INTRODUCTION

Life is a one-way street and as people make their journey, they will encounter various obstacles they must face. The first steps on this path, which take years, are full of changes; this means that this stage of childhood is considered in many cases as new as it is worrying¹. One of the best resources to solve the doubts that may arise to the youngest of the house is the use of reading.

The use of books, in addition to being an object of entertainment, can be a useful tool to help in various processes among which the healing process is. The fact of healing through books was first described by S.M. Crothers in 1916 under the term "bibliotherapy" in an article published by "The Atlantic Montly"; although the truth is that reading has been present in different times and places throughout the history of civilization².

Thus, in ancient Egypt, Pharaoh Ramses II grouped certain books of his library under the motto "Remedies for the soul" and in Rome, Aulo Cornelius Celso associated reading with medical treatment. In the same way, the Greeks used books as a medical and spiritual therapeutic tool. In the late eighteenth century, Pinnel in France and Tuke in England began to offer books to heal different types of ailments. The doctors of the nineteenth century, on the other hand, said that reading was one of the best methods to optimize the situation of inpatients²-³.

Another significant advance of bibliotherapy took place at the beginning of the 20th century, in the year 1930, when some libraries began to offer lists of books adapted to the characteristics of each person ³. In 2010 a list of books was created under the term "Compassion Books", with the idea of ​​offering books that try to heal, through the care of the soul, the pain suffered by the body².

Despite the fact that endless benefits have been associated with bibliotherapy, this technique goes beyond the simple fact of reading stories. Therefore, it is necessary to choose adequately the works that fit each personal situation and combine these stories with reflection, as only in this way will the desired effects be achieved¹,⁴.

In this way, the same book will not be offered to a healthy person or one suffering from a particular ailment, nor to an adult or a child. In the case of the youngest, the stories are the axis of bibliotherapy^{5 6}-⁷.

OBJECTIVE

Analyze the effects of bibliotherapy on the child's health-disease process.

METHOD

A narrative review has been carried out in order to analyze the effects of children's literature as therapeutic resource.

The bibliographic search was carried out in the following databases: Dialnet, Cuiden Plus, LILACS, Medline, Proquest, Pubmed, Scielo, Scopus, TDR, Trip and in the Virtual Health Library. Based on the characteristics of each of the databases, the following Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) have been used:

• DeCS: health, child, story, bibliotherapy, nursing and care.

• MeSH: children, health, stories, bibliotherapy, nursing care.

These keywords have been combined using the Boolean operators "AND", "NOT" and "OR".

Likewise, the filters used have been the following: articles published in the last 10 years and as languages, Spanish and English.

In addition, several inclusion and exclusion criteria have been defined (see Table 1).

Table 1 Inclusion and exclusion criteria 

RESULTS

The different search strategies used in each of the databases and the results of the bibliographic search are shown in Table 2.

Table 2 Results of the bibliographic search 

ART 1₍₁₎: Articles obtained after the combination of different key words.

ART 2₍₂₎: Articles obtained after the screening process.

After the literature search, 2018 articles were identified, out of which 376 met the selection criteria. Of these, after reviewing the abstracts, 71 were obtained for meeting the inclusion criteria. Finally, 26 articles were selected because they presented adequate levels of evidence (see Table 2 and Figure 1).

Figure 1 Flowchart of selection process 

After carrying out the selection of the most pertinent articles to carry out this review, the 26 articles obtained were analyzed. Table 3 shows the most relevant results of each of these articles.

Several studies have shown the usefulness of reading in the personal development of children (seetable 3). Different types of bibliotherapy are differentiated: the clinic (aimed at patients and set up by physicians and librarians) and the evolutionary (school or public libraries that promote self-knowledge at different stages of the person's development)⁵.

After analyzing thematically the selected publications, five categories were obtained: "Healthy child", "Alteration in the mental area", "Hospitalization", "Pathology in the physical area" and "Death".

Healthy child

Several works highlight the role of reading as a source of beneficial effects for a child who does not present any pathology, but who, despite this, must be able to adapt to various situations during their childhood development. The reading of stories and their reflection have effects such as reducing anxiety, promoting self-esteem and reflection, offering comfort, helping to cope with adversity and promoting development by improving communication and externalizing feelings¹,^{2 3}-⁴.

