The extra demands on parents of chronically ill children cause stress that affects the whole family, according to a systematic review conducted by Case Western Reserve University researchers that also explored what factors in the child’s care most contribute to the added strain.

The findings, reported in the August issue of the Journal of Pediatric Psychology article, “Parenting Stress Among Caregivers of Children With Chronic Illness: A Systematic Review,” were based on an assessment of 96 peer-reviewed studies in 12 countries between 1980 and 2012.

Researchers examined studies, involving parents of children up to age 21 with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis and/or sickle cell disease.

While many studies have examined parental stress associated with specific illnesses, this was among the first to integrate those findings into a single report to provide a broad view of the issue and potential interventions, said Melissa Cousino, lead author and a graduate student in the Department of Psychological Sciences.

In addition to identifying common stress triggers, parents also need help coping with the strain, report Cousino and co-author Rebecca Hazen, psychologist and assistant professor from the Department of Pediatrics at the university.

According to the Centers for Disease Control and Prevention, 15 percent of U.S. families have a chronically ill child with special needs. The researchers found that the demands of care created greater stress than the severity or length of their child’s illness.

In addition to usual parenting responsibilities, parents of chronically ill children deal with special needs such as doctor or therapy appointments, medical treatments, hospitalizations and school issues that can be overwhelming while trying to integrate the sick child’s needs into the family routine.

Parents reported suffering added stress from watching their child in pain, and from worrying about the child’s vulnerability and explaining the health problems to those outside the family.

Parenting stress can be intervened upon, the researchers said.

Hazen provided the following tips on reducing parenting stress:

• Be open to assistance from friends or family who may be able to help reduce some of the stress;

• To decrease the demands on one parent, parents should find ways to share parenting and treatment responsibilities;

• Let your child’s doctor know if you think you may need help in managing the stress related to caring for a child with a chronic illness.

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Case Western Reserve University, Cleveland, Ohio 44106.