Over the last decade, psychologists have made extraordinary strides (Olson, Mullins, Gillman, & Chaney, 1994), similar to those made by physicians, nurses, and others, in the identification and treatment of childhood health-related disorders during the last century. It is astonishing to recall that at one time even the process of handwashing was new, and modern medicine— with the development of antibiotics, immunizations, organ transplants, and even an understanding of psychoneuroimmunology (Cohen & Herbert, 1996)—has completely altered concepts of health and illness. The field of pediatric psychology is extremely diverse by comparison with that of five decades ago; it varies from intervening with children who are primarily healthy (e.g., assisting a healthy child to cope with an immunization to prevent disease and maintain good health), to working with children who have serious health problems due to unintentional injuries, and on to helping children with lifelong chronic diseases.
The field has developed a positive, preventive focus, such as working to help children and their families follow a healthy diet, avoid substance use, and generally establish a healthy lifestyle to prevent later health problems (Seligman, 1996). Pediatric psychologists initially focused on acutely or chronically ill children, with goals of ultimately improving all aspects of children's behavioral treatment. They did this by increasing the optimal application of diet and utilization of drugs, improving medication adherence, reducing nonorganic pain (e.g., headaches) maintained with secondary rewards, and decreasing pseudoseizures maintained by adult and peer attention. The field also assisted chronically ill children in coping with the many side effects of chronic conditions, such as the need to limit diet in phenylketonuria (PKU) or to test blood sugar in diabetes. Then pediatric psychology sought to expand its focus by becoming involved in other areas of the field, such as reducing the psychosocial sequelae of children's health-related disorders. Children can now receive help in many different ways, ranging from social skills self-training when they are deprived of normal peer contact to classroom education about the nature of a disorder such as diabetes or what can be expected for a child with cancer who is going to lose his or her hair. Teaching caring and “normalizing” peer responding can be invaluable. As can be seen from these varied activities, the area of health-related disorders ranges along a continuum of different conditions, challenges, and levels of severity.
Some of the problems discussed in this chapter are not truly “medical disorders,” but may be conceptualized as medical stressors with which children and their parents must cope. These stressors range along a continuum from mild difficulties that are experienced by a majority of children (e.g., injections, eating enough fiber), to rare health problems that are life-threatening and include complicated, daily medical treatment