Children’s reactions and consequences of illness and hospitalization and transition of care from pediatric to adult settings

Typical consult question “Please evaluate this twelve year old with sickle cell disease who had a bone marrow transplant three weeks ago. He was doing well, but had a seizure last night and now seems confused and says he is seeing spiders crawling on his bed.” Background Psychiatric consultation for medically ill children and adolescents may be sought for psychological aspects of specific diseases such as anxiety with pulmonary diseases, disorders unique to the medically ill such as delirium, or behavioral problems common in children across disease entities such as non-adherence. The psychological effects of specific medical conditions like asthma or cancer have been the focus of scientific inquiry. The most common pediatric chronic illness is asthma, which has been associated with psychiatric problems in both children and parents. More than one-third of children with asthma have anxiety disorders. Increased severity of illness is associated with increased psychosocial problems. Family therapy and pharmacologic treatments for anxiety and depression are effective for treating children with asthma. Pediatric patients with cancer have rates of depression similar to the general population, influenced, in part, by avoidant coping styles. Cognitive-behavioral techniques, topical anesthetics, and sedation given before and during invasive cancer treatments or procedures such as bone marrow aspirations can decrease anxiety, distress, and pain in pediatric patients with cancer. Delirium is relatively common and has a similar presentation in pediatric patients as in adults. (See example above.).