PEDIATRICS Vol. 39 No. 3 March 1967, pp. 441-445
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Green, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Green, M.

CARE OF THE CHILD WITH A LONG-TERM, LIFE-THREATENING ILLNESS: SOME PRINCIPLES OF MANAGEMENT

Morris Green M.D.1

1 Department of Pediatrics, Indiana University School of Medicine

THE PHYSICIAN needs to care for the child who has a long-term, life-threatening disease, such as ulcerative colitis, nephrosis or rheumatic fever, with the same competence and sureness as he applies to managing the disease. Such illnesses are psychologically as well as physically hazardous. Because of the variability of physician, patient, family, and disease, principles of care cannot be described nor applied in a simple fashion but rather with attention to individual differences.

DISCUSSION OF THE DIAGNOSIS

Discussion of the diagnosis must be straightforward and honest, reflecting the exact state of affairs without over-or understatement. Although truthfulness is an important principle, the doctor tempers it in order to express it to the parents and child at a time and in a manner that is helpful and understandable rather than overwhelming. Some tolerate it better if they are given the information all at one time while others benefit more from a gradual presentation. The parents may need to have the diagnosis, as well as the treatment, explained many times before they are able to understand and accept the painful reality. Where practical, the use of a consultant to confirm the diagnosis, treatment, and prognosis can be a significant aid to the family's acceptance.

COMPETENCE

Nothing allays unwarranted anxiety as effectively as competent, conscientious care. As Engel has emphasized, this is "the first and major requirement of the correct psychotherapeutic approach." The family's fundamental need to believe that they are entrusting their child to the best doctor available leads them both to over-value his skills and, perhaps not incongruously, to question his experience: "Have you seen other children like this?" "How many children like me have you taken care of?"