It has been observed that reading stimulates healthy lifestyles and can prevent various diseases such as obesity and childhood diabetes, and also that reading stories favors the reduction of BMI (body mass index)⁸.

Alteration in the mental area

The mental alterations experienced in childhood imply that both the child and his environment have to adjust to the new reality they are living.

Night terrors and fear of the dark, common in the children development are part of the group of the parasomnias, alterations that interfere in the quality of the dream. Bibliotherapy promotes the acceptance of phobia and a greater adequacy and initiative to change by the child and family, thus reducing levels of anxiety⁹. Another problem that often appears during childhood is disruptions of sleep and nocturnal awakenings. It has been observed that this problem appears in one of four children before the age of 5. In this, the reading of the story "The Sleep Fairy" has turned out to be effective, improving the behaviors associated with this problem¹⁰.

On the other hand, post-traumatic stress is a situation that can affect children in certain situations. The use of literature associated with traumatic processes has been studied mainly in relation to natural disasters, terrorist attacks or war processes¹¹. A traumatic situation can suddenly change the life of the child, producing alterations in their development and affecting family dynamics. Through the creation of children's bookstores, efforts have been made to favor the assimilation of this episode and its consequences. A study carried out in Pennsylvania (Waibel, 2010) describes the creation of two types of libraries, one aimed at cases in which children have been diagnosed with some serious pathology and another suitable for cases where children have turned out to be sexual or domestic violence victims. This initiative promotes adaptation to the new situation, through the sharing of experiences¹².

The use of reading has also been related to the treatment of another type of alteration that affects mental health: psychosis. This type of disorder can affect, in addition to the child who suffers, indirectly to the health of their caregivers. There are not many materials to promote the care of these patients, but it has been observed that the use of bibliotherapy can even be more effective, in the long term, than the usual medical treatment. According to McCann et al., Children treated with this therapy value the changes experienced more positively than those treated with usual medical treatment¹³.

In processes of anxiety, the mental alteration more frequent in childhood, the use of children stories has resulted in the improvement of these children. Literature for children has as a purpose the identification of the reader with the protagonist who fights against different stressors, thus achieving that, in the same way, they themselves can face the stress they are experiencing autonomously. The reflection on these stories is also necessary for the youngest to learn to behave adequately when having to face possible future situations¹⁴-¹⁵.

In addition, the use of children's literature may be beneficial for children with special abilities such as children with Autism Spectrum Disorder (ASD); psychological and behavioral disorder characterized by presenting alterations in socialization with others. The story "A friend like Simon: A story about autism" tells the story of a child with ASD from the point of view of his best friend and classmate. The objective of this story is to teach children about the special needs of people with ASD and the importance of accepting everyone, no matter how different they may be².

Finally, an increasingly common situation in schools and one that is related to the development of symptoms related to mental health is school bullying. Several studies have demonstrated the effectiveness and necessity of treating bullying through bibliotherapy. There are several children's stories that have been used in order to prevent and give other perspectives of bullying¹⁶-¹⁷.

Hospitalization

The disease generates the rupture of the balance that a child has until the moment it appears. In many cases the loss of health causes the infant to face a stressful situation such as hospitalization¹⁷.

The hospital constitutes an unknown environment that involves biopsychosocial changes and in which a person must face painful techniques carried out by people out of it. All this can produce fear, anguish, stress and even feelings of abandonment. Several authors suggest that health care should go beyond medical techniques; trying to humanize this care, suggest the use of various cognitive-behavioral therapies to change the perception that the infant and his family have about hospitalization. Bibliotherapy is considered a tool that offers emotional security, helps overcome fear of the unknown, promotes personal development and promotes emotional well-being, reflection and the construction of personal criteria⁵,¹⁰,¹¹,¹⁸,¹⁹. Regarding the professional-user relationship, the reading of stories favors feedback and communication. In addition, it helps the child continue with the process of schooling, being not only a therapeutic method, but also a pedagogical resource⁷,⁹,¹²-¹³,^{18 19 20 21 22}-²³.

One of the techniques to which people in the health area are more often exposed is blood extraction. The reading of a story has proved to be useful in children in terms of reducing and improving fear expectations associated with extraction⁴.

