A child has a "spiritual life that grows, changes, responds constantly to other lives that, in their sum, make up the individual we call by a name and know by a story that is all his, all hers.”
– Coles (1990:308)
In pediatric literature, the recognition of spirituality and religion more frequently addresses the parents’ viewpoints and much less attention has been given to the spirituality and religion of the child as patient or child as family member of a patient.
Note: At present, the preponderance of research related to spirituality and religion has been conducted from a Judeo-Christian perspective. Thus results report on issues related to God as understood within those religious traditions. Information reported in the following sections uses the terms that were used in the research cited. The concepts, however, may be considered in exploring the issues with children and families from other traditions that have different views of deities or transcendent beings or forces. Healthcare providers can take their cues from the patient or family members as to which term regarding the divine or supernatural or transcendent is most meaningful and use that term when speaking with them.
The interrelationship of spirituality, religion and health (including mental health) is already a complex issue. However, with children, it is further compounded by the overlaying factor of the developmental stage of the child. Carson (1989b:24-51) provides an explanation of spiritual development during different stages in a person’s life, beginning with infancy and Heilferty (2004) describes infancy through adolescence. As a child moves through developmental stages, concepts of right and wrong, good and evil, and guilt develop. For many, an image of God is formed and a personal relationship with a spiritual being may develop. A child may fear that openly questioning spiritual or religious beliefs that he/she has been taught will be viewed negatively by family members.
Studies often raised more questions rather than provide definitive answers when it comes to recognizing or defining the role of spirituality and religion and health and mental health in children (Pehler 1997). Many studies use Piaget’s stages of cognitive development in relation to what a child believes to be the cause of illness (Pehler 1997).
For a school-aged child, questions related to spirituality and religion may be very specific (Heilferty 2004). Research shows that children tend to attribute the cause of illness to internal factors more often than adults do (Pehler 1997). Blaming themselves may be a coping strategy that allows a child to feel that he/she has more control over an illness (Mickalide 1986).
However, some research also demonstrates that children who were able to associate their illness with external factors showed more signs of positive coping strategies (Pehler 1997). A report by the Foundation for Child Development studied the changes in child well-being among African-American, Hispanic, and White children from 1985-2004.
Gaps have narrowed, but still persist, with the overall well-being below levels that previously existed in the U.S. and below that of their international peers. Compared to White children, advantages were noted for African-American and Hispanic children in the “emotional/spiritual” domain, reflecting a potential resource of support for children and their families.
Heilferty (2004) lists resources for parents and for providers who assist with spiritual care for the dying child. Barnes et al. (2000:903) and Smith and McSherry (2004) present general guidelines or recommendations for integrating spirituality and religion into pediatric practice.
To identify a few of these suggestions, but not a complete list - Providers are encouraged to have a clear sense of their own spiritual and religious perspective; to be aware of the need to address this topic even in pediatric care; to have a general knowledge of world religions, but encourage the family and the child to provide the specifics of their beliefs; to use a non-judgmental approach; to build a network of consultants; and “to listen for understanding rather than for agreement or disagreement” (Barnes et al.).
