Handbook of Psychology

440 Child Health Psychology

including the fact that most children cannot consent for med-
ical care independently. The theory highlights reciprocity and
change in the course of development and rests on relation-
ships and opportunities that unfold in the interactions of the
child and his or her social ecology. Development also implies
change over time and reinforces the importance of viewing
the experience of children and families as ”uid, under going
many transitions over time.
At the time of a child•s health crisis, other circles and sys-
tems within the social ecology are added, activated, or
changed. The family remains the primary system, but school,
peer groups, neighbors, and work systems are critically im-
portant and impacted. Additionally, families must make ini-
tial, essential treatment decisions while under stress and in
the midst of forming new partnerships with health care
providers. Health care systems may have been relatively in-
signi“cant in the life of some families prior to the onset of an
illness (e.g., a three-year-old with leukemia who had primar-
ily well child care previously). Other families may have in-
volved histories with health care (e.g., another ill child or
other family member/s with chronic illness) and now forge
new relationships with memories of prior experiences color-
ing these collaborations.
Not only are relationships embedded in the social ecology,
but beliefs of the child, family, and health care providers are
as well. These beliefs are in”uenced tremendously by cul-
tures• and subcultures• views on illness and pain. At diagno-
sis, children have beliefs about going to the hospital (•The
needle is going to hurt,Ž •I don•t want my parents to leave
me.Ž) as do their parents (•Who can I trust?Ž •We will get all

the answers from the doctors.Ž) Children and families have

beliefs about childhood illnesses (•This cannot really be

diabetes. I feel “ne,Ž •Cancer is a death sentence,Ž •Cancer

can be cured,Ž •We are being punished,Ž •Pain is not a big

problem,Ž •Be strong. Don•t ask for help,Ž •Pray.Ž) Health

care providers have beliefs about patients, families, illnesses,

treatments, and outcomes (•This is a •good• family,Ž •These

people are crazy,Ž •This treatment will work. If it doesn•t, we

have another. And another.Ž)

Thus, social ecology theory provides a useful framework

not only for understanding illness but also for guiding inter-

ventions that promote competence and positive developmen-

tal outcomes. Although the importance of viewing the child

within the context of the family is widely accepted, many in-

terventions do not systematically include families. The ma-

jority of interventions (and prevention efforts) have focused

on the child in isolation. Moreover, few interventions for

children with chronic illness have targeted the outer circles,

beyond but in interaction with the child and family.

Assumption 2

Pediatric psychology provides an umbrella under which

child health can be summarized and integrated.While not

the only professional framework to inform the “eld of child

health, pediatric psychology offers a perspective consistent

with the themes of this chapter. From the masthead of the

Journal of Pediatric Psychology(JPP), pediatric psychology

is de“ned as follows:

Pediatric psychology is an interdisciplinary “eld addressing

physical, cognitive, social and emotional functioning and devel-

opment as they relate to health and illness issues in children, ado-

lescents, and families... exploring the interrelationship between

psychological and physical well-being of children, adolescents

and families, including: psychosocial and developmental factors

contributing to the etiology, course, treatment and outcome of

pediatric conditions; assessment and treatment of behavioral and

emotional concomitants of disease, illness, and developmental

disorder; the role of psychology in health care settings; behav-

ioral aspects of pediatric medicine; the promotions of health and

health-related behaviors; the prevention of illness and injury

among children and youth; and issues related to the training of

pediatric psychologists.

Building on the theme of a marriage between pediatrics

and psychology (Kagan, 1965), Wright (1967) wrote that the

offspring of such a marriage would be the psychological pe-

diatrician and the pediatric psychologist. Although clinical

psychologists had been working with pediatricians for some

time, these visionary writings set the stage for the birth of a

EXOSYSTEMS

MESOSYSTEMS

MICROSYSTEMS

Sibs Family

Parents Illness

CHILD

Neighborhoods

Hospitals

Staff

Peers

Schools

Cultures

Parents•

social

networks

Social

class

Law

Religion

Technology

Figure 19.1 Social ecology theory.