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Coaching Children Whose Parents Face Serious Medical Illness

A mother writes: Our family is in crisis due to my husband’s cancer treatment. We have explained to our three children what is going on and they have responded in different ways. Some of their reactions, since they seem so extreme, have caused us concern. How can we determine if their reactions are healthy or not?

One of the toughest challenges of adulthood arrives at our door when personal crisis and parenting duties intersect. Attending to children’s feelings, wishes, and needs can be especially taxing, and even troubling, against the backdrop of tragic news or terrifying medical problems. As the internal dialogue of fear and foreboding echoes in the mind, children can stir sudden tears, looming fear, or intense anger, often leaving us feeling helpless and guilty.

Parental angst is further compounded by the host of reactions triggered in children. Here are some coaching tips designed to soothe the rattled nerves of children facing these scary circumstances:

Understand how children draw meaning out of trying times. Children take their cues from parents, especially when circumstances are hard for them to understand. They closely observe facial expressions or conversations, trying to draw conclusions from ambiguity. This can lead to misinterpretations of a parent’s tearful outburst as a sign of the worst. They may hold onto their beliefs long after the actual threat has passed, enlarging the meaning of the event. Parents can educate children about the way their mind jumps to conclusions out of limited data, and encourage them to reveal their mind jumps when they occur so that they can be addressed.
“Please let me know when you see or hear something that worries you. This way we can make sure it doesn’t blow up like a worry balloon in your mind. I’ll help you let the air out if it does happen,” is one way to invite such discussion.

Normalize the lack of normal parental behavior. One way to minimize misinterpretation is to prepare children for the range of unusual reactions in parents. Explain how certain situations cause different reactions in adults, and how normal it is to let them out so that they don’t pile up inside. Describe how feelings of anger, worry, sadness, or fear, may create parent behaviors that pass through family life. Emphasize how these temporary behaviors help drain off feelings and are necessary for everyone facing tough times in life.

Offer a thermometer metaphor to distinguish between reactions and realities. Such a template helps children visualize the disproportionate nature of feelings. Explain how fears and worries might heat up during times of stress and uncertainty but then lower to the normal range during times of calm and familiarity. As an example, suggest that medications with obvious side effects, such as hair loss, might cause a “flare up” even though the reality is that the medicine is working to make things better. Provide for a continuation of family rituals and routines as one way to keep temperatures in the “normal range.”

Assess children’s reactions based upon prior functioning level, intensity, duration, and pervasiveness. Most children respond to such troubling news through the window of their temperament and personality traits. Empathic children tend toward a caretaker role, detached children may further withdraw, and needy children may protest the injustices occasioned by their parent’s illness. Reactions that do not follow the pattern of a child’s prior functioning may be cause for concern. Moreover, if reactions are particularly strong, long lasting, and/or spread over the areas outside of family functioning, parents may want to consider outside help. One rule of thumb to consider is the question, “Is my child reacting to this news with excessive behaviors or feelings that last longer than I would have expected?” If so, seek consultation.

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