ABSTRACT
The development of the child’s concept of illness is determined by both cognitive maturation and experience of, or exposure to, illness (Bibace and Walsh, 1979). Children’s understanding of the causes of illness progresses through a series of stages which is, broadly speaking, consistent with Piaget’s theory of cognitive development. Prior to age 3 years, illness is defined by children in terms of a single symptom, and the cause of illness is understood to be remote. For example, a child may say that tummy aches are caused by the man on the television. Between 3 and 5 years children still conceive of illness in single-symptom terms, but use the concept of contagion to explain the aetiology of the diseases. So a 5-year-old may
explain that you catch measles if you go too near another child who has them. Magical thinking may also occur during this stage, and children may wonder if something that they did caused their illness or if the illness is a punishment for wrong doing. Such magical ideas may persist as a feature of children’s thinking into teenage years and, since they can cause unnecessary distress, deserve clinical exploration. With the transition that occurs between 5 and 7 years to concrete operational thinking, most children develop a more sophisticated idea about the symptomatology and aetiology of illness. Most illnesses are construed at this stage as entailing multiple symptoms and being caused by internal processes such as ingesting germs. So children at this stage begin to develop health-related behaviours such as washing their hands before eating to remove germs, or exercising to keep their body healthy. As children approach adolescence and the onset of formal operational thought, they can give detailed physiological explanations of illnesses. So an 11-year-old may say that lung cancer is caused by cells growing too quickly and this in turn is due to their being covered in tar from cigarette smoke. Teenagers can offer sophisticated psychophysiological explanations for the aetiology of illnesses. For example, a diabetic teenager may explain that his blood sugar level is affected by his diet, insulin intake, level of physical activity and stress level.
