An aspect of the Center for
written by: Maritta H.
I attest that the following
report is a product of my own original work.
Anemia and Sickle Cell
Disease are an abnormal blood disorder most commonly found in the
American population. It is hereditary
and has a high mortality rate among children in the first five years of
lives. Fifty thousand African Americans
suffer from this disorder, and only one out of every 375 African
children can be affected. There are
complications such as chronic pain, multiple organ damage, and fatigue. Children in school have a hard time with
attention, and concentration. They also
have physical limitations due to the most common symptom, chronic pain,
causes them to be absent from school.
Treatment is hard to receive because of the low
socioeconomic status of
the child, and not having insurance that covers treatment.
Treatment of Sickle Cell is managed by
medical regimens, and depending on the severity of the symptoms, can
lead to a
child being hospitalized.
SICKLE CELL ANEMIA
Sickle Cell Anemia is a blood disorder in which red
blood cells are
affected, making them abnormal. As cited
in K. D. Scott & A. A. Scott (1999), Sickle Cell Anemia is rated
common genetic disease in the United States (Behram &
Vaughn, 1983), and is
most common among the African American population (Carter,1983; Nash,
Powars, Overturf, and Weiss, 1981).
Adults carrying the Sickle Cell trait can pass the
trait on to their
children at birth. The newborn child can
inherit the Sickle Cell trait or just Sickle Cell Anemia.
As cited in K. D. Scott & A. A. Scott
(1999), Sickle Cell Anemia is more of a chronic type of anemia, where
Sickle Cell trait is more of a mutation of the hemoglobin (Francis
Johnson, 1991). However, a high
mortality rate exists in the first five years of a child’s life
& Stowe, 1991).
CHARACTERISTICS OF SICKLE CELL ANEMIA
Sickle Cell Anemia can manifest itself in both males
and females. Although Sickle Cell Anemia
is most dominant
in the African American population, no information was found isolating
Cell Anemia to one race. As cited in V.
E. Maikler, M. E. Broome, P. Bailey, & G. Lea (2001), one out of
African American children are affected by Sickle Cell disease, and over
African Americans suffer from this disease (Agency For Health Care
Research). As with any other
disorder/disease, there are many complications to having Sickle Cell
<> As cited in K.
D. Scott & A. A. Scott (1999), Sickle Cell Anemia can
be traced to changes in the
way the red blood cells are made up (Wang et al.,
1993). These abnormal >red blood cells
forms, such as being sickled, rigid, or elongated.
When the red blood cells take on these
they become trapped in the blood vessels and block the flow of
This process is called
hypoxia, and can cause a variety of difficulties to take place. These difficulties
can be fatigue, damage to
multiple organ systems, such as the liver and spleen, heart, lungs,
and causing chronic pain (Carter, 1983; Whitten, 1992).
For example, when the spleen is affected,
jaundice becomes more visible. Sickle
Cell can also contribute to infectious diseases, such as
urinary tract infections.
As cited in K. D. Scott & A. A. Scott (1999),
there is an infectious
disease that is detrimental to a
This disease is called Sepsis, and can lead to death
in the first three
to five years of a
child’s life (Berg, 1994).
A child’s central nervous system is also affected by
the abnormal red
cells, which can cause the child to have a stroke.
Strokes can affect motor, intellectual, and
impairments from which a child can either recover or die.
Vision can also be affected, as well as
from seizures. However, the most common
symptom of Sickle Cell Anemia is the chronic
continuous pain, and physical
limitations of the child due to having frail bone structure. These
symptoms can affect adolescent children
as well. Adolescent children will have
sustained attention and academic achievement. Children
with Sickle Cell Anemia will also
complications with cognitive and psychological problems, and delays in
>such as learning to walk. Their lives are greatly
impacted by the Sickle Cell disease. They spend
most of their time isolated from their peers, as well as their school,
due to the effects that Sickle
Cell has on the body. This has an impact on their social skills,
which are poor, and on their self-
image. Most children who suffer from Sickle Cell Anemia come from
low socioeconomic families,
and do not have insurance.
