Tarnow Articles

Pediatric Psychology: Self-Management for Children's Health

With the addition of new clinicians to our staff, The Tarnow Center for Self-Management is delighted to announce the launch of our new program in Pediatric Psychology. Consistent with our treatment philosophy of integrating the patient's biological, psychological, and social well being, the start of this program adds a new dimension of multidisciplinary care to the Center.

María, an active adolescent, has recently been diagnosed with diabetes and is having difficulty eating the right foods, taking her insulin, and monitoring her blood sugar. Max, who is 18-months old, has begun to eat less and less. As a result, he is very thin for his age and height and meal times at his home have become battles. Jenny, a precocious preschooler, has been prescribed a medication only available in pill form. She is frightened of swallowing something so large and refuses to take the medicine. Paul, who is an honors student in middle school, is having daily stomachaches. His father has consulted a pediatrician who can find no medical cause for his abdominal distress.

These cases all involve the care of physicians and mental health professionals working together. They require mental health professionals who are knowledgeable and aware of medical, developmental, and psychological issues and, particularly, of how these domains can influence and interact with each other. Many people are familiar with clinical child psychologists who are highly trained in studying and treating children using a psychosocial perspective. Pediatric psychology is a specialized field within clinical child psychology. A pediatric psychologist uses a psychosocial perspective but also has special training and expertise in health-related issues. They use this biopsychosocial orientation to treat or study the psychological aspects of medical illness. They explore the interrelationship between psychological and physical well being of children, adolescents and families. Pediatric psychologists work closely with pediatricians and other interdisciplinary professionals to provide empirically supported treatments to children and their families whose complicated medical problems have psychological and behavioral components. They help parents and families to encourage the child's competence and self-management skills within the context of their medical issues.

Medical advances in the past few decades have changed the face of medicine. Many illnesses that may have been considered acute and possibly fatal in the 1950's are now considered chronic, and require long-term adaptations in lifestyle. As a result, the need for medical and pediatric psychologists has increased. Chronic illness greatly challenges families. Parents often have a hard time determining how much to expect from their child. Limited financial resources, frequent visits to the hospital or doctor, caring for other siblings and family members, frequent school absences, and the fear of the unknown can cause severe stress for even the most well adjusted family. For example, when health problems cause a child to face an uncertain future, a parent may have trouble setting limits for the child. The child or siblings may respond to this uncertainty with anxiety or behavior difficulties. Pediatric psychologists often play a critical role in helping children with chronic medical conditions to adjust to their new condition. Pediatric psychologists also help the family adjust and plan for the long term by helping the child (and parents) grieve the loss of health, assisting them in understanding the illness and communicating clearly with their physician, and emphasizing the importance of keeping life as normal as possible for the child.

Illnesses such as diabetes, cystic fibrosis, and kidney disease all require a considerable degree of self-monitoring and self-care (such as pill taking, insulin shots, dialysis, or breathing treatments). Pediatric psychologists help children and adolescents who have difficulty adhering to prescribed medical regimens. For children and adolescents who are eager to have "normal" lives, adhering to medical treatments is not always easy; they do not always understand that compliance with the doctor's orders will help them remain as "normal" as possible. Sometimes anxiety about a procedure (such as swallowing a pill or taking a shot) or depression can interfere with medical adherence; in such a case, the psychologist deals with the underlying psychological needs prior to addressing the adherence. In many cases, we can encourage medical adherence and promote healthy behavior through patient education, modeling procedures, teaching of problem-solving skills, and supportive parental supervision.

Pediatric psychologists play an important role in the management of pain and distress. Psychologists can help with acute pain (such as an injection, a dressing change, or a lumbar puncture) or chronic pain (such as that seen in sickle cell disease, juvenile rheumatoid arthritis, migraines, or pancreatitis). Pediatric psychologists often work using a behavioral orientation and teach children, adolescents, and their parents techniques such as relaxation, hypnosis, distraction, positive self-talk, and reinterpreting the pain sensation. Pain management techniques help the child tolerate pain with less distress and pain medication. Increasing the child's control over the procedures as much as possible also helps the child take a more active role in the treatment. For some children, pain is an expression of psychological distress. For example, a child can experience sadness or anxiety as abdominal pain. Pediatric psychologists can help these children understand the relationship between their emotions and their experience of physical pain and find more adaptive ways to cope with these emotions.

Pediatric psychologists often work with young children who have feeding problems. Sometimes these feeding problems arise because some children have complications in early infancy, which required using a feeding tube. These children miss out on important eating learning experiences. Other children suffered from gastro esophageal reflux during infancy and learned that eating causes pain and other unpleasant sensations. Yet other children engage in power struggles with their parent over meals. In all of these cases, pediatric psychologists collect information on the feeding history, learn about the family's efforts to alleviate the problem, and assess the current status of the difficulty (often by observing the child eat a meal). From this extensive evaluation, they offer suggestions to make meals less of a struggle and more of a pleasant family activity.

Pediatric psychology is an extremely broad and diverse field. Its professionals work with pediatricians and families in assessing and treating a number of developmental, behavior, or emotional problems. Pediatric psychologists treat elimination disorders (includes soiling or wetting), habit disorders (such as hair pulling), sleep disturbances, posttraumatic stress disorder, child abuse, attention difficulties, and developmental disabilities. At the Tarnow Center we use the team approach to promote a physically and mentally healthy adaptation to medical illness and psychological symptoms. By working with children and families, pediatric psychologists help children like María, Max, Jenny, and Paul become competent self-managers of their health.

Pediatric Psychology Team:

Lourdes Valdes, Ph.D.
Dr. Valdes received her doctorate from the University of Pittsburgh and completed an internship and postdoctoral fellowship in Pediatric Psychology at Baylor College of Medicine and Texas Children's Hospital. She has extensive experience and expertise in working with infant feeding disorders, juvenile rheumatoid arthritis, lupus, cystic fibrosis, asthma, diabetes, renal failure, pain management, anxiety associated with medical procedures, and family adjustment to chronic illness.

Meredith Sargent, Ph.D.
Dr. Sargent has been on the staff at the Menninger Center for Learning Disabilities and has considerable experience treating young adults with traumatic brain injuries. She has particular expertise and interest in performing neuropsychological evaluations. Dr. Sargent also has experience with treatment for adolescent eating disorders. Her research interests are in the area of psychopathology and brain functioning.

Sophia Havasy, Ph.D.
Dr. Havasy has been working in the field of trauma resolution for over twenty years. She has special training in Eye Movement Desensitization and Reprocessing, a treatment technique for traumatic experiences.

Leslie Solomon, M.A., LPC
Ms. Solomon is a biofeedback specialist who has particular interest in the treatment of stress-related and psychophysiologic disorders such as anxiety, headaches, and migraines. Ms. Solomon has extensive training and experience in hypnosis and cognitive-behavioral techniques.

Jay Tarnow, M.D. - Medical Director
Dr. Tarnow headed the first Pediatric Psychiatry Consultation Liaison Program at Texas Children's Hospital. He is considered a national expert of childhood and family stress, as well as psychosomatic illness and he has been a consultant to the National Institute of Mental Health. Dr. Tarnow also worked with Dr. Hilda Bruch to start the Eating Disorders Program at Texas Children's Hospital twenty years ago.