title: Coping with congenital hand differences.
abstract: BACKGROUND
  Although functional outcomes following reconstruction for congenital hand differences are frequently described, much less is known regarding children's ability to cope with the psychosocial effects of these conditions. The authors qualitatively explored stress and coping mechanisms among children following reconstructive surgery for congenital hand differences.
  
  
  METHODS
  Forty patients and their parents participated in semistructured interviews examining children's stress related to hand functioning and appearance, emotional responses to stress, and coping strategies. Interviews were audio-taped, transcribed, and analyzed thematically. A consensus taxonomy for classifying content evolved from comparisons of coding by two reviewers. Themes expressed by participants were studied for patterns of connection and grouped into broader categories.
  
  
  RESULTS
  In this sample, 58 percent of children and 40 percent of parents reported stress related to congenital hand differences, attributed to functional deficits (61 percent), hand appearance (27 percent), social interactions (58 percent), and emotional reactions (46 percent). Among the 18 children who reported stress, 43 percent of parents were not aware of the presence of stress. Eight coping strategies emerged, including humor (12 percent), self-acceptance (21 percent), avoidance (27 percent), seeking external support (30 percent), concealment (30 percent), educating others (9 percent), support programs (21 percent), and religion (24 percent).
  
  
  CONCLUSIONS
  Although children with congenital hand differences often experience emotional stress related to functional limitations and aesthetic deformities, many apply positive coping mechanisms that enhance self-esteem. Clinicians caring for children with congenital hand differences should inform families about potential sources of stress to direct resources toward strengthening coping strategies and support systems.
authors.affiliation: Ann Arbor, Mich.; and Hempstead, N.Y. From the Section of Plastic Surgery and the Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; and the Department of Orthopaedic Surgery, Hofstra North Shore-Long Island Jewish School of Medicine.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Franzblau
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Noelle
authors.initials: N
authors.lastname: Carlozzi
authors.forename: Autumn Y T
authors.initials: AYT
authors.lastname: Chin
authors.forename: Kate W
authors.initials: KW
authors.lastname: Nellans
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D005260:Female; D006228:Hand Deformities, Congenital / Q000150:complications* / Q000523:psychology*; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*