L. Nettles’ (1994) research
on the scholastic performance of children with the Sickle Cell
As cited in A. L. Nettles (1994),
is very important to have when you are a child
that has Sickle Cell disease.
children with Sickle Cell Anemia,
have difficulties with their
Their absenteeism was thought to be an indicator as
to why they were
with their academic achievement (Vaughn & Cooke, 1979;
Whitten & Nishiura, 1985; Williams,
Earles, & Pack, 1983).
found that absenteeism does play
a part in their academic
constant absence at school affects not only their academic achievement,
factor is the child’s socioeconomic status, especially, if their status
Children of a higher socioeconomic
status score higher on intelligence tests than children of lower
These children have learning
deficits in reading and spelling skills, making them
feel less competent and
accepted by their peers in school.
attend regular classes unless their
disease has affected them in such a way
that they need assistance with their schoolwork.
placed in a special education
Girls seem to perform much
higher than boys, in their
academic achievement (Farber et al., 1985).
In another study the focus is on the social
children with cancer, or children with
Sickle Cell Anemia, and their peers at
Teachers were to observe
children with cancer, brain
tumors, and Sickle Cell disease, and rate them on
their social skills with their classmates.
was on the children that were between 8 and 15 years of
The age of 8 is when a child’s
illness, race, gender, and closest to their date of birth (Noll R.,
LeRoy S. S., Bukowski W. M., Davies
W. H. et al., 1991).
Their match was
a child who did not have a
The teachers were
to assess the children and fill out the Revised Class Play (RCP)
This tool is used
measuring a child’s social reputation, and focuses on the roles that
takes while interacting
with their peers.
First, is the socialbility leadership role where
everyone likes the
Second, is the
aggressive-disruptive role where the child displays bullying behavior
picking on his peers, or is
Third, is the sensitive-isolated role where the
child is always sad, and
is not included in any
activities with his/her peers (Masten, A. S., Morison,
P., Pellegrini, D. S., 1985; Morison, P., Masten,
A. S., 1991; Rubin, K. D.,
Cohen, J. S., 1986).
roles were added to the (RCP)
assessment for measurement by the teachers.
roles focus on the chronic illnesses of
The teachers rated the
children on how often they get sick, how often they miss school, and
exhausted they become.
teachers conducted the Revised Class Play
assessment for elementary school
children, English teachers conducted the (RCP) assessment for
The results of the teachers ratings found that the
children with cancer
were rated higher in their
socialbility-leadership roles, and lower in their
There was no
sensitive isolated role between the children with cancer and the
children with brain
tumors, who were survivors, were rated high by the teachers in the
sensitive-disruptive roles of the children with brain tumors, and the
without brain tumors.
There were no
differences in the roles for the children with Sickle Cell disease.
Althought, they were
rated low on the
children with brain tumors, and cancer were not
rated by their teachers as
being exhausted, even though these children were receiving chemotherapy.
The children with Sickle Cell disease were
rated as always being exhausted.
cited in B. S.
Shapiro, D. F. Dinges, E. C. Orne, N. Bauer, et al., (1994), the
pain related to Sickle Cell disease is
reported to affect girls more so than
TREATMENT ISSUES RELATING TO THE CLASSROOM
There is not a lot of information about treatment
issues of Sickle Cell
disease in the Classroom, the focus is geared more toward how Sickle
disease is treated, and how the effects of the treatment affect the
child. What we do know is that chronic
pain is the
most common effect on the body of a child with Sickle Cell disease. As cited in L. P. Barakat, K. Smith-Whitley,
& K. Ohene-Frempong (2002), this chronic pain can cause poor
school if not treated. A child may have
to visit the emergency room or be hospitalized, at least twice a year
& White, 1986).
As cited in K. D. Scott & A. A. Scott (1999),
there isn’t a lot of
information readily available for families of children with Sickle Cell
to educate themselves on the disease. A
lot of times the families of children with Sickle Cell Anemia do not
have the right insurance to cover treatment
of their child’s disease, because the disease received minimal funding. This keeps children from receiving the right
kind of health care. Sickle Cell Anemia
can affect the children while in the classroom. They
become distracted more easily, their
ability to keep attention is poor, as well as having poor concentration
Buchanan, et al., 1993; Fowler et al., 1988; Swift et al., 1989). There are days at a time when children with
Sickle Cell disease are absent, because of being medically treated for
interacting with peers their own age, their social skills start to
affected. The severity of the disease
will determine how long the child will be absent from school. These absences from school lead to the child
having problems with their self-esteem, and the child being reluctant
new things. This puts the child at
psychosocial risk, and also places the child at risk for poor school
performance and academic achievement.
