Question

How do developmental differences affect the care of a child with cancer? Facing the end of life? Compare and contrast toddler & Teenager according to the 2 questions

Answer 1

Children have mainly four stages of development from birth to adulthood that includes infant, toddler/preschool, school age, and adolescence. The effect of cancer treatment depends on the developmental stages. Childhood cancer is often the result of DNA changes in cells that take place very early in life, sometimes even before birth. Most adult cancers are linked to lifestyle related risk factors or other environmental risk factors, that will further lead to DNA damage over time. As children age, they are exposed to more environmental factors that can cause cancer. Cancers in teenagers are a mix of the types of cancer that develop in children and adults. Infants and toddlers are often afraid of being separated from their parents and of painful medical procedures. Those old enough to be in school may be upset by the disruption of their routine, and miss their friends.

Challenges faced by teenagers diagnosed with cancer can complicate their treatment. Often, cancer in this age group is not found until later than it is for either younger or older people, which can make it harder to treat. Teenagers may wait longer to report symptoms because health concerns are not a priority for them, and when they do report symptoms, doctors often don’t suspect cancer at first. Symptoms like pain or feeling tired are more often due to causes other than cancer.

The effect of Cancer Treatment Across Development stages of child

TODDLERS

Psychosocial Challenges in toddler includes : Difficulties with regular feeding, comfort, and cares in can lead to caregiver mistrust and attachment disruptions.

Cognitive Challenges in toddler includes : Developing sensory and motor curiosities can be particularly disrupted by pain, nausea, and discomfort of treatment. Cognitive development is characterized by egocentric and magical thinking during this period, as well as associative logic. Children in this age group often contribute causality to animism (belief that an inanimate object is capable of action and has lifelike qualities), artificialism environmental characteristics such as thunder can be attributed to human actions), and transductive reasoning (inferring a relationship between two unrelated events), which can impact how they understand their illness.

Worsening abilities to self-soothe and be soothed. Increased irritability with touch or aversion to it are the behavioral results that are seen.

TEENAGERS

In teenagers, Psychosocial Challenges includes inability to find acceptance in peer groups and explore different roles can lead to frustration and confusion. Profound loneliness and isolation can develop without intimate peer relationships.

Cognitive Challenges in teenagers includes: Abstract reasoning and theoretical concepts of death develops. Concepts learned in one context can be applied to others. Critical thinking, planning, and agency in care are possible.

Risk-taking and non-adherence due to sense of invincibility or active denial. Behavior often for the benefit of social/peer values and activities with less influence or care about family values are some of the behavioral results that are seen.

Children can understand the universality and irreversibility of death as early as the beginnings of school age years. Even toddlers and pre-school aged children can understand that people who die no longer interact even if they cannot understand the permanence of death. Developmentally appropriate answers to children’s’ questions about death must take into account not saying things that will mislead them and make them potentially more worried. Despite common parental worries, children can maintain hope even when discussing potentially undesired outcomes and goals of care. Often, familiar objects, activities, and closeness of loved ones are most important to them, not unlike adult desires at the end of life. Adolescents and even young children regularly want to know where their belongings will go and how they want to be remembered. Some even want to plan what happens at their funeral.This meaning-making can be encouraging and comforting for many children who otherwise may be without a sense of control when they hear they are dying.

It is not surprising that cancer and its treatment significantly impacts children and their families, no matter their developmental stage. Providing children and families with psychoeducation, information, and anticipatory guidance about what to expect over the course of treatment, including implications for child development, is a psychosocial standard of care and can reduce uncertainty and distress over the course of treatment.