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The things that come to mind when we think about health are the well-being of mind and body, the mental and physical well-being, disease and illness, social well-being and many more. Although health is measured by the amount of disease and illnesses there are, it is difficult to define health. According to the World Health Organisation (WHO) (1948), health is defined as a complete state of physical, mental and social well-being. Another statement was recently modified, which includes the ability to lead a “socially and economically productive life”.
There are many things that influence the health and well-being of a child, one of them being poverty. Poverty has a huge impact on a child’s health, simply because a family with a low income will not be able to provide the best environment and the best type of treatment for an ill child. Whereas a family who has a better income can provide much more for their ill child. According to Aber et al. (1997), poverty was shown to negatively influence child health. He says that because of poverty, there are increased neonatal and post-neonatal mortality rates and also greater risk of injuries resulting from accidents or physical abuse.
Nutrition also comes as a problem together with poverty because, if a family cannot afford certain food types for the child, the child has a risk of bad health. As Rivera et al. (2004) states, “malnutrition causes death and impaired health in millions of children”. He draws attention to the fact that, every year more than 10.8 million children, under the age of 5 are dying because of malnutrition. Also as Hall (1996) states, iron deficiency is an important health problem in young children. (p. 6).
There are socio-economic and demographic factors influencing childhood mortality, such as; education, ethnicity, sex and gender. Education can come into this because in certain countries, women do not get educated well enough, certainly because the man is seen as the breadwinner. In most cases if a child is a girl, she would not be sent to school just because she is a girl. If women received a good education, they would have a role in protecting their child’s health.
Again in some places, the sex of the child is important because, if a woman is pregnant with a girl, she is most likely to have a termination. This is because the husband or the family would prefer having a boy so that he can carry on their surname. Hudelson (1996) states; socio-economic and cultural factors may be that they may play a role in determining overall gender differences in rates of infection and progression to disease. Secondly, they may lead to gender differentials in barriers to defection and successful treatment of the health issue.
According to Neff and Anderson (1995), children who have chronic illnesses are more vulnerable. They have more needs, such as treatment so caring for a child with chronic illness is significantly more expensive than for the average child. For example having a child who has a major illness such as HIV or Cancer, would put more pressure on the family. Simply because the child will need a longer period of treatment and also will need to be treated in larger centres and this may not always be accessible by the family so they would have to travel long distances, to be able to get the right treatment for their ill child.
There are also inequalities in health. A family who has a good income can provide their ill child with the best environment, best hospitals, the best treatment and well known best doctors. Whereas a family who does not have a good income will not have access to the best of everything. Therefore the health issue that the child has may cause more implications. It is always best to find out about a certain health issue while it is still recent, as treatment will be more successful. Families with a high income will have this chance, because they would be able to go for regular tests and check ups. Whereas a family with a low income will not even consider going to the doctor, unless condition gets really bad. In most cases, by the time a doctor is seen, it is too late.
There may be all sorts of factors affecting health. Some of these can be named as; genetic inheritance, parental health and life style, and chronic illnesses such as Cancer and HIV. Parental influences in health and the well-being makes important contributions to the development of their child. Professionals, health workers, psychiatrists and doctors also have a major role in the child’s well-being.
Cancer is less common in children. Only 1 in 600 children develop cancer and normally the cure is much higher in children than in adults. 70% of all children can now be completely cured. According to Cancer Backup Jamkit (2003), there have been huge improvements in the treatment of children’s cancer over the past 50 years. More than 7 in 10 children with cancer are now cured, compared with fewer than 3 in 10 in 1962-66.
There are many types of cancers affecting a child’s health. Some of these are; brain tumors, retinoblastoma, liver tumors, neuroblastoma, rhandomyosarcoma, wilm’s tumor and leukaemia which is the most common cancer known in children. As seen in appendix 1 and 2.
According to Cancer Backup Jamkit (2003), states that although there are many theories on what causes cancer, there is no clear explanation on what causes cancer. Cancers are not infectious so they cannot be passed on to someone that comes in contact with the child who has cancer. Also in most cases cancers are not caused by an inherited faulty gene and so it is very rare that, a second child in a family would develop cancer.
