Anxiety in Children with Chronic Medical Illness

Anxiety symptoms are common in chronically medically ill children and can have unique issues which make their management complex. Anxiety can precede the medical illness, be a consequence of the illness, or the two conditions may coexist with no clear chain of causality. As illustrative examples, certain medical conditions particularly notable for their relationship to anxiety are discussed in greater detail. These include asthma, headache, inflammatory bowel disease, other forms of gastrointestinal illness like irritable bowel syndrome, and cancer. For each of these conditions we discuss the impact of preexisting anxiety as well as how (psychologically and biologically) these illnesses can lead to anxiety. Psychotropic medication, psychotherapy, psychoeducation, family therapy, group therapy, and improved psychosocial supports are all options for management and have varying roles depending upon the particular medical and psychological concerns of a given patient. Addressing this anxiety is critical, as evidence has shown that increased levels of anxiety in the child and in their family can lower health-related quality of life, interfere with effective family functioning, and at times even biologically worsen the course of the illness itself.