Psychological and social stress in children with cleft lip and palate

UNLABELLED: The authors analyzed representative data on the increase of inborn developmental defects in Czechoslovakia; in 1970-1980 the increment was + 50%. Inborn developmental defects are studied from the psychiatric aspect as a stimulus causing a reaction of the family to the breakdown of their parenteral expectations of a healthy child and the problem of continuation of the family. The reaction of the mothers is usually post-partum depression and impaired development of attachment to the child. The handicapped child is stressed by operations, rehabilitation, the awareness of his own insufficiency and problems of parenteral attitudes. The authors investigated the family-history, development of the health status of the children, social status of the children and personality of mother and child. PRINCIPAL FINDINGS: children with cleft lip and palate suffer from social stigmatization and specific disorders of self-evaluation. In these children problems associated with adaptation in the child community, manifestations of depression, low self-esteem, impaired ego identity and a tendency of a negative attitude to the world were recorded. These phenomena increase with the severity of the damage and the visibility of the defect. If the mother bagatellizes or refutes the defect to achieve social desirability, the psychic position of the child is even worse. Approximately half the mothers and children expressed the need of special psychological care of problems associated with the defect. Actual areas are defined on which the need of care is focused in different stages of the family life cycle. The authors discuss the need of a realist attitude and acceptance of the defect in the interest of satisfactory adaptation, and the possibility of the paeditrician to assist families.