Pediatric Nursing Care for Chronic Issues
What Is Childhood Chronic Illness
There is no one accepted definition of a childhood chronic condition; however, a research consortium on chronic illness in childhood recommended that it be defined on two levels: duration of the condition and impact on the child's functioning (Perrin et al., 1993).
In a definition based on duration, a chronic condition is one that has lasted or is expected to last more than 3 months (Perrin et al.). This definition would include recurring acute conditions (eg, repeated ear infections) as well as those that are expected from the onset to be long-term (eg, diabetes).
In a definition based on impact on the child, a chronic condition would be one that limits the child's functioning or leads to the child's receiving additional medical attention beyond that expected for a child the same age.
A recent trend is to address morbidities that are often
associated with risk-taking behavior such as alcohol use, substance use,
contraceptive use, and being overweight (Brown et al., 1999).
Prevalence estimates for Childhood Chronic Conditions
Prevalence estimates for childhood chronic conditions, or the number of children with chronic conditions at any given point in time, vary according to the definition used.
Estimates of prevalence range from less than 5% to more than 30% (Newacheck & Taylor, 1992); they tend to be higher when the definition is based on duration and lower when the definition is based on impact on the child's functioning.
In 2001, more than 4 out of 5 children (83%) were rated as
having very good or excellent health by their parents; About 8% of school-age
children were reported to have their activities limited because of a chronic
condition (Federal Interagency Forum on Child and Family Statistics).
Risk Factors for Health Problems
Risk factors for health problems have been identified. Boys have more limitations from chronic conditions than do girls. School-age children (ages 5-17 years) are twice as likely to have a chronic condition as preschoolers (under 5 years).
Children living in lower-in-come families are less healthy than children living in families of higher income. There is also a trend for Black and Hispanic families to have poorer health than White, non-Hispanic children.
In contrast, White adolescents have the highest rates of substance use such as smoking cigarettes, drinking alcohol, and using marijuana (Brown et al., 1999). There are also changes in the prevalence of health problems experienced by children.
For example, pediatric AIDS cases are declining. In contrast, asthma
is increasing among all children, with the highest increases in children who
are under 4 years (National Center for Health Statistics).
Research On Chronic Childhood Chronic Condition
A large amount of research has been carried out to investigate children with chronic conditions. There is an increasing emphasis on assessing the health-related quality of life of these children.
This research has established that, compared to the general population peers, children with chronic conditions are at risk for a poorer quality of life related to physical, psychological, social, and academic functioning.
Furthermore, the families of these children are at increased risk for adjustment problems. Two major approaches to sample selection are used in research on children with chronic conditions and their families: noncategorical and categorical.
The major assumption behind the noncategorical approach is that there are many commonalities in the experience of families of children with chronic conditions.
These researchers generally study samples in which many different chronic conditions are represented. In contrast, researchers using the categorical approach generally study samples that are homogeneous in regard to chronic condition.
An example of nursing research using the categorical approach is the research on behavior problems in children with epilepsy (Austin, Dunn, & Hustler, 2000). Even though there has been much discussion about which approach is better to use, the current thinking is that the purpose of the research should determine the approach used.
In nursing, both approaches are needed to provide important
information that will improve nursing care of children with chronic conditions
and their families.
In the past decade there has been a strong trend to study chronic illness from the perspective of the person who is chronically ill. Many of these nurse researchers use qualitative methods to learn about the illness experience (Thorne & Patterson, 2000).
This focus on the subjective experience is also reflected in a number of scales being developed to measure chronically ill children's perceptions of the quality of life. Another trend is the increasing focus on interventions to help children cope with a chronic condition.
For example, common interventions for children with diabetes include educational programs, psychosocial interventions (eg, coping skills training, psychotherapy, stress management, and social support groups), and family intervention (Grey, 2000).
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