Development of children with a chronic illness.

About 5 to 10 per cent of all children have sometime during childhood a moderately to severely handicapping long-term illness or disability. These children are at risk, not only medically, but for complex social, educational, and emotional difficulties. The potential interferences with normal development imposed by a chronic illness are varied but pervasive, and depend on the specific characteristics of the illness, the child, and the child's family. There are known psychological effects of illness on a child, which can best be understood within a developmental framework such as that outlined above. Optimal health care of these children and families depends on a knowledge of the risks to normal development that are regularly faced by these children at each stage of their development. Physicians, nurses, and other health care providers have the opportunity to be powerful advocates for children with a chronic illness. We thus have a responsibility to facilitate these children's negotiation of the challenges and crises of childhood, so they may enter their adult years with strength and security. Such guidance requires an understanding of children's development and the impact of illness on that process, and effective communication with both children and families.