Deanna Johnston, M.A., LPC
February 15, 2021
From the moment we are born, we start processes of development of self and development of relationships with others. As we grow, so do these processes, but often unnoticed.
When a diagnosis such as cancer shows up, it simultaneously feels as if everything stops, yet, a new journey starts. This journey does not naturally unfold but demands attention.
Threat to Development
From the moment of diagnosis, to remission, a child’s need for the natural steps of development does not stop. Cancer’s threat to development needs to be addressed along with the need for treatment of cancer. If these developmental needs are not met, mental health is impacted. Each child and circumstance are different, but when developmental steps are missed, problems such as, but not limited to, anxiety, depression, and adjustment disorders may occur.
“Cancer therapy poses a threat to achieving greater mastery of the world in the toddler and pre-school child, of one’s own body during the school years, and the formation of a sense of identity in adolescents” (Holland, 1998, p. 897). Holland (1998) is clarifying that when a child of any age enters the hospital for cancer treatment, attention needs to be given to both the body and mind. Just as the treatment may differ for the diagnosis, so do the psychological needs differ by age. For example, from age 3-5, children are working to gain a sense of control over their environment. Often, cancer treatment interferes with this goal, yet the goal remains. Children may express the need to meet this goal in other ways, such as, but not limited to, using food as a source of control. Holland (1998) also mentions a threat to identity formation in adolescence. Adolescents may struggle to navigate peer relationships and returning to school during and after cancer treatment. This may be due to fear of being behind academically, change in appearance, or other factors. However, returning to school is fundamental in meeting developmental goals. It is a symbol of normalcy. In addition, it reconnects the child with peers. Peers play a significant role in assisting with identify formation (Holland, 1998).
Despite the desire for normalcy, a child and his/her family cannot pretend as if life is as it was. This need for ongoing development impacts both parents and children. Parents often find themselves questioning how to parent, such as being consistent in discipline, or report overprotectiveness (Holland, 1998). In cancer treatment, the medical restrictions placed by the doctor must be honored to protect life. However, where there is flexibility, we must then consider the lifespan goals the child needs to be working to meet and provide the space to do so.
Parents also question how to best help their children during the process of cancer treatment. It is beneficial to consider not only medical needs, but psychological needs. Not only do psychological needs need to be addressed in daily life, such as when the child returns home, but it is also important to preserve developmental goals during treatment itself.
There are age-specific competencies to minimize the adverse psychological effects of medical treatment. These competencies match with childhood development. When we discuss psychological development, we can break needs into age ranges.
From birth until 18 months, a child is learning trust or mistrust, meaning if the caregivers are consistent, the child develops trust in the world. During this time, caregivers need to be as involved in care as much as possible (Sun). When caring for a child with cancer, “parents may question their capacity to provide adequate home care” (Holland, 1998, p. 902). This is a normal feeling. Many hospitals help to transition care. In addition to infants looking for their caregivers to help develop trust, it needs to be remembered that there is anxiety around strangers. This includes doctors and nurses who may encounter the child.
From 18 months to three years, a child is working towards achieving independence. A hospital setting challenges the need for achieving autonomy when many procedures are out of the child’s control. During this time, children may need to handle medical equipment, where and when appropriate, before the procedure. It is also helpful to explain to children what is going to happen, but in language they can understand.
When a child is 3-5 years old, social skills are rapidly developing, with him/her becoming more assertive. Allowing children to make choices when they can, even if they are seemingly small (such as with food) or encouraging them to ask questions about what is happening in treatment, is important. This may also be a challenging time for the parents emotionally. The goal is to allow the child to take some control in their life, but there may also be a competing desire to protect.
The next age span is 5-12, and a child needs to develop a sense of competency. During this stage, it is appropriate to let children have input into their medical care. They may need the opportunity to discuss what they understand about their condition, and what they need to know. Allowing them to make some decisions related to care will increase competency. It is also important to let the child know what of their normal activities they will still be able to participate in.
In terms of pediatric cancer and childhood development, the last stage is 12-18, and it is when children form their identity, or identify their roles in the world. It is important that empathy and care be shown to how treatment may impact appearance or peer relationships. Treatment procedures should be explained. Adolescent patients may need to know how the diagnosis impacts their future (Sun Coast).
Cancer imposes a significant change in one’s life circumstances. From medical procedures to lifestyle impacts, it can de-rail life’s “normalcy.” However, children with cancer are still children. They still face the same development goals and landmarks. Meeting these goalposts is just as psychologically important as the physiological treatment of the cancer itself. When working with pediatric cancer patients, both their physical and psychological needs need to be accommodated for. Psychological development happens whether the child is in the hospital, at home, or in the community.
Deanna Johnston is a Licensed Professional Counselor in College Station, Texas. She attended the University of Mary Hardin-Baylor, earning a degree in Clinical Mental Health Counseling. She previously worked as an embedded counselor in oncology before opening her private practice. She works with trauma, chronic illness, and bereavement.
Holland, J.C. (Ed.). (1998). Psycho-Oncology. Oxford.
Sun Coast Hospital Pharmacy. Age-specific competencies and skills. https://www.quia.com/files/quia/users/juliehl2/Age-Specific-Competency