Rosenbaum P L
Department of Pediatrics, Chedoke-McMaster Hospitals, Hamilton, Ont.
CMAJ. 1988 Aug 15;139(4):293-5.
Children with chronic illness and disability are at considerably increased risk of psychosocial problems, such as neurosis, attention deficit and poor adjustment to school. Health care professionals, especially primary care physicians, can do a great deal to prevent such problems in these children and their families. The approach outlined here is based on an understanding of the transactional model of development, in which the child interacts with--and to some extent creates--the social environment, and on a "noncategorical" concept in which common elements in chronic illness are recognized and emphasized. The physician's role is to inform the family of the child's condition as soon as possible, to offer hope, encouragement and guidance, to watch the child's development, to maintain a shared view of the child and family, and, if possible, to ensure continuity of care.
患有慢性病和残疾的儿童出现心理社会问题的风险大幅增加，如神经症、注意力缺陷以及对学校适应不良。医疗保健专业人员，尤其是初级保健医生，在预防这些儿童及其家庭出现此类问题方面可以发挥很大作用。这里概述的方法基于对发展的交互模型的理解，即儿童与社会环境相互作用并在一定程度上塑造社会环境，同时基于一种“非分类”概念，该概念认可并强调慢性病中的共同因素。医生的职责是尽快告知家庭孩子的病情，给予希望、鼓励和指导，关注孩子的发育情况，保持对孩子和家庭的共同看法，并在可能的情况下确保护理的连续性。
