Physically Ill Child Resource Center

Physical illness can affect how the brain and body "talk to each other," leading to changes in a child or adolescent's mental health. Some illnesses and medical treatments can directly impact how the brain functions, how children respond to their environment, and process information. These changes can affect learning, communication, and self-care, and result in increased anxiety, mood changes, or confusion.  Physically ill children may feel overwhelmed, helpless, and bad about themselves. These thoughts and feelings may cause children to behave differently from how they usually do. 

Behavioral and emotional changes are common in physically ill children. Mental health is as important as physical health in a child's recovery and well-being. Changes in emotions and behaviors in physically ill children may be brief or long-term.

• Children may worry about their illness and be fearful of medical investigations, procedures, and treatments. 
• They can feel frustrated about the negative changes in their life due to the illness. These challenges lead to negative feelings about their health, body image, future, and relationships with others. 
• Anxiety and other negative emotions and thoughts can worsen appetite, sleep, pain, and energy. 
• Children may become more argumentative, disruptive, and oppositional, including refusal to cooperate with procedures or take medications 
• Children can develop depression, including low self-esteem, being more irritated, not caring as much as before, and losing interest in activities they used to enjoy. They may also have difficulties with schoolwork and a drop in their grades.

• Anxiety
• Depression
• Traumatic stress reactions such as Post-Traumatic Stress Disorder (PTSD)
• Angry or violent behaviors due to medical illness or medication effects
• Difficulties understanding and talking about their feelings
• Thoughts of self-harm or suicide
• Physical (somatic) symptoms that are not explained by medical/neurological illness or symptoms of a known illness.  These physical symptoms represent underlying emotional distress and may include seizure-like episodes, abnormal movements, muscle weakness, difficulty walking, changes in hearing and vision, sensations of pain, nausea, vomiting, dizziness, headaches, or shortness of breath.  Sometimes, these symptoms are diagnosed as Functional Neurological Symptom (Conversion) disorder.
• Delirium is a condition in which children experience confusion, difficulty with attention and concentration, agitation, sleep disturbance, and/or psychotic symptoms due to their illness or treatment. 

Consultation - Liaison psychiatry (C-L) is a medical specialty where mental health clinicians provide psychiatric assessment and treatment recommendations for children with physical illnesses. CL psychiatrists often lead a multidisciplinary team of mental health professionals.  The team may include psychiatrists, psychologists, social workers, and advanced practice nurses. 

• The C-L Psychiatry team will review your child's medical chart and discuss the patient's medical evaluation and treatment with the primary medical team to clarify the consult question.  
• The mental health professional first meets, when possible, with the parents to clarify the consultation goals and obtain background information.
• The mental health professional meets with the patient to conduct a confidential, thorough review of emotional, behavioral, and cognitive symptoms, including the patient’s social environment, personal strengths, and difficulties.
• With the caregiver’s permission, the mental health professional may obtain collateral information from your child's other providers (e.g. teachers, therapists, outpatient clinicians) to have a better understanding of your child's issues and to help coordinate their care. 
• The C-L Psychiatry team identifies a psychiatric diagnosis and provides mental health treatment recommendations. During hospitalization, treatment options may include education on symptoms and diagnosis, brief individual and family psychotherapy, environmental changes, behavioral modification, psychiatric medications, or a combination of these treatment strategies.
  • Behavioral therapy supports you and your child during hospitalization and treatment. It may include specific behavioral strategies to improve your child's ability to take medications, participate in evaluation and treatment, and build coping techniques to reduce symptoms of anxiety related to pain and medical procedures.
  • Psychiatric medications may help with symptoms of mental health illness (e.g., depression, anxiety, acute agitation), physical illness (e.g., insomnia, pain, nausea), or both. 
• The C-L team gives recommendations about additional supports if your child develops worsening symptoms of psychiatric illness or concerns regarding their safety, including suicidal thoughts or behaviors.
• The C-L teams assists in planning post-discharge outpatient mental health services, transition back to home, school, and other regular daily activities.