Children's Understanding of Illness.

Abstract

Although programs and strategies have been developed to teach chronically ill children about their illnesses and hospitalization experiences, the relationship between the child's cognitive maturation and his understanding of his illness has not been adequately examined. This study used the cognitive developmental theory of Jean Piaget to assess the child's conceptualization of the cause of illness and the intention of medical procedures. Fifty chronically ill, hospitalized children, ages five to twelve were interviewed. Cognitive understanding of each child was assessed in five areas: (1) logical thinking (conservation of mass); (2) understanding of cause and effect; (3) understanding of cause of illness; (4) ability to infer intention of adults; and (5) ability to infer intention of medical staff members in performing painful procedures. In addition, the following biographical information was obtained: type of illness, length of hospitalization, sex, socio-economic class, amount of parent-provided information, and degree of expressed parental guilt. The results demonstrated a significant correlation among tasks (p < .01) and a significant effect for age (p < .01). There was no significant difference in level of understanding between high and low affect tasks. Children did retain more egocentric thinking in responding to questions of illness and medical procedures than to neutral tasks. The results demonstrated that cognitive level was related to children's understanding of their illness. Three levels of explanation were used by the children, they were as follows: illness is (1) caused by human action; (2) caused by outside factors, e.g., germs; and (3) caused by an interaction of factors, including physical weakness or susceptability. There were three parallel maturational stages in the development of the understanding of medical staff intentions in providing treatment: (1) procedures were viewed as punishment; (2) the intention of procedures was understood, but staff empathy was not inferred unless the child expressed his pain; and (3) both intention and empathy were inferred by the child. Children process information about their illness through a predictable maturational cognitive sequence. They can understand stressful and neutral issues at a similar level of understanding, but retain egocentric reasoning as a coping mechanism in dealing with illness. The majority of parents do not discuss the illness. Medical staff need to recognize developmentally caused distortions that appear in conceptualization and be sensitive to various fears. Addressing the child's own ideas, distortions and fears is more important than providing information because all children come to the experience of illness with their own concepts as to why they become sick, and why they need medical treatment.