Atopic dermatitis is among the most common conditions that Jaquez sees in her practice.
“The skin is the first thing that many people see, and a lot of these kids with AD will go to great lengths to try and hide their skin. We’re in Texas where it’s 100 degrees, and I will see kids who are coming in with long-sleeved shirts and pants on because they don’t want their skin exposed for other people,” Jaquez says.
Helping kids accept their skin
Jaquez says she helps pediatric patients with AD to accept their skin. “I talk with kids all the time about how their skin is just different. It’s not that it’s bad. So, we practice how they can tell other people that,” she says. “Other children often are afraid to play with children that have AD because they’re afraid that it’s going to be contagious. So, we practice with the child and also the parent about how to educate others about what it is and that it’s not contagious.”
Jaquez also works with children and families to find things that they’re able to do and enjoy doing and encourages them to do those things. “If they’re able to accept their skin condition and that it’s going to ebb and flow in terms of flares, then we can find time that they’re able to do the things they enjoy doing,” she says.
Part of the work involves overcoming perceived barriers. If a child who likes to swim doesn’t think he or she can swim in public anymore, Jaquez will work with the child and family to find a way that the child can safely swim, without putting them in a situation where people are going to judge them for the way that their skin looks.
Atopic dermatitis may not be a life-threatening condition, but it is chronic and visible. It’s important, Jaquez says, that pediatricians don’t ignore the stress a chronic condition can put on the child and family.
“One of my biggest messages to pediatricians is to be aware that this is really difficult stuff and that it’s OK for a family to need extra support,” she says.
Jaquez recommends that pediatricians have a psychologist on their team—onsite or as a referral source. If the psychologist is onsite, pediatricians should consider introducing the psychologist to the eczema patient and family early on, before they need or access mental support. That way, the patient and family know the psychologist and might feel more comfortable accessing the provider when they do need help, she says.
When to consider referring
Pediatricians should consider referring AD patients to pediatric psychologists when pediatricians are concerned with patients’ mood, anxiety, or adherence to treatment.
“There’s a lot that patients have to do every day for their skin. I’ve talked to a number of patients where the doctor will tell me one medical regimen and I’ll check in with the family and they have heard it in a different way. Sometimes it’s just a matter of getting everybody on the same page and making sure they understand what they’re supposed to be doing,” Jaquez says. “I think if pediatricians are feeling frustrated with patients, that’s also a good time to make a referral because that means something is going on—even if they’re not able to pinpoint what that is.”
It’s important to keep in mind that parents might need psychologic support, too.
Researchers reported in a paper published in 2016 that AD in a child may lead to exhaustion, emotional distress, and depressive symptoms in parents.5 Identifying children with AD and their parents who need psychologic help may help to reduce emotional problems in these children and families, they wrote.
Helping to destigmatize mental health
A big takeaway for pediatricians is that they should help to destigmatize mental health by helping families understand that AD and other diseases are stressful, and that just because there’s a referral to Psychology doesn’t mean that there’s a larger concern about mental health. Rather, they’re simply in a stressful situation, so it’s OK to have Psychology involved.
“Families fear what it means when they’re getting a referral to Psychology and can be very resistant to that. It helps when pediatricians talk about Psychology as part of the team versus ‘You’re getting a referral to Psychology,’ which often can have negative connotations,” Jaquez says. “Working together as a team we’re kind of able to peel away their layers and work toward healing the whole person.”
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2. Halvorsen JA, Lien L, Dalgard F, Bjertness E, Stern RS. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Invest Dermatol. 2014;134(7)1847-1854.
3. Magin P, Adams J, Heading G, Pond D, Smith W. Experiences of appearance‐related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study. Scand J Caring Sci, 2008;22(3):430-436.
4. Vivar KL, Kruse L. The impact of pediatric skin disease on self-esteem. Int J Womens Dermatol. 2017;4(1):27-31.
5. Chernyshov PV. Stigmatization and self-perception in children with atopic dermatitis. Clin Cosmet Investig Dermatol. 2016;9:159-166.