Growth and development.

A sthma is a reversible obstructive airway disease. It is the most common chronic health problem seen in children, occurring in approximately 3% of all children. As in the case of all chronic illnesses, asthma may cause or exacerbate stressors that affect both the child and the family. It is generally agreed that the cause of asthma is multifaceted and may include hereditary, allergic, psychologic, and infectious factors. Unfortunately many cases of asthma are resistant to medical treatment. Parents are usually expected to monitor the child’s illness and to implement the care prescribed. They are also expected to give emotional support to the child and to assume responsibility for the overall development of the child. The stress experienced by parents as they attempt to deal with their child’s asthma may result in parental dysfunction. Sometimes this stress may manifest itself by the parent’s inability to perceive the illness in an appropriate manner. Signs may include excessive worry. In other cases parents may withdraw from dealing with the child’s illness; they may even deny that there is an illness. In this case care givers may become aware of noncompliance with the treatment plan. As in other cases of illness in children, parents may become overanxious about their parenting ability. Even experienced parents, those who have other children, may have difficulty in making child-rearing decisions. When and how much to discipline the child may become too difficult for the parent to decide and to implement. Parents may begin to doubt their own ability to parent. Children become aware of this parental insecurity and may “act out” in trying to test or establish limits of acceptable behavior. What parents appear to fear most is that the child will have an asthmatic attack because their actions may have upset him or her. Parents are also concerned about the effect of medications on their child’s behavior. Will the child become sleepy or hyperactive? Will there be mood swings? In their efforts to attempt to control possible environmental irritants, parents may become overprotective of the child. If they believe that emotional stress triggers an asthmatic attack in their child, they may avoid any situations that might upset the child. This fear may be justified, because it has been shown that approximately 40% of asthmatic children get bronchospasms from crying (Weinstein, 1985). It has been found by Hahn and Clark (1967) and Mathe and Knapp (1971) that physiologically stress lowers airway conductance in patients with asthma compared with control groups. How to be a protective caring parent rather than an overprotective caring parent is not always an easy determination. Support systems influence the parents’ ability to effectively function. A stable relationship with trusted health care givers is important, as are good familial relationships. Self-management courses and peer groups have also proved to be supportive for effective parental coping. Parents tend to worry not only about the child but also about finances, absences from work, and school absences for the child, and about the ability of others such as baby sitters to care for the child (Schwam, 1987). Most health care givers acknowledge the powerful role of emotional factors in acute asthmatic episodes. However, an understanding of why emotions affect or precipitate asthmatic episodes is not clear. Many studies of emotional problems in