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Lead paragraph

Childhood chronic illness refers to conditions in pediatric patients that are generally prolonged in duration, do not resolve on their own, and associated with impairment or disability. The duration required for an illness to be defined as chronic is generally greater than 12 months, but this can vary by source, and some define it by limitation of function rather than a length of time. Regardless of the exact length of duration, these types of conditions are different than acute, or short-lived, illnesses which resolve spontaneously or can be cured. Although there are many definitions for what counts as a chronic condition, children with chronic illnesses will typically experience at least one of the following: limitation of functions relative to their age, disfigurement, dependency on medical technologies or medications, increased medical attention, and modified educational arrangements.

There are many different diseases affecting children that have a prolonged course and can lead to disability or impairment including asthma, sickle cell anemia, congenital heart disease, obesity, neurodevelopmental conditions, and epilepsy (jackson vessel). Due to improvements in public health and health infrastructure, infant and child mortality has decreased in most areas of the world, such that chronic illnesses are providing a significant burden of disease rather than acute, or temporary, illnesses.

Epidemiology

Knowing the exact number of children who have a chronic illness worldwide is difficult for many reasons. Given that there is no agreement on the definition for a chronic illness and that quality data from every country is not guaranteed, there is a wide range of estimates of prevalence and incidence.

In the United States, one study noted the prevalence of chronic conditions among youth more than doubled from 12.8% in 1994 to 26.6% in 2006.

One important trend to consider is that the overall amount of children with chronic illnesses is increasing. This rise is likely due to decreased infant and child mortality from previously lethal diseases due to innovations in medication and other treatment as well as increased ability to diagnose and therefore discover chronic conditions.

Management

Behavior Therapy

Behavior therapy in the setting of chronic illnesses aims to change learned behaviors that are problematic using classical conditioning and operant techniques. Some examples of behavioral therapy for children with asthma include stress management techniques and contingency coping exercises. In one study, the asthma patients randomized to such therapies demonstrated fewer behavioral adjustment problems. Additionally, systematic desensitization can be applied to children with illness to decrease the fear associated with some medical treatments that could be required of their condition such as imaging or invasive procedures.

CBT

Cognitive Behavioral Therapy (CBT) is one of the most common techniques used to build resilience in children suffering from chronic illnesses. CBT includes the practice of breathing exercises, relaxation training, imagery, distraction methods, coping models, cognitive coping skills, reinforcement for compliance, behavioral rehearsal, role-play and direct coaching. Another intervention that is gaining popularity is the PASS Theory of Intelligence. The PASS Model combines a multitude of interventions to create a well-rounded program to foster resiliency in not only the children but the families affected as well. The goals of the pass model are to minimize trauma symptoms, develop adaptive coping skills, strengthen resiliency, and connect families to support networks.

Family therapy

Peer group interventions

Self-regulatory Skill Training

Outcomes

Although the conditions that children face may be distinct in terms of symptoms and treatments, there are important overlapping features between them all.

Some features that may cause the outcome to be disease-specific include nature of onset, life threat potential, visibility and social stigma (wallander 2003)

Impact

Family

The presence of a child with a chronic illness in the home has multiple effects on the family's life as it may affect daily routines. One potential consequence is the physical space inside the home being altered by the need for home health or medical equipment. As such children typically require frequent appointments, caregivers can feel strain to participate in their other children's lives equally and may develop increased levels of stress and family discord. The time requirements could also increase social isolation from extended family members. Given the cost associated with the greater need for specialized treatments as well as decreased time to work, these families may also experience economic difficulties.

Developmental

In terms of education, one study found that children in Australia with at least one chronic illness scored lower in five domains of educational readiness including social competence, emotional maturity and communication skills.

Economic

Psychosocial

Advocacy / research organizations