken not to be accusatory when making explanations to children during this period. It should be emphasized that the illness is not his/her fault.
When explaining to children, it is necessary to pay attention to the child's beliefs about the disease or medical interventions, as well as the characteristics of their developmental periods. For example; Telling a child who believes that all his blood will be taken and his blood will run out when blood is taken from him, "Don't be afraid, you will feel very little pain" cannot comfort the child.
In the following years (7-11 years), logical thinking develops in the face of diseases. In other words, if an adequate and accurate explanation is given about the disease by the relevant specialist doctor, they will better understand the cause of the disease and the necessity of the treatment.
When explaining the disease to the child, pictures, photographs, stories, other patients can be used as tools, depending on their age and level of understanding. . It should be done in a way that the child can understand, with an empathetic approach (making him/her feel that we understand his/her feelings and thoughts by putting ourselves in his/her shoes) by choosing appropriate words.
1.b.Characteristics of the child's psychological and social development stages.
In the newborn period, babies reflect the emotions of their mothers (caregivers). If the mother is peaceful, the baby may be peaceful; if the mother is restless, the baby may be restless. Therefore, if the mother has a psychological problem (such as postpartum depression), support should be given first to the mother.
It is very important for children between the ages of 1-3 to be in an environment where they feel safe. They are especially sensitive to separations and changes in the environment they are accustomed to. They are afraid of separation from the family, hospitalization, and medical procedures.
The disease, which occurs at the age of 3-6, can disrupt children's ability to take their parents as a model (identification) and their socialization process. Children's sense of entrepreneurship may be damaged and, accordingly, they may become passive, more dependent on their parents, cowardly, anxious children.
Illnesses during the school period may lead to problems with success, socialization, etc.
Illness in adolescents, independent It can lead to loss of homeliness and disruption of plans for the future, changes in physical appearance (e.g. hair loss, weight changes, darkening of skin color), problems with peer relationships and at school, a feeling of isolation, and feelings of hopelessness and inadequacy.
1.c.Child's temperament
Temperament; It is the emotional predisposition inherent in the child. Children whose temperament is evaluated are grouped as easy children (who have the ability to adapt to new situations easily), difficult children (who have difficulty accepting the disease and treatment) and children who warm up slowly (who can adapt to the new situation over time).
1.d.Defense mechanisms used by children against diseases
Defense mechanisms; It is very important in a person's adaptation to the environment and personality development. All defense mechanisms develop unconsciously (children and adolescents do not do this knowingly or willingly) and are widely used in children and adolescents. Some of the defense mechanisms are also found in healthy children, adolescents and adults. Here, the problems encountered in children and adolescents with the disease will be discussed:
Regression (regression, infantilization); It is when the child loses the abilities he has acquired and begins to show the characteristics of the backward period of development. Every illness and hospitalization causes regression. Because sick children are put to bed, fed, washed and dressed.
Denial (denial); Children ignore and deny their illnesses. This defense mechanism makes compliance with treatment difficult.
Reflection; It is the reflection of children's feelings and thoughts about the disease on others. For example; He/she may project his/her anger towards the disease onto a friend, sibling or parent.
Rationalization (the mechanism of finding logical excuses); This is because children can find logical excuses for the things they cannot do due to their illness. For example; A child who cannot study due to his illness attributes this to the inadequacy of the education he received.
Isolation (what happened) n suppression of emotional aspects of events); When children with the disease use this defense mechanism, they do not show emotions such as anxiety, sadness, hope and anger. It is thought that people around them accept the disease very easily.
Glorification; Children's health conditions allow them to use their energy for socially acceptable, creative and constructive actions. For example; educational, artistic, scientific, sports activities.
2. FACTORS RELATED TO THE DISEASE
2.a. How it occurs
Whether the child's disease is congenital or acquired, it may lead to different psychological and social situations. For children who have a disease from birth, going to a doctor and receiving treatment and living with the disease become a part of their lives. Children who go through normal developmental stages have a harder time adapting to the treatment team, the treatment method, and the restrictions imposed by the disease when they later develop the disease. Although in both cases, children experience psychological problems such as depression, adjustment disorders, post-traumatic stress disorder, various anxiety disorders, and conduct disorder, these problems can usually be more frequent or more severe in those who have the disease later.
2.b.Course of the disease
The fact that the disease is acute (sudden onset and short-term) and chronic are also important factors for the mental health of children. Chronic diseases; These are diseases that can cause permanent disability and require care and supervision for a long time. Various chronic diseases can be seen in children (such as epilepsy, mental retardation, congenital heart diseases, autism, kidney failure, cancers, diabetes).
Children with chronic diseases; They may have difficulty being accepted by their peers. In these cases, the attitudes of parents with healthy children are also important. Because some parents do not allow their own children to play with sick children, to be together and to study in the same class. Therefore, the message that sick children should be excluded is received from the parents, who will be a model for the healthy child.
Cronically ill children are received.
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