Successful Transitions: Take Advantage of Teachable Moments

Every day, we have a new opportunity to teach our kids something. Take advantage of it!  Sometimes in our busyness and haste in getting things done, we forget to notice the little things that come up in everyday life that give us a chance to teach our children. In addition to talking about the big issues, parents can "think out loud" to their children daily about what is going on with their body, why things are happening, and what decisions are being made.

Since my thirteen-year-old son will soon be driving (argh!), I take every opportunity to talk out loud about why I am making certain decisions as I drive; things that I can do as a defensive driver to be safe. I notice out loud- in a conversational way, not an angry way-what other drivers do that are dangerous or discourteous. I always point out unsafe drivers who are texting or drunk or speeding excessively and “talk through” what my “safe driver responses” are (stay away from them). I figure the more I can teach my kids now as they sit in the back seat, the better the odds are that they will be good drivers when they are behind the wheel!

We can also talk out loud about issues they might be having medically and take the time to teach them about their bodies. If my child complains of a tummy ache, I might respond with something like:   

"Hmmm. I wonder if your body is not digesting its food right. That might be why you have gas and tummy aches today. Let's see if it continues for the rest of the day, and if so, we'll call the doctor." 

We can draw a simple picture about how the body digests food, read a picture book, or go online to an appropriate site to learn about the body. After talking with the doctor, share (as possible and appropriate) what is said and engage your child in the process:

"Dr. Jones thinks it might be time to increase your medicine so your body can digest its food better. Let's try it today. Can you keep me posted on how you are feeling?"  

Teenagers can make the call to the doctor themselves with you coaching as needed. Communicating about these kinds of details in a matter-of-fact, "let's take care of business" manner will help your child cope well with the challenges and learn about the nuances of caring for their bodies. Solving the day-to-day problems together is where the training about medical knowledge begins.

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic®. Lisa C. Greene is a parenting educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health issues."  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com.  

Successful Transitions: How to Discuss Difficult Issues with Children

In our last blog in our transition series, we talked about the importance of honesty. In order for children to make good choices about their bodies, they need to know the truth about the potential consequences for bad ones.  Which brings us to our blog for this week: Learning good communication skills for discussing difficult issues.

Early education about your child’s medical condition is critical. This will probably come naturally because around the ages of three and four, children start to ask a lot of questions about everything. "Why is the sky blue?" "Why is a ball round?" Why, why, why... Of course when a child has a medical condition, some of the questions will be about that as well. "Why do I have …?" And, some may ask, "Will I die from ….?"

That's what Lisa’s two children with cystic fibrosis (CF) asked her, at around ages 6 and 4, as they were driving home from school one day. Here's how she answered: "Well, everybody dies of something. Some people do die from CF. Some die from cancer and others die in car accidents. We just don’t know the future. And, if you keep taking good care of yourself like you do now, you will be more likely to live a long time. The doctors are working hard on finding new medicines to help. So, there's a lot of hope for people with CF." After a brief pause, her son said, "Oh. Okay. Hey Mom! Can we stop at McDonald's?"

These "pivotal parenting moments" can take us by surprise so be prepared ahead of time. Answers should be honest, calm, matter-of-fact, and hopeful. We can emphasize our children's role in good self-care. We shouldn't use words like "fatal" or "life-shortening" nor should we make empty promises. Use words like “healthier” rather than “healthy”, “more likely to live a long time” rather than “will live a long time.”

The key is to show curiosity and interest, rather than fear and angst, while outlining the consequences of non-adherence. We need to try our best not let our own worries show- both in our words and body language. Children pick up on (and tend to mirror) their parents' emotional cues especially when they are young. If you are having trouble controlling your own emotions about these tough issues, grief counseling might be helpful.