A person may require hospitalization for various reasons, both for the fact of suffering a chronic and acute pathology. One of the most common reasons among acute pathologies, in the case of the youngest, is tonsillitis or angina. In order to help in the process of this pathology, Hartling et al. evaluated an intervention based on the use of various stories, after which they pointed out the benefits of this tool²⁵.

Another reason for hospitalization in childhood may be the fact of undergoing surgery. To deal with this situation, Orihuela-Pérez et al. they created and evaluated the use of a story entitled "Diario de Paula", which helps both the child and their family in the preparation of this new experience²⁶.

Pathology in the physical area

A chronic pathology is a long-lasting disease and usually of slow progression. The reading of stories to children who suffer this situation favors acceptance of the diagnosis, adhesion to treatment and as a consequence, a higher quality of life².

One of the most frequently diagnosed chronic pediatric pathologies is cancer, leukemia in particular. Working with a story like the "Ugly Duckling" helps the child and their family to minimize the emotional effects and to favor the trust in the health professional. This tale tells the story of a duckling that is discriminated by his peers due to his physical appearance and with the passage of time, becomes a beautiful swan. Children tend to identify with the protagonist, since, like the ugly duckling, as a result of chemotherapy they experience a notorious physical change, resulting from hair loss¹⁴,²³-²⁴.

Another chronic alteration present in childhood is the various disabilities. The story "Finding Nemo" refers to disability processes, since it is based on the story of a fish that, even though one of his fins is shorter, manages to fulfill all his dreams and objectives. Through this story, the child can internalize that, despite having a disability, with effort, he is able to face the obstacles that life brings, like "Nemo" with his tiny fin²⁰.

One of the most serious infectious and contagious diseases that can appear during childhood is HIV or AIDS condition in its most chronic evolution. It is a pathology that is difficult for the child to cope with, among other things, due to the stigmatization and associated stereotypes that exist in society about HIV-positive people, which can affect the child's social environment. In 2013, a study was carried out to evaluate the effectiveness of a story for children with this condition. The results showed that the children's story "Peter's and Julia's Discovery: conversing about health and illness" is a useful resource that encourages conversation with children about the health-disease process, favoring the understanding of their situation and the importance of antiretroviral treatment⁶.

Death

Different stories tell the reality of the last days that a person has to face. The reading of stories like "Gentle Willow", where a squirrel gives support to the tree that one day had sheltered him in his last days of life, is a tool to help children deal with feelings of fear, anger, pain and frustration. In this way,

it favors that they and their families prepare themselves better for the harsh reality of the end of a life⁸.

DISCUSSION

The results of this review reveal what the effects associated with bibliotherapy are and its importance. 54.1% of the studies focus on studying the effects of bibliotherapy in children aged around 2-16 years. On the other hand, 10 of the studies, representing 41.6%, focus on analyzing the effects of bibliotherapy on children in different areas without specifying ages. And only one has focused on the effects of bibliotherapy during adolescence.

Regarding the city where the research was carried out, half of the studies were carried out in the United States, 7 of them in North American countries, and 5 in South America. Only 4 were carried out in Europe, of which only 1 was in Spain. In this line, it is worth mentioning that the studies have been chosen in order to show the diversity of the use of bibliotherapy in different areas. In 29.1% of the selected studies study the effectiveness of reading books linked to the process of hospitalization.

Despite having demonstrated the effectiveness of bibliotherapy, it would be advisable to give continuity to this therapy and those professionals who work with children in health centers, hospitals or different institutions related to health, had enough knowledge of the benefits of books and could thus work in a more appropriate way with the little ones. In addition, more experimental or quasi-experimental studies should be carried out, since only 37.5%, 9 of the studies, are clinical trials, being the majority, 54%, reviews or descriptive and qualitative studies.

CONCLUSIONS

The use of reading as part of child cognitive-behavioral therapy is a tool that requires precision and knowledge for its optimal implementation. It is considered necessary to follow a few steps and an adequate methodology, which is why an adequate training is essential to achieve its beneficial effects such as: reduce anxiety and stress, favor the diagnosis of the disease, help adherence to treatment, improve psychosocial health and improve well-being and quality of life. In addition, the promotion of research lines related to the use of bibliotherapy is suggested in order to obtain a greater number of scientific evidences that evaluate its quality. The use of this technique could favor the humanization of care, a fundamental aspect in the health-disease process, especially when we talk about the youngest, who usually lack the knowledge and appropriate coping strategies.