Normalization Strategies of Children With Asthma

Asthma rates have increased dramatically in the past 40 years.  12% of Canadian children now live with this chronic disease. Chronic asthma can psychologically affect children.  Children have reported having feelings of  anger, fear, frustration, guilt, loneliness and anxiety. Exploring one’s self-identity is an important task of early adolescence. Children want to be considered “normal”, and be treated by their peers as such.  Living with a chronic illness may affect how children view themselves and their health.

Research Question: How do older children and adolescents perceive living with a chronic illness?  What strategies do they use to help them cope with asthma and “feel normal”?

Researchers interviewed 22 boys and girls 11 years of age. 7 children had mild asthma, 9 had moderate asthma and 6 had severe asthma. Questions were designed to have kids describe their experiences of living with asthma and compare their health to that of their peers.  Children were also asked how they would describe asthma to a friend who had been recently diagnosed?

Findings:

• All children but one acknowledged that asthma had an impact on their  life at least some times and to varying degrees.
• Children describe asthma attacks as painful, “it takes your breath away”, affecting their ability to complete or participate in an event.
• Asthma also affects children emotionally. Some girls said that asthma made them feel different or weird and that asthma was scary. One boy felt that asthma prevented him from getting good marks in gym which made him feel horrible.  
• Asthma sometimes stops children from doing what other kids can do.  These feelings were  motivation for developing strategies to minimize the impact and normalize their life.

What do children do to “normalize” asthma?

• 16 children saw their health as just the same and pretty good.
• 6 children saw their health as all right, but not perfect, due to asthma attacks.
• Many emphasized their abilities and minimized their differences.
• All mention wheezing and coughing but then tend to say “it’s really not that hard to live with” – children look at the activities they can and do take part in rather than those they don’t.
• Children take pride in participating in all activities, at time finding ways to adapt their participation (playing goal).
• Children don't necessariy change their activities but may decrease their physical exertion during an activity.
• All view medications as an important part of managing asthma and permitting participation in activities. 

Conclusion: Children with asthma see themselves as different but develop normalization strategies to fit in with their peers. Children see the use of medication as a means of achieving normalcy.

Understanding a young’s person’s desire to integrate with peers and live as normally as possible could help provide a more holistic dimension to care.  Also asking questions about normalization strategies may help uncover true asthma control.  The desire to keep up with peers may be a way to motivate a young person to follow measures required to maintain asthma control.

Normalization strategies of children with asthma. Protudjer JL, Kozyrskyj AL, Becker AB, Marchessault G. Qual Health Res. 2009 Jan;19(1):94-104. Epub 2008 Nov 7.

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