According to Z. Jane et al. (2002), mothers of children with serious illnesses have lower levels of well-being than mothers in general population. Problem solving therapy (PST), a general cognitive-behavioural intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being.
According to Statistics (2004), since the 1960s, there have been great advances in the treatment of most childhood cancers, resulting in markedly higher survival rates. By the mid 1990s, nearly 75% of children with cancer survived at least five years after diagnosis (known as five-year survival). Mainly in childhood leukaemia five-year survival was above 80% and exceeded 50% for every main type of childhood cancer. Statistics show that childhood cancer is about one fifth more common among boys than it is among girls. The different types of cancer tend to occur predominantly at different ages. For example, there is a peak in the most common type of leukaemia at ages 2 and 3. In Britain, the incidence of all is higher status, particularly in early childhood.
When it comes with coping with treatment procedures it may be difficult for some families. Burton (1974, p. 74) states that, involvement in treatment, necessitating as it does, actively on the parents part can also be of use in helping parents to forget some of their otherwise, overwhelming anxiety. But as with any other excessive activity, it may tax their overall strength, producing a loss of personal energy and enthusiasm. Parents may find it hard to cope with the treatment because a child who has cancer would need to visit the hospital very often and treatment may cost too much.
Cancer is mainly divided into four stages, these are as follows; stage 1 is, small and localised. Stage 2 is, when it has spread into surrounding structures. Stage 3 is, when it spreads to other parts of the body and the final stage is, if the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer, which is stage 4.
It can be really tiring for the family and the child while in the process of the tests, as there are several tests such as; Biopsy, blood tests, bone marrow aspirate, lumbar puncture, x-rays, ultrasound, scan, bone scan, computerised tomography (CT), magnetic resonance imaging (MRI) and position of the cancer in the body and to asses the child’s general health, as this may affect the treatment that is given.
Having to live with cancer is really hard for children and their families as it affects them in many ways. Some of these problems can be; firstly schooling, according to Cancer Backup Jamkit (2003), children with cancer often have gaps in their education: due to going into hospital, side effects from treatment, or generally because they do not feel well enough to fully take part in daily school life. Another issue may be that the child has a risk of catching an infection while at school, such as; chicken pox, measles, mumps or flu can be dangerous to children who have low immunity due to cancer treatment.
Parents also come across some difficulties such as having to make hard decisions. One example of this can be that, if the child who is diagnosed with cancer and has not yet started school. Parents may have to choose whether they want to send their child to school throughout the treatment (with the risk of infection) or to keep their child at home. This means that they have less chance for social growth and development.
Leukaemia is the most common type of cancer which occurs in children, as it can be seen in appendix 2. Leukaemia is divided into two types; one being, acute myeloid leukaemia (AML) and the other acute lymphoblasic leukaemia (ALL). Cancer Backup Jamkit (2003) describes leukaemia as types which can be divided into different sub-titles. Blood and bone marrow samples will be checked by haematologists and pathologists to find out which type of leukaemia a child has. They try and find out exactly which type of cell has become leukaemic and at which stage of their development. The cells may also be tested with antibodies for specific proteins on their surface. This process is known as immunophenotyping.
The genetic make-up of the leukaemia cells will also be examined as different types can be associated with particular genetic changes. All of this process takes place because knowing the exact type of leukaemia helps the doctors to know which treatment is likely to be most effective in treating the leukaemia.
Out of the two types of leukaemia, the most common type which occurs in children is acute lymphoblastic leukaemia (ALL). ALL can affect children at any age but is most common in children aged 1-4. It is also more common in boys than it is in girls. Leukaemia is a cancer of the white blood cells. All of these blood cells are produced in the bone marrow which contains; red blood cells, white blood cells and platelets. Although it is yet not known what causes leukaemia. According to Cancer Backup Jamkit (2003), children with certain genetic disorders, such as Down’s syndrome, are known to have higher risk of developing leukaemia. Also brothers and sisters of a child with ALL have a slightly increased risk of developing ALL themselves, but this risk is still very small. Like any other cancer, ALL is not infectious and cannot be passed on to other people.
Generally the symptoms are just like of those viral infections. They may start to get tired and lethargic due to anaemia which is caused by lack of red blood cells. They may start to develop bruises. They may feel generally unwell and complain of aches and pains in the limbs, and may have swollen lymph glands.
