Table 3.

Psychological management plan for children with chronic kidney disease and their families

Intervention with the child
	Psycho-education. When therapeutic work is done with a younger child, often modelling is used. The care provider may, for example, educate a doll about the doll’s problems and how thinking affects behavior. In this manner, the care provider may teach skills and alternative behaviors.
	Self-care skills related to their illness include taking medicine following a proper daily routine, self-monitoring calendar or using alarm clocks or a checklist or sticker charts for young children and the importance of diet. Involve older children in health-related discussions (concerns about illness, treatments).
	Relaxation skills training such as controlled breathing and muscle relaxation exercises as stressful events can increase physiological arousal and maintain or exacerbate symptoms.
	Cognitive coping strategies such as distraction techniques, positive self-talk (can use storybooks in young children) help children manage their pain and other problems.
	Cognitive restructuring to help children replace maladaptive thoughts with more adaptive and productive thoughts.
	Group interventions allow children to share their experiences and challenges, help other sick children, learn problem-solving, increase self-confidence and self-efficacy, and facilitate a healthy adjustment to one’s illness.
	School readjustments
		- Attending school for shortened periods.
		- May benefit from tuition or attending a temporary classroom aid to assist them in learning concepts they may not have learned.
		- Identify a peer who can be a ‘buddy’ to support the child reintegrating into the classroom’s social networks.
		- Provide medical information to the teacher.
Family intervention
Parents
	Connecting a parent with another parent who visits the medical team.
	Help support parents in balancing their responsibilities as a caregiver and in their personal lives.
	Parent training program. Reduce dysfunctional parenting styles, improve communication patterns, increase parental self-efficacy and decrease parenting stress, promote parent-child support for autonomy, reinforce positive behaviors.
	Practical guidance and assistance regarding transport, financial management, and child’s school reintegration.
Siblings
	Psycho-education about chronic diseases.
	Brief involvement in counseling sessions may assist a child in dealing with his or her feelings related to the troubles and pain his or her sibling is facing.
	Support groups for siblings may help them cope with grief and trauma related to a brother or sister’s illness.