As cited in L.
P. Barakat et al., (2002), treatment must be implemented
when the child with Sickle Cell disease starts to exhibit signs of
discomfort. When this treatment is
implemented, the child will have to be treated in the home. This is due to the medication he or she will
have to take. The child will start
taking analgesic medication that will help fight infectious disease in
child’s body. The effects of the
treatment of Sickle Cell disease are unpredictable and can be fatal
Buckloh, Woods, & Butler, 1995). As
children with Sickle Cell disease grow older they have a tendency to
sticking to their treatment regimens.
There are many factors as to why this happens. These factors are the children being under
stress because of coming from poor backgrounds, and being the ethnic
minority in the United
which affects African Americans directly (Baskin, et al., 1998). Being able to measure adherence for treatment
is more complicated by the type of disease and it’s treatment. There are some recommendations concerning the
adherence to treatment of children with Sickle Cell disease that vary. This depends on how severe the disease is and
prior displays of symptoms that occur.
Managing pain and fever receive standard
recommendations for treatment,
which are usually limited. Treatment
that prevents a relapse of the disease is preventative treatment, which
implemented in the home by using medication.
Treatment of pain requires the use of prescription
medication to help
with the pain, in some cases. Normally
prescription medication is used to fight infection.
Lack of trust of health care professionals,
and the inconsistency of health care professionals is due to families
treatment in emergency rooms (Viera, 1986).
As cited in V. E. Maikler, et al., (2001), the focus
is on the levels of
pain that a child with Sickle Cell Anemia experiences.
Some forms of treatment for Sickle Cell Anemia
are transfusions, transplantation, and gene therapy (Bunn, 1999; Reed
Vichinsky, 1998; Steinberg, 1996). There
is also treatment for acute pain episodes such as hydration (Shapiro,
Steinberg, 1999). Children who have the
Sickle Cell disease are learning to deal with their illness. During treatment the child is given a diary
to keep track of his or her pain, the severity of the pain, and how
occurs. This is typically done in the
home while in treatment, but can also be done while hospitalized. These diaries are more of a record keeper or
log of the data the children will record.
They are self-report techniques that will help the
child keep track of
how often the chronic pain occurs and how severe (painful) it
(Shapiro et al., 1990). These pain
intensity reports rate pain as being mild, moderate, and severe. These diaries will help determine future
possibilities for adolescent children with Sickle Cell disease to be
self medicate themselves, and for younger children with Sickle Cell
have a parent administer the medication.
Hospitalization would not be needed for children who
were suffering from
chronic pain due to Sickle Cell disease.
There are certain risk factors that affect the
adaptation of children
with Sickle Cell disease and their parents.
These risk factors are stress-processing (coping),
(family functioning), and intrapersonal factors (Wallander et al.,
1988). If the parent and child aren’t
coping strategies, the greater the use of health care services when a
in pain. On the other hand, less health
care services are used when the parent and child are actively using
strategies. For further information
on Sickle Cell disease please go to the following web sites:
Barakat, L. P.,
& Ohene-Frempong, K., (2002). Treatment adherence
in children with sickle cell disease: disease-realted risk
Journal of Clinical Psychology in Medical Settings,
Maikler, V. E.,
Broome, M. E.,
Bailey, P., & Lea, G., (2001).
adolescents’ use of diaries for sickle cell pain. Journal
Society of Pediatric
Nurses, 6(4), 161-168.
>Nettles, A. L., (1994). Scholastic performance of children with
sickle cell disease.
Journal of Health and Social Policy,
Noll, R. B.,
Ris, M. D., Davies, W.
H., Bukowski, W. M., & Koontz, K., (1992).>
Social interactions between children with cancer or sickle
and their peers:
teacher reatings. Journal of Developmental and
Pediatrics, 13(3), 187-
Scott, K. D., & Scott, A. A.,
(1999). Cultural therapeutic awareness
and sickle cell
anemia. Journal of Black Psychology, 25(3),
Shapiro, B. S.,
Dinges, D. F.,
Orne, E. C., Bauer, N., Reilly, L. B., Whitehouse, W. G.,
Ohene-Frempong, K., & Orne, M. T., (1994). Home
management of sickle
Related pain in children and adolescents: natural history
and impact on
Attendance. Journal of the United Kingdoms Elsevier
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