No one worries about children like parents, and having a child with a pacemaker is even more worrisome. But kids who are worried over too much develop a low sense of self-competence which can contribute to decreased quality of life, according to a paper in Journal of Developmental&Behavioral Pediatric.

The authors suggest that young patients with pacemakers might benefit from interventions to help them feel more confident in social interactions and other areas of life. The pacemaker doesn't need to define them, and that has to start with how their families treat them.

The researchers administered a self-competence questionnaire to 27 children and adolescents with pacemakers. The patients, average age 13.5 years, had pacemaker implantation because of disease causing abnormal heart rhythms (cardiac arrhythmias).

Self-competence refers to "how well an individual believes he or she generally functions" in various areas, such as academics and social life. The patients also completed evaluations of health-related quality of life, psychosocial adaptation, and behavioral and emotional problems.

Scores for self-competence were decreased for children with pacemakers, compared to healthy children. The patients had relatively large reductions in scores on all four questionnaire subscales: cognitive, social, physical, and general self-competence.

As the researchers hypothesized, patients with lower self-competence also had lower health-related quality of life. Low perceptions of social competence seemed particularly important, linked to lower scores in physical, social, psychosocial, and overall quality of life.

Unexpectedly, self-competence was not strongly associated with psychological problems, such as depression or anxiety. Self-competence was also unrelated to behavior problems.

 "Self-competence may function as a protective factor against lower health-related quality of life in children with pacemakers," according to Ana M. Gutierrez-Colina of University of Georgia, Athens, and colleagues.  

Higher Self-Competence May Be a Protective Factor

For children with cardiac arrhythmias, pacemaker implantation is a standard treatment that leads to positive health outcomes. As survival improves for infants with congenital heart abnormalities, more children are living with pacemakers, which may affect their lives in many ways.

For example, children with pacemakers may have to limit their physical activity level. They may have scars and a visible chest bulge, and may require repeated surgeries. Few studies have focused on the social, behavioral, and emotional issues affecting children with pacemakers.

Based on the new study, higher self-competence may act as a "protective factor" against lower quality of life in children with pacemakers. The researchers write, "It is possible that children's belief in their ability to successfully engage in a variety of activities, including social interactions, prepares them to better cope with the challenges that they may face as a result of their illness."

Gutierrez-Colina and colleagues suggest that children with pacemakers might benefit from interventions aimed at enhancing their sense of self-competence. Children could be taught problem-solving skills to help them believe in their ability to succeed at school, in social situations, and in managing their health—ideally in a group setting, where they could meet and learn from peers with similar health conditions.