At some point, the issue of shortened life-expectancy should be addressed if it doesn't come up naturally. Hopefully this will be clarified by around the age of eight (around 3rd grade) depending on the maturity of your child. This might sound young to some of you but we want our children to get this kind of information from us, not on the playground or online. And sadly, this does happen. We've heard so many stories of kids who become terribly upset after hearing difficult information about their illness from a thoughtless peer at school or on Facebook. It's best for parents to be in control of how this information is delivered.

One way to address this issue is to ask your child questions to open up dialogue. Some examples are:

·    “How much do you know about ____?”

·    “Is there anything about ______ that worries you?”

·    “How are you handling it?”

·    “What can I do to make things easier?”

·    “Is there anything more you need to know?

When your child asks a tough question and you are at a complete loss for words, it's perfectly okay to say something like, "Wow, that's a really good question and I want to do a good job of answering it. Let me think about it and then get back to you in a little while." Just be sure you do- preferably over a big bowl of ice cream or other  treat that you both enjoy.

With a little awareness and preparation, you can make talking about these difficult issues a positive experience. Relationships can grow closer when people go through tough times together.

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic®. Lisa C. Greene is a parenting educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health issues."  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com. 

© Copyright by Foster Cline, MD and Lisa Greene. All rights reserved.  

Successful Transitions: Honesty is the Best Policy

Last week we talked about how to use choices and questions to help children learn responsibility at as early an age as possible. This week, we talk about an important part of asking questions and giving choices: making sure a child has enough information to make good choices.

If a child does not understand the possible results and consequences of bad decisions, how can they make good ones? This is why it’s so important to teach your children early on about their medical condition and be honest about the consequences of non-adherence. Early education is critical. Children need to learn the facts and details about their medical condition including care requirements.

Many parents have a really hard time with this because of their own fears and emotions. I remember one dad saying, "I refuse to use the loss of a limb or eyesight or death as a threat to make my (ten-year-old) daughter take care of her diabetes. I don't want to scare her and ruin her childhood by telling her about these issues."

And, while I understand where he is coming from, this is not a wise decision in the long run. How can his daughter take her diabetes seriously if she doesn't know how serious it is? We certainly don't use these issues as a threat, but we do need to make sure our children are educated. And there's a big difference. But parents can understandably get this mixed up.

So, like this dad, we struggle with communication and, oftentimes, just don’t bring it up.  But then our kids learn about these things from other sources like thoughtless peers or the internet. Or, they just don’t make good choices about their bodies.

To help avoid these problems, start teaching your child about his or her medical condition at a young age with resources that are developmentally appropriate. There are many good books including ones for young children that address most special healthcare needs.

For cystic fibrosis, "Cadberry's Letters" and "Taking CF to School" are among my favorites. The website www.Jayjo.com has published “The Special Kids in School” series which includes most special needs and chronic illnesses. Your doctor may have good resources, too.

Honesty is important. In order for children to make good choices about their bodies, they need to know the truth about the potential consequences for bad ones.  Which will bring us to our blog for next week: Learning good communication skills for discussing difficult issues.

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Lisa C. Greene is the mother of two children with cystic fibrosis, a certified parent coach, parenting educator, and public speaker. She is also the co-author with Foster Cline, MD of the award-winning Love and Logic® book “Parenting Children with Health Issues.”  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com. 

Successful Transitions: Give Some Independence, Gain Some Cooperation

Up until now, in this series on transitioning from the pediatric to adult medical systems, we have focused on defining transition and why it matters.

Now, we are going to start looking at how to start the transition process at as young an age as possible. In fact, the transition to responsibility starts when kids are old enough to spit peas from the high chair!

First, let's briefly discuss the concept of “control.” Control is a basic human need just like food and water. When humans feel like they have no control, they do some pretty crazy things to get control including things that may be self-destructive. And when children have special medical needs, there are times when they have little or no control over their bodies. So much in their lives can feel out of control! And when they feel out of control, they can act out, misbehave, and cause all kinds of trouble. So, Love and Logic® teaches us to share control as much as possible.