Once the type of leukaemia is diagnosed, the best type of treatment is identified. There are different types of treatments, this involves; Chemotherapy as being the main treatment for ALL together with combination of chemotherapy drugs and steroid medicines. Consolidation and central nervous system (CNS) treatment, to prevent the spreading of leukaemia. Maintenance treatment which involves the child taking daily tablets and having monthly injections of chemotherapy. This normally takes 2 years in girls and up to 3 years in boys. Bone-marrow transplantation, used for children whose leukaemia has come back. Testicular radiotherapy which involves boys having radiotherapy to their testicles. Lastly central nervous system (CNS) radiotherapy for children who have leukaemia cells in their CNS when they are first diagnosed with ALL.
During the treatment there may be several side effects such as; hair loss, loss of appetite and weight loss, nausea and vomiting and an increased risk of bruising, bleeding and infection. In some cases there may be late side affects, which sometimes takes place many years later. These include possible problems with puberty and fertility, a change in the way their heart works, and a small increase in the risk of developing another cancer in later life.
According to Hargrave et al. (2001), in the last 20 years, the survival rate for children with ALL has markedly improved, largely owing to a decrease in relapses. However children still die from complications of treatment and these are potentially preventable.
While the child is diagnosed with cancer and the treatment has started. This will have a huge impact on the family. The child itself may be frightened and may have symptoms of the cancer or side effects of the treatment to cope with. They may become very clingy and argumentative and difficult to get on with. The child’s whole discipline will change, with stays in hospital and going to hospital for appointments. Therefore the family has to adapt themselves to this routine.
Often as parents this is the worst situation to face. Every parent would be worried and under a lot of stress. In some cases parents may think that the diagnosis is a death sentence. The parents would worry about how the child will cope with this and family life will be disrupted. Some parents may absolutely be confused and feel numb and in some cases they may feel guilty that this has happened to their child. They may have all sorts of mixed feelings such as; fear-they may deny the fact that such a terrible thing has happened to their child. Sadness-at times they may feel hopeless about their child’s recovery.
Anger and uncertainty- may feel angry with hospital staff or even at each other because, they have different ways of coping with cancer. It may also have an effect on their social life as they may not want to socialise with friends and family because they are feeling unhappy. Finance is another issue, such a major health issue will cost a lot and they may not be financially ready fort his.
It is also very hard for the extended family and friends such as; grandparents, aunts, uncles to cope with this some may not be able to believe that this has happened to someone in their family. They may go through similar emotions as the parents. Some may avoid seeing the family, simply because they do not know what to say to the family or because they do not want to see the child going through pain.
Siblings may also be affected by this, as all the attention will be given to the child that has cancer. Siblings may feel left out and not loved. Some may become very quiet and withdrawn. They may at times become frustrated and have outbursts of anger, because they keep their feelings bottled up inside. There may be disruptions to their daily routine because the family has to spend time taking the child to hospital for appointments.
The Children Act (1989) states that; children should always be consulted (subject to age and understanding) and kept informed about what will happen to them. Children’s issues must be determined as soon as possible so that minimum disruption is caused to the child’s life.
Every Child Matters (2005), children’s trust bring together all services for children and young people in an area, underpinned by the Children Act 2004 duty to cooperate to focus on improving outcomes for all children and young people. They will support those who work everyday with children, to deliver better outcomes.
Alan Milburn, Secretary of State for Health (2000) today launched the first ever comprehensive NHS Cancer PlanA plan for investment. The plan sets out the future of cancer services, setting waiting time targets for the treatments of cancer patients and unprecedented investment in cancer hospices. The plan includes; maximum two months wait from urgent GP referral to treatment for all cancers by 2005. Extra specialist’s cancer nurses with new training and responsibilities. 1.000 more cancer specialist I the service over the next 6 years. New treatment equipment and 250 new cancer scanners.
In concluding; a clear reference to the meaning of child health has been built. The types of health issue and the effects it has on the child’s health and also the impact it has upon the family has been covered. The health issue and the treatment have been discussed. Policies and procedures have also been looked at and were made clear that some policies and reports aim to fight against cancer.
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