Adolescence can be a stressful developmental time, even for healthy teens. Acute or chronic illness can cause added concerns with how a teen develops.

Health issues, treatment, hospital stays and surgery can:

• Lead to more intense concerns about how they look
• Interfere with the process of gaining independence
• Disrupt changing relationships with parents and friends

Developmental issues can also complicate a teen's transition toward becoming responsible for managing their illness and learning to comply with treatment.

Developmental Complications

Teens who are faced with acute or chronic illness are likely to have more concerns and fears when their illness or healthcare needs conflict with these normal teen issues:

Body Image Issues

It is normal for teens to be focused on the changes in their bodies. Chronic illness can make these concerns worse. Teens may have fears or distortions linked to their illness (such as fearing a surgery scar will make them less attractive or not able to wear certain clothes). It may help to have teens:

• Share concerns about their body and how their illness or treatment may affect their body
• Talk about possible physical effects of medicine and treatment with their doctor
• Discuss ways to reduce or cope with the effects

Developing Independence

Chronic illness often gets in the way of a teen’s comfort in becoming less dependent on their parents. Also, parents of a teen with a chronic illness often resist the teen’s efforts to be independent. Some ways to address the conflict between normal development of independence and meeting healthcare needs are to:

• Involve teens in healthcare discussions (concerns about their illness, treatment choices)
• Teach them self-care skills for their illness (this should start before the teen years if possible)
• Teach them to track and manage their own treatment needs as much as they can
• Help them build coping skills to address problems or concerns linked to their illness. Talking with other teens with like illness, healthcare providers, or seeking other professional support may be helpful.

Relationships with Peers

Chronic illness and treatment often interfere with time spent with peers. They also affect time spent in school (the teen’s main social setting). This may make self-esteem issues worse. To address these concerns, help teens:

• Spend time with friends as much as possible
• Plan what to share with friends and how to share that information
• Find ways to respond if teased by peers
• Learn to see humor in the situation (in terms of both illness and interaction)
• Foster friendships that provide support

Non-compliance with Medical Treatment

As teens with chronic illness learn more about their illness and start to be responsible for its management, they may attempt to make their own decisions about their health needs. Often, a teen may change the way they take their medicine without talking to their doctor first.

While this may be normal teen behavior, it may create the need for more healthcare measures. Angry or self-conscious feelings linked to having a chronic illness, or poor judgment in how to cope with their feelings about their illness, can make teens less likely to follow the advice of the healthcare team.

It is vital for parents and the healthcare team to help teens foster healthy ways of living with and managing their chronic illness. To help teens deal with this:

• Encourage them to share their ideas and concerns with the healthcare team.
• When chronic illness becomes unstable because they did not follow their treatment, talk with the teen about what happened. Don’t scold them. Teach and foster the use of problem-solving skills related to their illness. Ask questions such as: "What do you think you would you do if ...?" or "What do you think would happen if ...?" or "What would make it easier for you to ...?" Encourage teens to ask you the same kinds of questions.
• Seek mental health services when:
  • A teen seems overwhelmed with emotional issues linked to living with a chronic illness
  • A pattern of not following treatment continues
  • Development regresses, overly dependent behavior carries on, and / or the teen withdraws from or gives up interest in normal activities for their age