 

1. The easiest way to share control is with choices. Rather than telling a child what to do and when to do it, use choices. What happens when we say to a child: “Come here and take your medicine!”?  Power struggle, arguing and complaining, right? Instead, try: “Would you like to take your pills with apple juice or grape juice?” or “Are you planning to do your medical treatment before or after soccer practice?”  Give choices as much as possible in all areas of life including food, homework, chores, and medical requirements. The more control is shared, the less the likelihood of control battles.

2. Replace statements with questions. Here's what Jim Fay, co-founder with Dr. Cline of Love and Logic, says about this: "How can we make sure that our kids are doing their fair share of the thinking? How can we keep ourselves from getting pulled into working harder on their lives than they are? How can we help them become prepared for a world full of decisions and consequences? Replace statements with questions.”

Some of the most powerful moments come when we empower kids by asking them what they plan to do about various situations instead of telling them what they need to do. The implied message we send says, "You are smart. You can come up with the answer." Children who are given this gift are far more likely to succeed in school and in life. On top of that, the human brain has a hard time ignoring the questions. It automatically searches for the answers - it just can't help itself.

What a gift we give kids when we encourage them to think rather than telling them what to do. A child who is redirected with the question, "Are you sure this is the right place for that behavior?" will respond much more thoughtfully than the child who is told, "Stop that!" One method invites thinking; the other invites resistance and battles for control. Which do you prefer? In either case, we are enticing young brains to do lots of thinking by simply asking questions rather than stating "how it is." So, do your kids' brains a favor and feed them a steady diet of questions." 

Some questions you might ask your child with special healthcare needs are:

"What kinds of foods can you eat today to get the proper nutrition?" 

"What do you think might happen to your body if you forget your medication?" 

"What is the best choice for your body?" 

 "Have you thought about what might happen if you don't listen to the doctor?" 

“What is your plan for getting your medical treatments done on time today?”

Give choices and questions a try especially if you are experiencing power struggles with your children. You’ll be amazed at how well they work to reduce power struggles and give your children the opportunity to do more of the thinking than you. 

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic^®. Lisa C. Greene is a parenting educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health issues."  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com. 

©Copyright by Foster Cline, MD and Lisa Greene. All rights reserved. 

Endless Parenting Struggles: When adult children rebel

A new question popped up recently from a concerned parent regarding her newly troubled adult son. Dr. Foster Cline gives his expert advice in regards to helping these parents deal with the situation.

Photo by Photostock

Question:
I have a 21 year old son.  His dad and I have not been together since he was 3.  He has always been a good boy and respectful. Now that he is living on his own, he is very verbally abusive. He does not want anything to do with his dad or I.  We have tried everything to get him to let us help him.  But he is just so mean and hateful. I feel he is crying out.  But will not let us do anything except he wants money from us.  Please help us help him. Kim

Successful Transitions: It All Starts with the Toddler Years…..

This is Blog # 4 in our Transition series. The last three blogs discussed what transition is and why it matters. This week, we start looking at parenting strategies for raising children with special healthcare needs who are responsible, independent, confident and prepared for the transition/ transfer into the adult medical system.
Raising Responsible Children

All children must make a shift from parental to personal responsibility. All children must learn to make good choices which are independent of active adult involvement. And when a child has special healthcare needs, there is the additional process of shifting the medical tasks and responsibilities.

The challenge is, telling our children to simply “Be responsible!” doesn’t work. It is ineffective to demand, “Do your homework, take your medicine, and make good choices." Responsibility is something that has to come from inside the child- not from parents trying to force it from the outside.  And taking responsibility starts early. In fact, learning about responsibility and making good choices starts when children are old enough to throw peas from the high chair!

This brings us to a critical subject: Parenting Skill Training. This includes how to talk and work with children: what to say and do when they are resistant, how to avoid power struggles in the first place, what responses work and don't work, and how to structure a home environment in such a way that best promotes responsibility, positive attitudes and a desire to make good choices. Research shows that parenting skills, responses, and disciplinary styles have a significant impact on all of this. 

