Chronically ill hospitalized children's concepts of their illness.

This study investigates the relationship between cognitive development and children's understanding of the cause of illness, intent of medical procedures, and role of the medical staff. A group of 50, chronically ill hospitalized children of normal IQ, aged 5 to 12 years, was given five tasks, scored in ascending order of cognitive maturation. Results indicated a correlation coefficient of responses (P less than .01) among tasks. Analysis of variance yielded an age-related maturation of responses (P less than .01). No significant difference in level of response between high and low affect tasks was found. There was a three-stage sequence of conceptual development in understanding cause of illness: (1) illness is caused by human action; (2) illness is caused by germs; (3) illness is caused by physical weakness or susceptibility. A parallel three-stage sequence of understanding of the intent of medical procedures was discerned: (1) the child views procedures as punishment; (2) he/she correctly perceives the procedures, but believes that the staff's empathy depends on the patient's expressing pain; (3) the child can infer both intention and empathy from the medical staff. Specific illness, sex of the child, and length of hospitalization did not affect the child's level of response. Children process information about their illnesses through a predictable maturational cognitive sequence which medical staff members must address for comprehension to occur.