It is important to remember that when a child is ill that normal hygiene routine continues although washes may be more acceptable than a bath as sometimes this can make a sick child feel worse. Hair brushing and teeth cleaning should continue as normal, although this may be done after a child has been sick. The whole families personal hygiene should be stepped up to ensure the spread of the disease is minimal, by frequent hand washing, and the child should be made to wash their hands frequently to reduce the risk of cross-infection.
Most children require more sleep when they are unwell, giving the body time to recover from the illness. Children should therefore be encourage resting whenever they feel uncomfortable and be given quiet and simple activities to do to keep them stimulated.
Emotionally and socially children who are unwell often feel “unhappy and isolated from the rest of the family therefore the need more support from their parents and carers than usual and will need to be cared for by someone who they trust.” (Pamela Minett: Child Care and Development 2000).
In the home environment, sick children need the security of their normal routine to continue as much as possible. Mealtimes and bedtimes should where possible continue as normal. It can be very worrying for a child to be ill and young children may not have the right vocabulary to express how they are feeling. Parents should allow their children to express their fears, and validate their feelings. For a chid there is nothing worse than feeling scared confused and not being able to talk about it. Some children will become clingy when unwell and behaviour changes may be notice by other people who care for the child. Children need to be reassured that they are going to get better and that they are still loved.
If a child’s emotional needs are not being met then the child may regress. Regression means that the child reverts back to the behaviour of a younger child. This can happen with any illness and is normal for a short period of time, but over a longer period of time it can affect a child’s development. It is important to recognise this behaviour and provide the child with reassurance, routine and extra attention.
There are signs, which show if a child is demonstrating regressive behaviour.
- Plays with toys from an earlier age group
- Excessive crying
- Lack of concentration
- Inability to learn
- Clingy
- Aggressive
- Unusual behaviour such as laughing.
The child with a serious medical illness is at risk for developing associated emotional problems. Unlike a child with a temporary sickness such as the flu, the child with a chronic illness must cope with knowing that the disease is here to stay and may even get worse. Child and adolescent psychiatrists point out that “almost all of these children initially refuse to believe they are ill, and later feel guilt and anger.” (www.about.com/terminalillness: Article about Terminal Illness).
Play is very important when a child is unwell. When a child is first unwell they often need more sleep, but in between periods of sleep and rest the child can quickly become bored and frustrated. Parents can sometimes keep some toys and play materials tucked away ready to bring out when the child is ill or recovering. Some of these tings may have been given as a birthday or Christmas presents, and then put aside for just such an occasion. In addition having new or different toys to play with a child always loves someone who will play with them, or read or tell stories.
Children who have to be absent from a learning environment for a period of time will “lack the stimulation offered by the environment and will be restricted from learning through observation and imitation of others.” (Yvonne Nolan: BTEC National Early Years). Children will often sleep for longer periods when unwell and aren’t interested in much, except perhaps when being read to. During recovery, however they may become bored and frustrated and require activities which are short and simple and which require little concentration. Children often play with toys and read books, which are suitable for a younger age group when unwell, and the carer needs to play appropriate activities throughout the day such as drawing and colouring, which can be provided for children of any age. Books are good as children often have favourite stories that they like to have and read to them. Play dough can help children express their feelings and frustrations and keep the child stimulated creatively by making different shapes, houses, objects, animals etc.
“Friendships can also suffer if a child has frequent prolonged absences from nursery or school.” (Sandy Green: BTEC National Early Years 2002). It is important that friends should be encouraged to visit the child, if possible, letter writing, e-mailing or sending pictures to each other cab also help sustain friendships.
Even short- term illness can cause disruption to family life and the normal daily routine of the household and it can be a very worrying time for parents. If the child’s parents work, alternative care may need to be arranged. Chronic, long-term and life-threatening illnesses may cause the family to make adaptations to many aspects of their lives to meet the needs of the child and other family members. Parents may go through grieving pr “A child’s illness may therefore affect the family in the following ways:
- Physically: it can be physically demanding to care for an unwell child, especially if any lifting is required. Sleep deprivation can also lead to exhaustion.
- Emotionally: there is always a multitude of emotions, such as fear, uncertainty, anxiety, insecurity, guilt, depression, which arise when a child is ill, especially when there is long-term illness, or if hospitalisation is required.
- Financially: if a parent has to give up work either temporarily or permanently, it can have huge financial implications n the family. If a child is in hospital, this can also cause more expense.
- Isolation: it is often not possible for the parent to have the same contact with friends or work colleagues when a child is ill, and this can cause the parent to feel isolated especially if the care is very demanding.” (Yvonne Nolan: BTEC National Early Years 2002).
Caring for a sick child can be stressful for parents. It is important to know how to care for a child’s symptoms as well as when to get immediate medical help. It is “essential to keep certain symptoms such as a fever, diarrhoea, and vomiting under close supervision when a child is young.” (Penny Tassoni: Child Care and Education). If these symptoms are not controlled quickly, then the child can experience problems such as seizures, brain damage, nutrient losses, dehydration and even fatality. Also early identification of a sick child can prevent the spread of sickness and disease.
When a child is unwell it can upset the routine of other children and can also cause a variety of different emotions to surface, especially if the child is seriously unwell. “Siblings can often have unsure feelings towards each other, illness can cause them to feel guilty if they think unkind thoughts about their sibling, and they might also feel that they have caused the illness in some way.”(Penny Tassoni: Child Care and Education 2002). Other children may feel jealous of the attention the ill child is getting or feel confused. Siblings may become attention seeking or develop behaviour problems and they therefore need time spent with them by themselves. Older children will understand if they are told what is wrong with the sibling and can be involved in playing games and reading to them.
