title: Educational paper: parenting a child with a disfiguring condition-how (well) do parents adapt?
abstract: Studies indicate serious levels of stress among parents of children with a medical condition. Moreover, adaptation seems to be a specific challenge for parents of children with a disfiguring condition because of the visible nature of the condition. In the present overview, we performed a literature search in PubMed, Embase, and PsycINFO to identify both qualitative and quantitative studies concerning psychological distress among parents of children with a disfiguring condition. Two of the authors critically appraised the retrieved citations. A total of 1,459 publications were identified, of which 21 qualitative and 22 quantitative studies met our inclusion criteria. Most qualitative studies infer that the birth of a child with a disfiguring condition starts an adaptation process in which parents experience a range of negative emotions and have concerns related to the visible nature of the condition. The results of quantitative studies are mixed and contradictory, and together suggest that some, but not all parents of a child with a disfiguring condition experience stress. Methodological limitations of the quantitative studies and potential stressors are discussed, and recommendations for future research are made.
  
  
  CONCLUSIONS
  The present overview neither shows that the existing literature is conclusive about the perceived strain among the parents of children with a disfiguring condition nor does it provide evidence for a relationship between visibility and parental strain.
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands, w.leemreis@erasmusmc.nl.
authors.forename: Willem H
authors.initials: WH
authors.lastname: Leemreis
authors.forename: Jolanda M E
authors.initials: JM
authors.lastname: Okkerse
authors.forename: Peter C J
authors.initials: PC
authors.lastname: de Laat
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Madern
authors.forename: Léon N A
authors.initials: LN
authors.lastname: van Adrichem
authors.forename: Frank
authors.initials: F
authors.lastname: Verhulst
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Oranje
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D019988:Children with Disabilities / Q000523:psychology*; D006801:Humans; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*