Children and skin disease

Since the psychological problems associated with
a child’s medical condition can have long-term
implications (for instance, for the way that they
develop socially), addressing these problems
could be even more crucial for children than it is
for adults.
There are significant barriers against children with chronic medical conditions
receiving mental health treatment. These barriers can be put up by GPs and
dermatologists, by the family and by mental health providers themselves. Parents
can become defensive as soon as psychological factors concerning their child are
mentioned and can interpret any advice by professionals as a comment on their
ability as competent parents. Also, many people are very sensitive to the perceived
stigma associated with health problems and family problems. With respect to
the child’s doctors, problems such as a failure to recognise behavioural aspects
of an illness, a lack of belief in the efficiency of mental health procedures and
concern about sharing their patient with another professional can all hinder the
treatment process.
It can be difficult for dermatologists and GPs to properly explain the link
between medical treatment and the psychological effects of a skin disease because
the psychological explanations familiar to dermatologists in the past have been
unacceptable to most families.
Finding less difficult ways to explain the link between psychology and skin
diseasemay increase the acceptance of referrals and successful treatment of all the
problems associatedwith skin disease. This chapter seeks to explore the relationship
between childhood skin disease and the psychological factors associatedwith it and
to look at the ways in which psychology can help children who are suffering with
skin conditions.
The diagnosis of a progressive or episodic skin condition within the family can
be stressful for both the child and the parents. Skin diseases may signal a loss of
‘normality’, alter the family’s concept of its ‘self’, challenge coping methods, and
lead to changes in roles, plans and dreams. Parents may blame themselves if they
believe the disease to be hereditary, and siblingsmay themselves fear acquiring the
disease. Janice is a mother of a 15-month-old baby with eczema and she describes
her feelings about her baby:
“When Jessica was born, I was really excited that I’d had a little girl. I
wanted a girl somuch that I had even bought little dresses for her before she
was born! She was going to be my little doll. I think when the eczema came
on it was a real shock to me. I had heard about the condition but didn’t know
much about it. I didn’t expect that I would have to make so many changes
to deal with it. You see, Jessica’s skin gets very itchy so she becomes really
uncomfortable and cries a lot, sometimes all through the night. I can’t dress
her in the clothes that I want because she has a bad reaction to certain
fabrics. Also, I have to apply this special ointment to her patches, but she
hates that and starts screaming when she sees me coming with the tub of
cream. I feel really bad when she struggles with me like that. Sometimes I
feel that we aren’t close enough, you know. I can’t play with her or cuddle
her, because she gets really uncomfortable. It’s very hard for us. It’s like the
eczema won’t allow me to have the relationship, the closeness that I want
with my daughter.
”
This case illustrates some of the difficulties that can arise when a young child
develops a skin condition. A central concern of this mother was her relationship
and attachment to her child. Her story illustrates how anxiety-provoking it can be
not to be able to bond easily with her child.

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