Other siblings may be expected to help more in the house and behave more responsibly. If a child is seriously ill, siblings can “worry that their brother or sister may die or that they may also catch the illness.” (Sandy Green: BTEC National Early Years 2002). Siblings therefore need time with parents and carers to be able to express these feelings and have details about their sibling’s illness explained in a simple way. They should be included in family discussions and know in advance whether there will be any change in their routine, e.g. who might pick them up from school. It is important that the early years setting knows what is happening at home and any change to the routine, in order that th early years practitioner can support the child appropriately.
A child’s emotions can be affected by the way their family members cope with the illness, as well as other issues including the stress felt by the family. Finances, work, and insurance problems the family may face, or siblings who are jealous of the extra attention the child with the illness may receive due to their illness, will all affect a child's emotions
Chronic, long-term and life-threatening illnesses, may cause the family to make adaptations to many aspects of their lives to meet the needs if the child and other family members. An example of this was on the documentary of Fleur and her family, and how they had to make adoptions to their lifestyle and look after Fleur, and her aging illness (BBC Documentary of Fleur’s life: Panorama 2000).
Once a child has been diagnosed as having a life-threatening illness, they parents will initially be in shock and will not really take in what they have been told. The family as a whole will continue to need support, which can be provided by hospital staff, counsellors, advisors, or other parents who are going through, or have been through similar experiences. Support can also be obtained from one of the voluntary organisations such as Action for the Sick Child.
Inevitably, family routines are also disrupted - at least for a period of time - during an illness. There can be numerous doctor's appointments, lab tests, treatment schedules, hospital visits, and other tasks that need to be done. The demands of the illness can affect the entire family. Schedules will change, and everyone will need to pitch in. The best thing to remember is to be flexible. “Special attention should be paid to children who are involved because disruption is especially difficult on younger people.” (Sandy Green: BTEC National Early Years 2002).
When illness strikes families with children, communication becomes especially important. “Children are smart and can usually perceive that something is wrong.” (Penny Tassoni: Child Care and Education 2002). Providing them with an honest explanation about the illness will help them cope with the situation in a healthy way. Helping young people adapt properly to a family illness will influence how they deal with other difficult situations in their future. Communication is not a one-time event, rather a very important ongoing process that will need to continue throughout the course of the illness and beyond.
“Assigning children small tasks to help can make them feel involved in and part of the process.” (Tina Bruce and Carolyn Meggit: Child Care and Education 1999). Older children can take on bigger responsibilities such as cooking, helping to care for the younger children in the family, or running errands.
Terminal illness may also have a tremendous impact on the roles people play in their family. A person whose main role is resourcefulness or problem solving may find him or herself unable to deal effectively with the situation. A person who has always been dependent may suddenly be called on to take charge of enormous responsibilities and momentous decisions. To some extent, the patient must become more dependent, an especially difficult role for those who are accustomed to independence.
In order to cope, families need a familiar routine and a sense of security during this time when so much is changing in their lives. Maintaining meaningful family "rituals" (e.g., eating pizza every Saturday night, celebrating holidays together) can be reassuring even though these activities may have to be modified to fit the new circumstances.
An illness can stress the entire family as constant demands are placed on its members. Nevertheless, family members need to maintain a commitment to the family. Family relationships need special attention. Keeping communications open. Spend time together that is not focused on the illness. Siblings often feel overlooked when a brother's or sister's needs demand so much family time.
The problems facing the family are in some ways similar to those facing the patient. The most common problems are grief, isolation, feelings of uselessness and helplessness, depression, anger and conflict, anxiety, sexual problems, and physical and emotional fatigue. As with the problems and issues of the individual, those of the family are often interrelated and thus may be more complex in reality than presented here.
In the family, isolation and loneliness occur when other family members and friends do not come, or when they come and do not help or do not seem to have an appreciation for what everyone is going through. Some visitors expect to be entertained as if nothing of import was happening; others want the patient and family to be cheerful or "positive." In either case, the visit is not particularly helpful. Families that were never very social or involved in church or community activities tend to become less social and may receive little social support.
Especially in the later stages of disease, the overwhelming physical and emotional demands of giving care means that there is little opportunity or inclination for social contact. The amount of work and the stress of giving care in later stages are hard to exaggerate. No matter how many people are around, in the later stages, the primary caregiver is likely to feel isolated.
Families most prone to depression include those in which: there is unresolved grief or conflict, one or both spouses are alcoholic, or when there is a history of depression. Many of the symptoms of depression are similar to characteristics of people who are caring for a person with terminal illness. These include deep sadness, fatigue, and inability to experience pleasure, feelings of helplessness and worthlessness, and difficulty sleeping. These characteristics also are manifestations of grief.
Caring for a loved one with terminal illness is physically, emotionally, and spiritually tiring well beyond what many people expect, especially when one family member has total responsibility for the care. There is often a cyclical nature to the fatigue, beginning with physical labour and sleep loss. The labour is harder and sleep more difficult because of associated grief and anxiety. Isolation is a common complicating factor. The caregiver's schedule of leisure activities and other work and is also altered, thus further compromising her or his energy and abilities.
