Promoting healthy function and development in chronically ill children: A primary care approach

The treatment of childhood chronic illness is a complex process. Good medical care requires both an understanding of the developmental issues for the afflicted child and an appreciation of the interactive nature of the relationship between the child's illness and the functioning of the family, school, and peer social systems. The challenge to the health care team involves attending simultaneously to the child's illness and to his or her developmental needs while assisting the family's efforts to support the growing child in the school and peer settings. The purpose of this article is to provide a simple developmental, biopsychosocial framework for understanding this complex set of interactions, and to guide treatment. The goal of treatment is to promote a developmentally appropriate biopsychosocial balance for the child in his or her psychosocial contexts, and to facilitate adaptive functioning of the psychosocial surround of the child. Specific strategies for intervention are suggested, along with steps toward establishing adaptive interactions among family, school, peer group, and the health care systems.