Child Development

CHRONIC ILLNESS

Chronic illnesses among children traditionally have
been defined based on a specific diagnosis. More re-
cently, chronic conditions are being defined along
several dimensions: they have a biological, psycholog-
ical, or cognitive basis; have lasted or are likely to last
at least one year; and result in limitations of function,
activities, or social roles, and/or dependence on medi-
cations, special diets, medical technology, assistive
devices, or personal assistance to compensate for
functional limitations, and/or require medical care or
related services. The impact of childhood chronic
health conditions on the child and the family vary,
even among children with the same diagnosis, de-
pending for example, on age of onset, whether the
condition is stable, whether it affects a child’s ability
to participate in normal childhood activities, whether
normal life expectancy is threatened. Major condi-
tions—asthma, spina bifida, craniofacial anomalies,
congenital heart disease, and sickle cell anemia—
require diverse medical, allied health, educational,
and supportive interventions.

See also: DEVELOPMENTAL DISABILITIES

Bibliography
Perrin, James. ‘‘Introduction.’’ In Nicholas Hobbs and James Per-
rin eds., Issues in the Care of Children with Chronic Illness. San
Francisco: Jossey-Bass, 1985.
Stein, Ruth, Laurie Bauman, Lauren Westbrook, Susan Coupey,
and Henry Ireys. ‘‘Framework for Identifying Children Who
Have Chronic Conditions: The Case for a New Definition.’’
The Journal of Pediatrics 122, no. 3 (1993):342–347.
Anita Farel

CHRONOLOGICAL AGE

Chronological age refers to the period that has
elapsed beginning with an individual’s birth and ex-
tending to any given point in time. Chronological age
is used in research and in test norm development as
a measure to group individuals. Developmental re-
search looks for age-related differences or behavior
changes as a function of age.

Using chronological age provides a means to
roughly assure the equivalence of such factors as
physical experience, social interaction, learning, and
acculturation among others. Chronological age is not
necessarily a predictor of an individual’s stages of de-
velopment, as the rate at which individual’s progress
through stages may not be identical. Problems in
using chronological age include such issues as school
readiness and the evaluation of premature infants. As
medical technology has advanced in the treatment of
premature infants, chronological age has been chal-

lenged as an appropriate measure for this group with

gestational age or durational pregnancy being pro-

posed as a means of adjusting chronological age.

See also: DEVELOPMENTAL NORMS; STAGES OF

DEVELOPMENT

Bibliography

du Toit, M. K. ‘‘A Life-Span Developmental Orientation: The Rele-

vance of Chronological Age in Life-Span Developmental Psy-

chology: A Theoretical Observation.’’ South African Journal of

Psychology 22 (1992):21–26

Kraemer, Helena, Anneliese Korner, and Shelley Horwitz. ‘‘A

Model for Assessing the Development of Preterm Infants as

a Function of Gestational, Conceptual, or Chronological

Age.’’ Developmental Psychology 21 (1985):806–812.

Kenneth F. McPherson

CIRCUMCISION

Circumcision in the United States refers to the remov-

al of foreskin from the glans (head) of the penis. This

is a surgical procedure, primarily performed in neo-

nates. Developmentally, the foreskin becomes retract-

able by three years of age. Neonatal circumcision is

safe, requiring only locally applied anesthesia. Com-

monly used devices are the Gomco and Mogen

clamps or Plastibell. These methods involve estima-

tion of the amount of foreskin to be removed, freeing

the inner layer of the foreskin from its attachment to

the glans, and control of bleeding. Circumcision is

considered an elective procedure, requiring parental

request and written consent. The decision regarding

circumcision includes consideration of cultural, reli-

gious, and ethnic traditions as well as the medical

risks and benefits. Controversy exists as to the relative

medical benefits of circumcision because of issues in-

volving urinary tract infections in infants under

twelve months old, sexually transmitted diseases

(STDs), HIV transmission, and penile cancer.

See also: MILESTONES OF DEVELOPMENT

Bibliography

American Academy of Pediatrics, Task Force on Circumcision.

‘‘Circumcision Policy Statement.’’ Pediatrics 103 (1999):686–

693.

Stang, Howard, Megan Gunnar, Leonard Snellman, et al. ‘‘Local

Anesthesia for Neonatal Circumcision.’’ Journal of the American

Medical Association 259 (1988):1507–1511.

Carol A. Miller

CLASS SIZE

Many studies have linked smaller class sizes in schools

to increased student achievement, yet this finding

CLASS SIZE 85