Explaining Asthma to a Child
Learning self-help skills is the best way to manage your asthma. Even young children can learn to manage some aspect of their care, and the earlier they feel they have some control the better. Piaget described the Theory of Intellectual Development based on four levels of development which we can use to help children learn about asthma.
During this period, learning is attained through sensation. Infants learn through simple, repetitive behavior and by imitation. Cause and effect by trial and error are the tools used to learn and reinforce behavior. If a child learns that if he fights hard enough or cries loud enough that Mom and Dad will stop the nebulizer treatment or not give it, the behavior is reinforced. If, however, the treatment is given when needed regardless of the behavior, most children will learn to cooperate. During the Sensory Motor Stage, object permanence is developed (the concept that even when out of sight, objects still exist). Object permanence is the prerequisite for all other mental activity.
During this time, the child is very egocentric. They are unable to “put themselves in another’s place” and see situations only as they relate to themselves. Everything is interpreted by how it relates to them. They cannot see things from any perspective other than their own and do not see any reason to do so. Reason beyond what is observable is not possible. Visual models are very helpful at the upper levels of this stage. Seeing the muscles around the airways and what inflammation looks like is very helpful. Recognizing that play is easier after treatment can help them cooperate with their care. Allowing older children to feel some control (do you want to do your medications before this story or after?) also helps.
In this stage, thought becomes increasingly logical and coherent. These children are able to classify, sort, order, and organize, but they cannot deal in abstraction. They must solve problems in a concrete, systematic fashion based upon what information they can perceive. They can classify their asthma medications in this stage (relievers or controllers), use peak flow meters and spirometric readings to support changes in lung function and develop the ability to use their asthma action plans. They can understand how to work their asthma skills into their morning routine instead of doing everything right before running out of the house. At this age, relating new concepts to ones already established can increase positive outcomes (we use fluoride to prevent cavities, we use controller medications to prevent asthma exacerbations). Also, tying new activities (taking controller medications) to already established activities (brushing our teeth morning and evening) can make the new activity part of the old one. Tying a MDI to the toothbrush for a few weeks so that every time they pick up the toothbrush, they are reminded of the inhaler is an example.
At this stage, learning is no longer restricted to the real or actual. Children in this stage are concerned with future possibilities and can understand the consequences of their actions. (This doesn’t mean that they will do what is asked, only that they understand the consequences of such acts.) They can detect logical consistencies that all members of the health care team give the same information and instructions.
Understanding what developmental level your child is can help you in explaining asthma to your child, reduce your frustration, and give you reasonable expectations about what responsibilities your child is able to assume in the daily management of his /her asthma.
Based on article by Christine W. Wagner, MSN,RN,CPNP
Adolescents display abstract thinking and can conceptualize events that have never been experienced. Acceptance from peers becomes more important than acceptance from adults, and they begin declaring their independence by testing rules and boundaries. Adolescents believe in an imaginary audience and personal fable . The imaginary audience reflects the adolescents belief that the whole world is focused on them. The personal fable reflects the adolescents belief that they are so special and unique no one else could possibly understand what they are going through. They are risk-takers and are unable to appreciate the consequences of not adhering to their asthma management plan, especially when it comes to long-term control medications.