Psychosocial Support Services for Appearance Differences

Having a congenital or acquired appearance difference can present a variety of challenges for children and their families. Our dedicated clinical psychologists and social worker are here to help you navigate these challenges and maximize your child’s well-being at home, school and in your community.

These professionals work with children, adolescents, and their families to address psychosocial concerns before and after surgery and throughout the entire treatment process. This support is an important element of the care we provide.

Your child's experience with our psychosocial specialists

Your child will be introduced to our psychosocial support services team during a meeting where our specialists will get to know your child and evaluate her psychosocial functioning. Throughout your child’s care, you can meet with our specialists during team appointments or while you’re here to see your surgeon or other provider. You can also set up a separate individual or family-based appointment with our psychologists.

Families can contact us for a consultation or outpatient therapy session at any time, even after the physical treatment is over. Parents and siblings are important to our family-centered care, and are welcome and encouraged to participate in these counseling sessions. During every meeting, we will learn how your child is doing at home, at school and in her social relationships.

Our team is available every step of the way to:

  • Provide support, education and information about your child’s condition and treatment.
  • Connect you with resources that can help both patient and family members.
  • Make referrals for additional assessment and treatment as needed.
  • Facilitate connections with other families or support groups in your community.

The Division of Plastic and Reconstructive Surgery also actively participates in clinical and psychosocial outcomes research. To learn about our research studies, ask a member of our team.

Who you'll meet

Psychologist: Our certified clinical psychologists are specially trained to provide education, therapy and intervention related to emotional and behavior concerns in children. As part of your medical team, our psychologists assist with the evaluation of potential developmental, behavioral, emotional and educational difficulties and can make appropriate referrals for comprehensive treatment. Our psychologists have many years of experience assessing and treating babies, children and their families, and specialize in working with patients with appearance differences.

  • Leanne Magee, PhD is a licensed clinical psychologist in the Division of Plastic and Reconstructive Surgery and the Department of Child and Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia. Dr. Magee’s clinical and research interests include psychosocial adjustment in children and families affected by acquired and congenital appearance differences, psychological aspects of plastic and reconstructive surgery, body image and anxiety.

Social worker: A social worker’s role, as part of the medical team, is to help assess the psychosocial needs of your child and family, and offer support, information and education. Our social worker provides guidance and counseling for patients and families in dealing with the social and emotional aspects of your child’s condition. Social workers will connect you with the appropriate community or hospital resources as needed, including support groups, financial guidance, and more.

  • Kim St. Lawrence, MSW is a licensed social worker in the Division of Plastic and Reconstructive Surgery and the Department of Social Work and Family Services at The Children's Hospital of Philadelphia.

Parent Liaison: Diana Sweeney is a Parent Liaison for the Division of Plastic and Reconstructive Surgery. As a parent of a child who received medical care at CHOP, Diana offers a unique understanding and experience, partnering with staff to bring the family voice and perspective to everything the Division does. She meets new families and introduces them to our programs and services, organizes social events, and provides support to help parents cope and care for their child. A key part of Diana’s role is in connecting families with a network of others who have been through similar experiences.

Psychosocial counseling and support before and after birth

Some conditions, such as cleft lip and palate, may be diagnosed before birth, while others are discovered after your baby is born. Depending on when your child’s condition is diagnosed, our psychosocial staff works closely with the Center for Fetal Diagnosis and Treatment, the Neonatal Craniofacial Program and the Newborn/Infant Intensive Care Unit (N/IICU) to support families through this stressful time.

Psychologists and social workers from each team collaborate to prepare parents for what to expect, providing support and coping skills for dealing with guilt or grief, and advice for how to talk to family members about your child’s diagnosis.

As your child grows, he or she will go through many transition periods and you will have a variety of treatment decisions to make. You may need help making these decisions and coping with the social or emotional challenges that can come with having an appearance difference. These are some examples of the resources and services we provide to support your child and family during every stage of treatment and development.

