Promoting Resilience in Pediatric Patients

Ten years ago, “Jackson Stone’s Brave Decision to Amputate His Foot” was uploaded to YouTube.¹ The video includes interviews with the 13-year-old Jackson and a clip of him discussing the decision with his physician. His mature and thoughtful processing will be familiar to many clinicians who work with patients in this age group. The way that many children, including those much younger than Jackson, respond positively to challenges is one of the most rewarding aspects of providing care to this population. Many of them have experienced significant difficulties related to the underlying conditions necessitating O&P care, face new challenges as their conditions change, and must make significant adaptations even after their medical conditions have stabilized. In Jackson’s case, his left foot was amputated when he was an infant, and he underwent more than eight limb preservation surgeries prior to choosing amputation on the right side.

The medical experiences of our patients impact them psychologically and socially in ways that can compound their physical challenges. Despite the many benefits of O&P care, the device itself and the inability to function optimally or participate fully in activities affect their sense of identity and interactions with peers. The transition through adolescence and adulthood is challenging for most children, and working with them during this time provides an opportunity to observe their development and the consequences of their individual and family situations. At one point in the video, Jackson is asked by the interviewer (presumably his mother) whether he is worried about girls accepting him because of his legs. His answer is thoughtful and confident, and the influence of his family members is apparent. The impact of family systems and parenting styles becomes obvious as we observe how parents either provide support or contribute to barriers. Despite challenges on multiple levels, many of our pediatric patients demonstrate a positive attitude that is in stark contrast to adults who need O&P care. Working with children who have less effective coping and adaptation skills provides another, often heartbreaking contrast. According to Southwick et al., “The scientific study of resilience…began with questions about why some at-risk children and youth somehow defy the odds and thrive….”²