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. 2025 Mar;51(2):e70069.
doi: 10.1111/cch.70069.

'Bear Feels Sick': A Systematic Review of Picture Books About Physical Symptoms in Dutch Children's Literature

Sterre van der Ziel  1 , Elske Hogendoorn  1 , Brian A Jorge  1 , Marijn W G van Dijk  2 , Michel J van Vliet  3 , Judith G M Rosmalen  1   4
Affiliations

'Bear Feels Sick': A Systematic Review of Picture Books About Physical Symptoms in Dutch Children's Literature

Sterre van der Ziel et al. Child Care Health Dev. 2025 Mar.

Abstract

Background: Young children frequently experience physical symptoms, such as common cold, vaccination pain or a playground injury. Picture books about physical symptoms and illness are a source of information for young children. This study assessed the nature and causes of and responses to physical symptoms depicted in Dutch children's picture books.

Methods: A systematic search for Dutch picture books for children between the ages of 2 and 8 years about physical symptoms or illness was conducted in public library catalogues in the Netherlands, with terms such as 'pain' and 'doctor'. Only picture books with a fictional storyline, in which the main character experienced symptoms or illness, were included. A content analysis was conducted by two independent reviewers.

Results: Fifty-five books met the inclusion criteria. The most common symptoms were injuries (29%), cold symptoms (21%), fatigue/malaise (14%) and fever (11%). Causes were mostly unknown (41%), due to accidents (38%) or infections (18%). Accidents were always caused by the main character. In 89% of the picture books, remedies were necessary to resolve the symptoms, including bandages (36%), bedrest (33%), medical interventions (33%) or medication (27%). Fifty-six percent of the books depicted seeking medical care. Four themes regarding the morals of the stories were identified: the seemingly scary hospital or doctor, the responsibility of the main character to engage in coping strategies, the importance of social contacts, and illness gains after possible unpleasantness of symptoms.

Conclusions: The picture books about physical symptoms and illness in our sample depicted various symptoms, limited causes and a range of responses. Physical symptoms and illness were rarely normalized in the stories, often requiring medical intervention rather than spontaneous resolution.

Keywords: health communication; physical symptoms; picture books; systematic review; young children.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA 2020 flow diagram.
FIGURE 2
FIGURE 2
Described physical symptoms*. * Not all physical symptoms were experienced by the main character of the story.
See this image and copyright information in PMC

References

    1. Arruda‐Colli, M. N. F. , Weaver M. S., and Wiener L.. 2017. “Communication About Dying, Death, and Bereavement: A Systematic Review of Children's Literature.” Journal of Palliative Medicine 20, no. 5: 548–559. 10.1089/jpm.2016.0494. - DOI - PMC - PubMed
    1. Baeyer, C. L. , Baskerville S., and McGrath P. J.. 1998. “Everyday Pain in Three‐ To Five‐Year‐Old Children in Day Care.” Pain Research and Management. 3: 111–116. 10.1155/1998/198043. - DOI
    1. Bandura, A. , and Walters R. H.. 1977. Social Learning Theory. Vol. 1. Englewood Cliffs, NJ: Prentice Hall.
    1. Brussoni, M. , Gibbons R., Gray C., et al. 2015. “What Is the Relationship Between Risky Outdoor Play and Health in Children? A Systematic Review.” International Journal of Environmental Research and Public Health. 12, no. 6: 6454. 10.3390/ijerph120606423. - DOI - PMC - PubMed
    1. Bugge, K. E. , Helseth S., and Darbyshire P.. 2009. “Parents' Experiences of a Family Support Program When a Parent Has Incurable Cancer.” Journal of Clinical Nursing 18, no. 24: 3480–3488. 10.1111/j.13652702.2009.02871.x. - DOI - PubMed

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