Helping Children Through an Adult's Serious Illness
Of the many life crises that a child may encounter on the path to adulthood, one of the most common is the serious or terminal illness of a loved adult. It is a reality that facing such illness can result in trauma, insecurity, and future psychological and behavioral problems. Alternatively, such challenges can produce enhanced family communication, increased compassion, and coping skills that can last a lifetime. The pediatric nurse, by embracing core principles of openness and honesty and by providing concrete developmental information, can empower parents to support their own children. Nurses use family-centered assessment skills to determine the impact of an adult's illness on the child and then guide the parent through those topics that are most likely to be of concern, including (a) the name of the illness, (b) the cause of the illness, (c) the potential contagion or spread of the illness, and (d) the ultimate impact of the illness on the life of the child.

Of all medical practitioners, the pediatric nurse is uniquely sensitive to the ways in which a child's physical illness can impact his or her psychological, emotional, and cognitive development, both at the time of the illness and into the indefinite future. But there is another type of illness, not usually addressed by pediatric caregivers, which can have an equally profound impact on the child for years or decades to come: the serious or terminal illness of a parent or other beloved adult. The alert pediatric nurse, with her or his special skills, insights, and access, can play a crucial role with families in this situation. By preparing families for the difficult challenges and helping parents identify problem behaviors, the nurse can assist parents and children through a family medical crisis with the least possible harm to the children.

For the family facing the serious, life-changing, or potentially fatal illness of an adult, it is all too easy to overlook the effects on the children. Yet experience shows that the children are always affected. Parental efforts to protect children from emotional responses and shield them from information are not only destined to fail, but can be terribly counterproductive. Children whose needs are not recognized and addressed throughout the adult's medical crisis can suffer psychological consequences either immediately or later in their lives - even if that adult crisis is successfully resolved.

Most of the literature addressing the impact of parental illness on children comes out of the field of oncology. In a study by Heiney and colleagues (1997), parents with cancer were not only found to have higher state and trait anxiety when compared to the norm, but they were also less successful at judging their children's anxiety level. In the same study, adolescents reported increased anxiety while latency-aged children showed difficulties with somatic complaints and in self-concept. A more recent study (Zahlis, 2001) identifies nine categories of worry that school-age children experience when mothers are diagnosed with breast cancer. Another group of authors looking at children of breast cancer patients (Birenbaum, Yancey, Phillips, Chand, & Huster, 1999) discovered that both school-age children and adolescents in this group have significantly more behavioral problems than the general population. Although no empirical data were found related to the impact of adult illnesses other than cancer on children, Morgan, Sanford and Johnson (1992) determined general parental illness to be a significant factor in a population of adolescents with psychiatric disorders. Skolnick (1990) anecdotally documents the risks to children when a parent has kidney disease.

It is frequently the pediatric nurse working in a clinic, pediatric unit, or pediatrician's office, in well-child care, in the school, or the community, who is called upon to provide information and support for families beyond the realm of specific health care for the child. The pediatric nurse, whose focus is the whole child and the whole family, is uniquely positioned to assist when a stressful and potentially detrimental family situation presents itself. It is important for nurses to note that it is not just the illness of the mother or father that can impact the child. The serious illness of a beloved grandparent, aunt, uncle, or even teacher or coach can also have a powerful impact on the child.