Preparing for surgery and other procedures

Fears, worries and anxieties that naturally come up around surgery and other procedures can be eased by working with our team to develop coping skills. A member of the psychosocial services team can accompany you during surgical preparation to help answer any questions or concerns you may have at this time, and to explain procedures to children in age-appropriate terms.

We can arrange Hospital tours to show patients the perioperative area, a patient room and waiting areas, and connect patients and families with educational tools such as Kid’s Health Galaxy, Megan’s story, and other resources to prepare children for their surgical experience. Child Life Specialists play an important role in working with our patients to minimize stress and make the Hospital experience as easy as possible.

Making decisions about surgery

When making surgical decisions for your child, there is a lot of information to gather and process. Our psychologists and social worker work closely with you and your child’s surgical team to help you:

  • Understand your surgeon’s recommendations and any other surgical options available to you.
  • Understand all the information you're being given about the surgery and recovery process.
  • Help you think of questions you want to ask and talk through all of the information you’ve received.
  • Facilitate follow-up consultations if you’d like to meet with your surgeon again.

Early on, it is likely that your surgeon will manage your child’s treatment plan with clear recommendations for what procedures are necessary at what time. But as children grow, elective procedures may be presented as additional options to consider.

While many older children and adolescents want to be involved in the decision-making process, it is common for kids who have undergone many surgeries to feel “burnout.” They’re likely to make decisions based on the short term without thinking about long-term benefits because they don’t want to miss more school or have to spend more time in the Hospital. We help these patients understand how a surgery might help them now and in the future, and help them weigh the risks and benefits of elective procedures.

Our psychologists will talk these things through with your family, recognizing the opinions of every family member to help you come to the best decision for your child.

Managing social situations

Our team can offer advice for how to manage difficult situations such as responding to questions and comments about appearance differences, telling others about surgical procedures, or coping with teasing and bullying.

We will practice some ways to respond to these situations so that you and your child can be prepared to confidently manage these tough situations. Responses that have been effective for families in the past include three key parts:

  1. Acknowledge the difference.
  2. Give a brief but honest explanation.
  3. Move the conversation on to something else.

Returning to school after surgery can be difficult for patients, especially if the procedure significantly changes your child’s appearance or if the treatment includes multiple stages. Communicating with schools is an important step to easing your child’s transition. We will help you explain important details to your child’s teacher and provide guidance for communicating with your child and their school about what to expect.

Body image and appearance concerns

We offer outpatient therapy to help kids and families cope with appearance differences and difficulties with body image dissatisfaction. Adolescence can be an especially challenging time because teens tend to be very focused on appearance, comparisons with others, and are more likely to be unhappy with how they look.

Visible appearance differences, teasing or bullying, and multiple surgical changes in appearance can also contribute to difficulties with body image. We can work with you and your child to help them manage any appearance-related distress they are experiencing.

Learning, developmental and behavioral problems that can be associated with congenital or acquired conditions

Children with cleft and craniofacial conditions may be at higher risk for learning difficulties, trouble with attention, concentration, memory, and skills like organization and planning. If we feel your child may have early signs of these difficulties, we can help arrange psychoeducational or neuropsychological assessments. Addressing these potential problems early in development will help patients later.

We collaborate with a wide variety of pediatric specialists to provide coordinated, multidisciplinary care. This includes the Division of Child Development and the Department of Child and Adolescent Psychiatry and Behavioral Science for consultations with neuropsychiatry, psychiatry and more. Our team can also connect you with resources in your school and community to address the specific needs of your child.

Transitions in education and development

We are also available to meet with our patients during transitional times, such as the move to middle school or high school. As your child reaches adolescence, he or she will likely encounter all of the normal issues that adolescents and teens face – teasing and bullying, body image, dating, etc. These times can be challenging for all children, and having an appearance difference may add a unique challenge to an already difficult time.

We may recommend an evaluation at their school or through one of CHOP's specialty clinics if we think it will be helpful in informing treatments or educational planning.

Accessing services in your child’s community or school

We can help connect you and your child with support resources in your community at every stage of development. Our team can make referrals and recommendations as needed, work with you to find a provider, and collaborate with other members of your child’s care team.

December 2013