Coaching
Compliance With Chronic Medical Restrictions
A
parent writes: Our ten year old was recently diagnosed with juvenile
diabetes. Although she first showed much courage and cooperation with
medical treatments and restrictions, things have changed. Now she
is angry and defiant. We are worried about her health but don’t
want to come down too hard. Suggestions?
All
parents are familiar with the pacifying and policing roles required
when children experience broken bones or sickness. Sacrifices of enjoyable
activities and the discomforts of illness are assuaged by the reassurance
that these problems are temporary. Most children reluctantly accept
the restrictions, often aided by parents’ indulgence with favorite
foods and other goodies.
Children
have a much harder time accommodating to such limits when chronic
conditions, such as diabetes, are thrust upon them. Placating them
with treats can create more problems. Parents often find themselves
thwarted in their attempts to soothe and supervise. Here are some
coaching tips to consider:
Recognize
the impact of the condition upon the child's developmental push for
independence and autonomy. It is traumatic to suddenly discover
that one's activity level and eating habits must now be carefully
monitored and reported. This circumstance can trigger painful feelings
of being trapped in a defective body, thoughts of being unfairly denied
what other kids take for granted, or angry impulses to throw caution
to the winds and eat whatever and whenever. Parents need to be prepared
for this emotional backlash to the diagnosis, and respond with patient
listening and gentle guidance.
Structure
discussion by talking with your child about the challenges faced.
Some children are particularly troubled by the dietary restrictions
while others dread the injections or medications. Sometimes
a shaky relationship between parent and child becomes more contentious
with the advent of a chronic condition. Eating meals with carefree
peers may stir up resentment and jealousy. Rate the challenges from
least to greatest on paper and explain how more self-control and strategic
planning is required as you go up the list.
Extend the list into a kid-friendly plan of action that pairs each
challenge with a coping strategy. For example, the temptation to eat
banned snacks might be described as a "snack attack." Review
the circumstances and times when such attacks are most likely. Document
which permitted snacks can help them overcome the attacks and mental
distractions that are beneficial. These include talking to a family
member, reading a book, watching a movie, writing in a journal, or
practicing an instrument. If these don’t work, explain that
it might be necessary for your child to come to you with the following,
" I'm feeling tempted by a snack attack. Can you help me not
give in to it?"
Consider the psychological task of acceptance, for both of
you. Unlike most other hurdles in childhood, it can take tremendous
time and mental energy for children to truly assimilate the restrictions
into their lives. Psychological forces can help and hinder
this process, depending upon the stages of development and personality
of the child. Parents are also urged to consider their own feelings
about their child‘s plight. A parent’s guilt, anger, and
sadness, to name just a few, can complicate the child's attempts to
reconcile themselves to the rules and restrictions. Parents can help
the acceptance process move forward by having open and informed discussions
without allowing their own fears and emotional baggage to interfere.
Dr. Steven Richfield is a child psychologist in Plymouth Meeting,
PA. He has developed a child-friendly self-control/social skills building
program called Parent Coaching Cards. His new book, The Parent Coach:
A New Approach To Parenting In Today’s Society is available
through Sopris West (sopriswest.com or 1-800-547-6747) He can be contacted
at www.parentcoachcards.com or 610-238-4450
