Maintaining the Thread: Including Young Children with Chronic Illness in the Primary Classroom.

Introduction The importance of establishing positive attitudes and behaviours in the early school years cannot be overstressed. Maintaining a positive relationship within the school community, in spite of elevated absenteeism and interrupted school experiences, can ensure the child with a chronic illness has the same opportunities as his or her peers for equal educational outcomes. Acute childhood illnesses such as colds and flu briefly and frequently afflict all children; however, recovery from these illnesses is quite rapid. In contrast, chronic illness may have a prolonged recovery, or the illness may last a lifetime and require frequent medical attention and possible hospitalization. In this study, a chronic illness is defined as a condition which 'lasts for a considerable period of time or has a sequelae which persists for a substantial period and/or persists for more than three months in a year or necessitates a period of continuous hospitalisation for more than a month' (Thompson & Gustafson 1996, p.4). In a US-based study, Newacheck and Stoddard (1994) reported two per cent of the total child population had a severe chronic illness and a further three per cent had multiple chronic illnesses. In the Sydney region this means approximately 6,000 children between the ages of four to eight have a severe chronic illness, and a further 10,000 children have multiple chronic illnesses. The most commonly occurring childhood illnesses are respiratory illnesses--asthma and associated wheeze, ear infections, eczema and allergies, bowel troubles, severe headaches, heart disease, kidney disease, diabetes and epilepsy (Newacheck & Taylor, 1992). Incidence of chronic illness in young children is similar to that for older children (Waldman, 1994); however, the illnesses may vary. For example, there is a much higher incidence of ear infections, and diarrhoea/bowel trouble in younger children (under 10 years), whereas older children's (10-17 years) rates for illnesses such as severe headache, heart disease, respiratory allergies and arthritis are higher (Newacheck & Taylor, 1992). Australia has one of the highest prevalence patterns in the world for asthma. Asthma and wheeze have been estimated to occur in about 40 per cent of Australian children (Robertson et al., 1998). Rising rates have been shown for insulin-dependent diabetes mellitus (Kelly, Russell, Jones & Byrne, 1995), epilepsy (Epilepsy Association of NSW, 1999), neurological impairment and traumatic brain injury (Carter, 1993), and survivors of bacterial meningitis (Forkosch, 1996). Increasing child survival rates and advances in medical treatments and technology are permitting many children with chronic conditions to survive and live longer, increasing the numbers of young children with chronic illness that attend our child care centres, preschools and schools. For the majority of children, the impact of chronic illness is mild and places few restrictions on their lifestyle. However, for a reported 29 per cent of children with a chronic illness their illness bothers them often, and a much smaller group (five per cent) of children are constantly and severely affected by their illness (Newacheck & Taylor, 1992). This smaller group also accounts for much of the absenteeism reported among children with chronic illness. While technology and treatments can prolong life, many children with chronic illness live a lifestyle that is dramatically different from that of their peers at critical stages in their social and emotional development. Healthy peer relationships can help the child to deal with many of the stressors of life. Poor peer relationships and the accompanying lack of social support make children more vulnerable to other life stressors, and can directly result in increased absenteeism from school (DeRosier, Kuperschmidt & Patterson, 1994). …