[The child with a chronic disease at school-age]

Advances in medical treatment have led to an increase survival of children suffering from severe diseases. Often times, these children will develop a chronic disorder thereafter. The care of these children and families is a challenging task for primary care providers. Children with chronic disorders may manifest medical complications, but may also face psychosocial and neurodevelopmental sequelae. Psychological maladjustment may occur independent of the underlying medical condition and quality of life can be impaired. Interestingly, quality of life is better if rated by the children themselves than if judged by their parents. Obviously, children with a chronic condition of the central nervous system have a high prevalence of neurodevelopmental problems. However, neurodevelopmental problems may also occur frequently in children at risk for developmental sequelae. Among those are children born before 32. weeks of gestation, those after perinatal asphyxia and children with a severe congenital heart defect. The prevalence of these three conditions is equally high at around 1 in 100 newborns. All three groups may face mild neurodevelopmental problems, which typically present at school-age. Problems may constitute of motor and intellectual difficulties and specific deficits in visuomotor and executive functions and often occur in combination. It is therefore of outmost importance that aside from regular specialized neurodevelopmental follow-up visits, these children are being followed closely by their primary care provider to early assess psychosocial and neurodevelopmental difficulties. These need to be evaluated and treated in association with other health care specialists.