Addressing parenting concerns of bone marrow transplant patients: opening (and closing) Pandora's box.

Although a significant number of adults undergoing stem cell transplant (SCT) or bone marrow transplantation (BMT) care for dependent children, and these treatments pose significant challenges for families, research has virtually ignored the impact of parenting on patients' quality of life during BMT/SCT and children's responses to having a parent undergo these treatments. Physicians rarely inquire about parenting concerns related to the extended hospitalizations necessitated by these treatments, yet clinical experience suggests that addressing patient concerns about children's reactions to cancer and BMT/SCT can improve the experience of the patient and the patient's family, and help the medical team respond effectively to sources of patients' distress. Parents frequently want to know what reactions to expect from children, thus general developmental information is reviewed, and recommendations given for when professional help for children is warranted. A key way for parents to support their children is with open, honest communication; however, parents often find it extremely difficult to talk about cancer and BMT/SCT with their children. The medical team can assist patients' efforts to communicate with and support their children by asking about a patient's children, providing some targeted information, and discussing the potential impact of treatments on parenting capacity. Inquiring about and addressing parenting concerns may initially seem difficult, but can ultimately facilitate stronger doctor-patient alliances, and more compassionate care.

Screening for psychosocial dysfunction in pediatric dermatology practice.

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n = 377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.

Pediatric dermatology: developmental and psychological issues.

Adolescence is characterized by a sensitivity to issues of attractiveness, emerging sexuality, and the challenge of parental rules and values. The latter tends to carry over into the relationship with other authority figures like the dermatologist. Noncompliance is a significant problem in treating this age group. It can be decreased by establishing an alliance with the patient concerning the goals of therapy. Although the parent may have brought in the teenager, the success of treatment depends on the patient himself or herself. The adolescent is most likely to follow through if the dermatologist presents the pros and cons of the treatment and explicitly leaves the choice of implementation to the adolescent. Parents who confidently offer to make sure the adolescent follows the treatment plan may only increase noncompliance by placing the treatment in the middle of existing parent-child struggles. For a variety of reasons, adolescents are hesitant to ask questions of the dermatologist, but this is especially true in sexually transmitted conditions. Teenagers may turn to each other and receive inaccurate information unless the physician actively invites their questions. In sexually transmitted illnesses this potentiates public health hazards, and in all dermatologic conditions it adversely affects compliance.