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).