The birth of a child with a disfiguring skin condition can be very stressful or at least a shock for parents. Langlois and Sawin (1981) found that 2-day-old infants judged to be less attractive were held less close and given less attention than infants judged to be attractive. Such early reactions may disturb attachments, predisposing a child to the later development of psychological distress. Although it is likely that the majority of parents quickly overcome any initial negative reactions, some may continue to struggle to truly accept their child (Walters, 1997; Kent & Thompson, 2002; Rumsey & Harcourt, 2004).
In addition, we live in a society where a premium is placed on appearance and, as stated earlier, the reactions of others to those with a noticeable disfigurement can be less than charitable. Other children can be particularly discriminatory and those children with an altered appearance can be singled out for bullying and social exclusion. Typically, we face constant messages from the media that to be beautiful is also to be good (Dion et al., 1972). Indeed, children's stories often carry the message that to be disfigured or different in appearance is to be bad in some way ('Outpopped the troll's ugly head. He was so ugly that the youngest Billy-goat Gruff nearly fell down with fright': The Three Billy Goats Gruff cited in Kent & Thompson, 2002).
As previously stated, children are likely to internalise the prevalent stereotypes and any consistent negative reactions received from others, particularly significant others. Such factors are likely to be instrumental in shaping underlying cognitive structures associated with self-concept and personality. Indeed, Cash and Labarge (1996), and Altabe and Thompson (1996) have defined body image in terms of appearance-related schemas or mental representations developed in childhood.
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