Tuesday, April 17, 2007

Helping Children Cope

Leukemias are cancers that occur in the tissues within the body that produce the body's blood cells and bone marrow. Leukemias are the most common form of childhood cancer. About one-third of all cancers in children under the age of 15 are leukemias, as are about one-fourth of all cancers in people under 20.
Stems cells are present in healthy bone marrow and naturally develop into red blood cells, white blood cells, and platelets -- all of which are found in blood. Sometimes certain types of immature white blood cells undergo a random mutation, or change, of a gene in the DNA that can cause the cell to grow and multiply uncontrollably, resulting in leukemia. These uncontrolled cells flood the body's organs and interfere with their function. The cells also inhibit the body's ability to produce red and white blood cells and platelets normally.
Stem cells that produce white blood cells come in two major types: myeloid cells and lymphoid cells. When uncontrolled cell growth begins within a descendant of a lymphoid cell, it is acute lymphoblastic leukemia (ALL). This is the most common type of childhood leukemia; it accounts for about 85 percent of all childhood leukemias. When the uncontrolled growth originates within a descendant of a myeloid cell, it is acute myelogenous leukemia (AML), the second most common type of childhood leukemia.

Being hospitalized can be a frightening experience for a child. Most children are used to a predictable and safe world of family, home, and school. When they are faced with a world full of new people and strange machines and their parents seem scared and upset, many feel a loss of control and order. When a child has just been diagnosed with leukemia, parents are likely to be feeling a wide range of emotions, including shock, anger, hope, fear, guilt, and even grief. These are all normal and expected as the family adjusts to the news of a serious illness. Family and friends will probably find that over time they will accept the diagnosis and focus more on treatment. The emotions may become less intense as time goes by. It's important to understand that they (family and friends) shouldn't hesitate to seek counseling - talk with a trained counselor or participation in a support group can be very helpful for all.

Knowing what is going on seems to help children cope with procedures better. And even if parents try to hide it from their child, he/she is likely to figure it out anyway - and to perhaps try to hide that knowledge to spare their parents any further pain. Keeping such secrets only makes it even harder for children. It often helps to have trained social workers or nurses who can help shape an age-appropriate message. There are books and videos that can help to explain the diagnosis, treatment and what to expect. Encourage the child to ask questions. When telling a child that he/she is seriously ill, keep in mind the fears and anxieties that are typical for his age.

Children under the age of 4 or 5 mostly fear separation from their loved ones.
Children aged 4 or 5 to 12 can understand quite a bit of what is going on. The fear of separation is less acute and may be replaced with a fear of pain and injury. Make sure your child understands that nothing he did - such as falling off a bicycle - caused the illness. Also make sure he understands it is not contagious.

Teenagers are usually well aware of how serious their disease is and may fear illness and death more than anything else. They also are likely to be quite concerned about possible changes to their bodies and how their peers will see them. Teenagers also may find it hard to suddenly be so dependent on others, just when they were becoming more independent.

Helping Children Cope with Procedures
Medical procedures such as blood draws and bone marrow aspirations can be frightening for children. A child may have no idea what is going to happen and may think he is being punished. He/she may feel a severe loss of control over his/her life, and may react with anger and frustration. Some guidelines for parents and or friends dealing with a child needing procedures or treatments:
Make sure you understand the procedure fully so you can explain it to the child. Be honest, but don't overwhelm him with information.

Use dolls, drawings, books, and videos to help explain what will happen. Get a toy medical kit so you and the child can act out the procedure on stuffed animals or dolls.

Ask a doctor, nurse, or other health care worker for help in explaining procedures to the child. They have lots of experience in what medical information children are comfortable hearing and common misperceptions.
Try to have procedures done by health care professionals who have experience with children. If possible, have the same people do procedures in the future - familiarity can be comforting.

Find out how much advance notice of procedures the child wants. Some like to know several days ahead of time, some don't. Encourage questions and expression of feelings. Don't dismiss their fears as nothing. Remember that children can imagine some very wild ideas of what is going to happen.
If possible, stay with the child during the procedure or be there when he/she wakes up.

Help the child to maintain some sense of control. Let him/her make as many choices as possible: choosing a toy to hold during a procedure, choosing which arm gets a needle stick, or choosing which pills to swallow first.
Consider the promise of a special treat or toy after the procedure.
Honor the child's preferences if at all possible. As they get older expect them (preferences) to change over time. Treatment for leukemia can take months or years. The child's needs will change during that time; teenagers, for example, might no longer want their parents to accompany them during exams and procedures. Respect their decisions.

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