If a child won't get their shoes on without arguing, brush their teeth without nagging, and pick up their belongings when asked, how can they be expected to do their medical treatments? Or, from an article called Take as Directed: Improving Adherence in the Primary Care or Specialist Care Setting by Edward Christophersen Ph.D. and Susan Mortweet VanScoyoc Ph.D.:

"In the area of pediatrics, an often overlooked but important part of the medical adherence equation is that of the general behavioral compliance of the child. It is unrealistic to expect a child who will not follow the directions of her parents on anything else to follow the directions of her parents with respect to medical regimens. Often, failures with complicated regimens like Type 1 diabetes could have been predicted by the parent's prior lack of knowledge of strategies for addressing general compliance issues."

So the big question is: How do we raise kids with special healthcare needs who are respectful, responsible and prepared for the real world?  Next week, we'll start to answer this question.

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic®. Lisa C. Greene is a parenting educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health issues."  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com. 

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Successful Transitions: Medical professionals share perspective and adviceSuccessful Transitions from Pediatrics to Adulthood: A Matter of Life and Death?

This is Blog #3 in our Transition series. The last blog discussed what patients have said about their transition experience. This week we'll discover what the medical professionals have to say.

Current research shows that an organized, methodical approach to transition is crucial. A. Kennedy et al. states: "Increasing evidence shows that adverse health consequences occur when inadequate transition arrangements are in place. Poor transition processes are increasingly recognized to have a significantly negative effect on morbidity and mortality in young adults."

Research also shows that starting the transition process early is essential. Research by Hewer and Tyrrell recommends that a formal "transition process should start from 11 to 13 years of age."

Unfortunately, this isn't happening in a majority of cases (in the cystic fibrosis community). In 2008, research of 87% of all US CFF-accredited programs shows that: "Although transfer of care in CF occurs at a median age of 19 years, initial discussion of transition does not occur until a median age of 17 years, leaving a limited amount of time for patients, families, and care teams to delineate and foster key self-care skills. In fact, an international survey of individuals with CF found that only 10% reported introduction of the concept of transition before the age of 15 years." (McLaughlin et al.) 

Researchers may recommend that the formal transition process start in the preteen years but child development experts recommend that a developmentally-based transition process ideally starts much younger.

Preschoolers can learn to label medical equipment, body parts and medications. They can help count out pills, push buttons on medical equipment, and answer basic questions about why they take medication. In our Transition Blog #1, we showed a simple transition plan for PKU starting at about age four.

Children in elementary school can start to take the responsibility for some aspects of their care with the watchful support of adults. Examples for cystic fibrosis might include independent management of pancreatic enzymes, initiating breathing and chest therapy treatments, and cleaning and properly storing medical equipment. These are all examples of transition tasks that can be, and should be, purposefully shifted much earlier than the preteen years.  

Transition is a cumulative process meaning that all of the little things we do over the years as a parent will "add up" and help our children be ready (as young adults) to successfully move into the real world. For our children with special healthcare needs, this includes the adult medical system.

Clearly this is a critical area that needs to be addressed by both parents and medical professionals. As parents, we must be proactive about initiating an effective transition process with our child even if our medical clinic lacks a formal one. So let's discuss the transition experience and examine ideas about how it can be most effectively accomplished from a parent's point of view.

The transition process really consists of two parts: the shifting of medical tasks and the shifting of personal responsibility in general. There is certainly some overlap but the personal responsibility piece encompasses a whole lot more than the medical tasks.

Generally speaking, if a child is responsible around schoolwork, chores, money, and basic self-care issues (like personal hygiene), then the child will be responsible around the medical tasks as well.  This is great news for us parents because general personal responsibility can be learned much earlier than medical tasks and around less risky issues.

Parents must focus their attention on two primary areas: Responsibility Training and Medical Task/ Disease Knowledge.  We will discuss these important areas over the next few weeks with this blog series on transition.

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic®. Lisa C. Greene is a parenting educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health issues."  For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com.