stress disorder (PTSD) later in life,219–220 which may independently affect the family functioning, child self-image, and child-rearing schema Attention to this important, modifiable risk factor for later neurodevelopment both in the inpatient and outpatient settings holds promise for improvement in our patients with cCHD FIG 76.3 (A) Potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in the infant (B) Potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in the child ADHD, Attention deficit hyperactivity disorder; cCHD, complex congenital heart disease (From Wernovsky G, Licht D Neurodevelopmental outcomes in children with congenital heart disease: what can we impact? Pediatr Crit Care Med 2016;17[Suppl 1]:s232–s242.) FIG 76.4 Progression of multiple factors related to adverse neurodevelopment and “the fragile child” following a prolonged intensive care unit stay (From Wernovsky G, Licht D Neurodevelopmental outcomes in children with congenital heart disease: what can we impact? Pediatr Crit Care Med 2016;17[Suppl 1]:s232–s242.) Parents of children with CHD and acquired heart disease are at increased risk for stress, anxiety, and feelings of powerlessness related to the financial and emotional burden of their child's disease.221 In a prospective study of mothers whose children underwent CPB for CHD, 16.4% met criteria for a PTSD diagnosis at time of hospital discharge, while 14.9% continued to experienced PTSD symptoms 6 months following discharge.222 PTSD is also prevalent among parents whose children underwent a heart transplant, with 39% experiencing mild to moderate PTSD symptoms and 19% meeting diagnostic criteria for a PTSD diagnosis.223 Caregiver and family wellbeing should be addressed during interdisciplinary medical rounds, by the unit social worker or psychologist, and during follow-up outpatient cardiology evaluations Caregivers should be provided information about support groups, counseling services, and recommended websites to learn more about their child's medical condition and the support services available to them Mental Health in the Patient It is well documented that children, adolescents, and adults with CHD struggle with increased levels of mental health and psychiatric symptoms In a recent study of adolescents with single-ventricle CHD, 65% had a lifetime psychiatric diagnosis compared to 22% of healthy adolescents.224 In the Boston Circulatory Arrest Study, adolescent patients with d-TGA had a higher prevalence of attention-deficit and/or hyperactivity disorder when compared to their healthy peers.225 Mental health conditions are also seen in patients with implantable cardioverter-defibrillators who, like patients with CHD, have significantly higher levels of anxiety when compared to healthy peers.226 Psychiatric disorders continue to impact the daily lives of adults living with CHD In a cross-sectional study of 280 adults with CHD who completed a self-report measure, 50% met diagnostic criteria for anxiety or depression.227 As medical professionals, it is essential that we care for the physical, emotional, and psychosocial well-being of our heart patients Sibling Effect Siblings of children with chronic health conditions have a higher likelihood of depression, social isolation, guilt, disruptive behaviors, and poorer QOL compared to their peers.228–230 This is related to the well sibling's lack of knowledge of their sibling's condition, separation from their family due to frequent hospitalizations, financial stressors, and fear of their own personal mortality While there is limited research into the effects on well siblings of patients with CHD, it is important that their psychosocial needs are met inside and outside of the hospital to support their overall well-being During hospitalizations and clinic visits, the Child Life Specialist can be utilized to educate and support the well sibling.231 Implementation of a Child Life Specialist has been shown to reduce levels of anxiety in the well siblings Camps can also have a positive influence on improving the disease knowledge, selfesteem, and confidence of well siblings The camp environment allows the siblings to be in a supportive environment where they can reflect upon and share their own experiences among like peers.232–233 ... addressed during interdisciplinary medical rounds, by the unit social worker or psychologist, and during follow-up outpatient cardiology evaluations Caregivers should be provided information about support groups, counseling services, and