• Missing time at school

• Parental neglect of siblings

• Parents’ own problems at work

• Uncertain prognosis

20.4.4.2 Requirements

• Adaptation and organization of daily life in the family, at school and work

• Flexibility (e.g., when therapy is postponed at short notice)

• Clear and consistent attitude toward the sick child

• Involvement of siblings

• Time taken by parents for their own relationship and interests

20.4.4.3 Reactions

•Patient: regression, fears and phobias, social withdrawal, depression, disorders of self-worth and body image, refusal of therapy

•Parents: exhaustion, depression, anxieties, sleep disturbances, psychosomatic problems, conflicts within the relationship, concentration of attention on the sick child, neglect of the siblings

•Siblings: jealousy, guilt, forced independence, social isolation, failure at school, psychosomatic problems, hypochondria

20.4.4.4 Interventions

•Support for the understanding of therapy and willingness to cooperate

•Encouragement of responsibility

•Support for intrafamilial communication

•Reinforcement of individual and familial resources, and promotion of adaptation to the changes in family life caused by the disease and therapy

•Psychotherapeutic support if indicated

•Support of the parents in educational matters, with inclusion of sibling children

•Educational encouragement, contact with the patient’s school and possibly with siblings’ school(s)

•Other supportive measures (relaxation techniques, art and music therapy)

20.4.5 Surgical Intervention

20.4.5.1 Problems

•Fear of the intervention and the result

•Postoperative pain and complications

•Loss of physical integrity, mutilation

20.4.5.2 Requirements

•Adapting to fear and uncertainty before the intervention

•Dealing with physical change and impairment or disability

•Motivation in postoperative care (e.g., physiotherapy)

•Parental support of the child in coping with possible disablement