Immigrants into society. Children with craniofacial anomalies

Some of the adaptive coping styles of children with craniofacial anomalies are discussed. Three cases of children with microtia are described to illustrate developmental pathways used in adapting to their deformities. The complexity of the chronic medical and psychological challenges these children face is illustrated and discussed. In contrast to previous frameworks dealing with the problems of deviance and stigmatization, we use a psychological historical framework, drawing an analogy to Handlin's work on immigration. These children are born into a world that considers them strange and abhorent. They can be considered aliens entering a society of normal, non-disfigured people. The craniofacial center is conceptualized as a "naturalization" office where highly valued health care professionals are counted upon to reconstruct facial appearance and function. An enduring attachment and bonding process to the staff takes place, and the center becomes of considerable importance to the craniofacial patient's identity. The craniofacial patient often has to carry the pain of social isolation and stigma. Physicians caring for these children should be cognizant of their coping styles; so that development can be directed to move away from deviance to successful "immigration into the country of normals" and adaptation to life.