Baptist Children's Hospital
Pediatric Psychology Services
Ask most parents whose children have received the diagnosis of “CANCER” and they will tell you that they remember very little about the details of what was discussed immediately after receiving the diagnosis, but they do remember the “feelings” and “emotions” that hit them and their children like a ton of bricks.
The diagnosis itself carries a weight of its own and parents quickly begin to appreciate how the diagnosis and treatments greatly impact the psychological, emotional, behavioral, social, and cognitive functioning of their children. And the effects are not just limited to the patients themselves, but extend to parents, siblings, extended family members, friends, teachers, and everyone who surrounds them. For these reasons, the Pediatric Psychology staff is intimately integrated as part of the Pediatric Oncology Services at Baptist Children’s Hospital from the time of diagnosis.
Some common reactions from parents about the involvement of a psychologist in their child’s treatment are, “My child isn’t crazy, she has cancer!” and, “My child doesn’t need a shrink, he needs a cure.” At Baptist Children’s Hospital, we want parents to be informed of the many aspects of your child’s life that can be affected by their diagnosis and treatment.
It is not uncommon for children to have a variety of reactions to their diagnosis and treatments—with depression, anxiety, and aggression to name a few. Pre-diagnosis psychological stability, that is, how stable a child is before diagnosis, how confident he/she is about him/herself in the various aspects of his/her life, can often predict the kinds of reactions or difficulties that fighting this illness might impose on him or her during the treatment.
Psychological defense mechanisms such as denial, anger and projection (casting frustration and anger onto loved ones) are often perceived as negative by-products of the entire experience. In fact, many defense mechanisms are actually protective in nature and serve to provide an important set of coping skills that enable children to get through the arduous ordeal. Pediatric Psychology staff can help both children and parents to understand the kinds of defense mechanisms being employed and provide strategies for helping them develop more adaptive ways of coping with the experience.
Knowing how your child handles frustration, negative emotions, anger, and fearful medical procedures (e.g., getting a needle at the pediatrician’s office) can help us provide suggestions that might build in the necessary frustration tolerance to promote a more adaptive response while in the hospital. Having a child act out, scream, refuse medications, make scary statements like “I hate my life” and “I wish I didn’t have to live with cancer”, could all be indicators that his or her emotional functioning is off track. Specialized interventions for managing anxiety more effectively, for developing pain management skills (e.g., self-hypnosis, EMDR, visualization and relaxation skills), and for handling negative emotions in general are available through the Pediatric Psychology staff.
Children, when stressed, often display extreme behavioral reactions that may or may not have been present previous to their diagnosis. Symptoms such as acting out, rejecting loved ones, experiencing separation anxiety, displaying aggressive behaviors, showing emotional withdrawal, and even self-destructive reactions are common. Sometimes, the negative association with the taste of chemotherapy can cause other problems to develop as well: selective food refusal, decreased appetite, and even anticipatory nausea and vomiting. Anticipatory vomiting symptoms occur when the child vomits or feels nausea during times and places that are associated with receiving chemotherapy. She might get nausea upon entering the doctor’s waiting room, upon entering the elevator on the way to the doctor’s floor, or even in the parking garage that is connected to the doctor’s office. In these cases, behavioral techniques such as systematic desensitization can be developed to minimize the long-term negative effects that these negative associations can cause. In contrast to this is the child who, previous to the diagnosis and treatment was a very docile and mild mannered child who, when placed on steroids during his treatments becomes aggressive, impulsive, and uninhibited. Some children, particularly younger children, may have significantly elevated activity levels accompanied by mood swings and high levels of irritability when receiving certain types of medications. Failure to recognize the potential impact of these medications on children’s behavioral functioning may lead to inaccurate and inappropriate attribution of mental health or cognitive problems to those children. These behaviors are common, some are temporary, and can be lessened by some changes in parenting and discipline practices. Let us know if any of these concerns arise during your visits to the doctor or to the hospital.
As a result of the frequent hospitalizations, trips to the oncologist’s office, physical weakness as a result of the chemotherapy, and other physical side effects (e.g. losing hair, skin discoloration, shaky motor movements), many children’s social lives are disrupted during their treatments for cancer. They tend to have less contact with peers, are more isolated, and are often denied the consistent social interactions that are essential for sharing, for friendship making, for reciprocal socialization skills, and for interpersonal problem solving skills to develop. Some may show body image disturbance due to the changes in their psychical features, and some are unable to attend school and remain on Home-bound educational services as a result. Encouraging involvement through the Child Life program activities during the hospitalizations is seen as essential to minimize the socialization effects. Keeping some consistent contact with other same age peers outside of the admissions is often important in maintaining your child’s growth and development in the social areas. Maintaining a child’s attendance at school if medically cleared, can also serve to minimize the above concerns. Keep your treatment team members informed if any of the above issues are concerns for your child.
Depending upon your child’s type of cancer and the treatment protocols, parents should be aware that the disease and its treatment can adversely affect the development of the central nervous system that can, in turn, result in both short-term and long- term cognitive impairments. Some of the side effects of treatment can impact a child’s intellectual skills, processing skills (auditory, visual, and processing speed), motor skills, and academic skills development. The highest risk for cognitive side effects are those children who receive surgery (tumor removal) , along with radiation therapy, and chemotherapy. Common factors that may affect school performance or all children include school absences due to hospitalization for treatment, dealing with acute side effects of treatment such as nausea and low blood counts, and inconsistent or inappropriate educational planning for the child while on treatment. Problems with attention, memory, with motor skills and motor planning, with mental processing speed, development of learning deficiencies, and intellectual skills deterioration are all potential issues that may need close monitoring. Our School Reintegration Program in conjunction with the Child Life Specialists can formally evaluate your concerns and develop a plan to educate teachers and school personnel about the special needs that your child may display.