Thursday, August 16, 2012

Our Blog Has Moved....

Our blog has moved to a new location. Check out our NEW blog at http://blog.pcwhi.com/.

All of the blogs have been transferred over and our new ones are posting there. See ya at our new address!

Tuesday, May 15, 2012

Resilience Through Adversity: Gaining strength from life's hardships


Last week I attended a conference held by a pharmaceutical company for leaders in the bleeding disorder community. Many of the leaders were parents of a child with a bleeding disorder such as hemophilia or von Willebrand’s. Others had the diseases themselves and all were learning how to "tell their stories" in order to mentor and inspire others living with the disease. These folks came from many different backgrounds including ethnicities, geographical locations, and socio-economic situations. Yet, we were all bound by two things in common: our resilience in the face of medical adversity and our passion to help others cope well. It was an amazing experience.

Photo by PhotoStock
While working toward my masters degree, I was reading from a Walsh’s text “Strengthening Family Resilience” at the time of the conference. Everything that I was reading I was witnessing right in front of my eyes. For example, on page 7 she says: “As researchers have discovered, resilience is forged through adversity not despite it. Life crises and hardship can bring out the best in us as we rise to meet the challenges.” She quotes a study on resilient adults by Higgins (1994) that showed they “became more substantial because they were sorely tested, endured suffering, and emerged with strengths they might not have developed otherwise. They experienced things more deeply and intensely, and placed a heightened value on life. Often this became a wellspring for social activism, a commitment to helping others overcome their adversities; in turn they experienced further growth through these efforts." This was clearly apparent in the eyes and the hearts of the courageous and amazing people I met within the bleeding disorder community -  these are amazing people…



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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


Monday, April 30, 2012

Parenting Mistakes: We are only human!


After having an argument with my teenage son this morning, I was kind of feeling like a parenting failure. I lost my cool. Raised my voice. He stomped out the door. Pretty typical parenting story, especially with a teenager in the house! The difference is: I am a parenting educator. I am supposed to know better. And I do! And so I felt like a failure. How can I teach parenting skills including not responding with anger if I can't even do it myself?

Photo by PhotoStock
But then, a few minutes later, I thought: “Wait a minute. Just because I know what to do doesn't mean I will always do it. It's the human condition. In fact, even Paul in the Bible struggled with this: “I decide to do good, but I don't really do it; I decide not to do bad, but then I do it anyway.” -Romans 7:19

So as I'm pondering this, I'm feeling kind of bad. But then I realize, knowing good parenting and communication skills doesn't always mean that things are going to turn out perfectly. Life is messy and unpredictable.

What it does mean is that even in the face of things going badly, I know what to do (even if I don’t pull it off perfectly). I know how to turn it around later today, after we’ve both cooled off. I know that the limits I set with my son are right (this is what caused his frustration and argument). And, I know that even if things don't turn out well in the long run, I did it right as a parent. Most of the time. :) 


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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



Tuesday, April 17, 2012

Be a Contagious Encourager!

When times are tough or when children face tough times, it’s natural to feel discouraged. However, both encouragement and discouragement are the most contagious of emotions. Effectively showing encouragement will help our children better cope with their health issues. 
Image: Stuart Miles / FreeDigitalPhotos.net
Do you know what the opposite of encouragement is? It is generally the showing of frustration. Frustration creeps in as children grow older and parents start to realize they can’t control their children’s responses to their illnesses but somehow still think they should!

Show your children encouragement by the pleasure you display when you turn over increasing responsibility for healthcare to your children.  Start with small, steady increments in the early elementary years. “Wow, I bet you feel pretty good about the job you did on that!” Or, “How are you feeling about the decisions you are making?”  Correct wording such as this puts the problem on the resistant child while providing the child a sense of accomplishment for making healthy decisions. 
                       
As noted, the positive attributes of Encouragement are contagious. Simply saying, “I bet you are proud of how you remember your medicine” is more effective than saying, “I’m proud of the way you take your medicine.” Effective communication is easily learned and especially effective for kids with special healthcare needs. We give many examples in our book, Parenting Children with Health Issues.

Praise and encouragement are very different. The better the parent/child relationship, the better praise works, but praise can be used to manipulate both sender and receiver. Encouragement through questions puts the healthcare issues and results directly on the child. Questions promote a high self-image and allow the adult to express both joy and disappointment while encouraging the child to think. 

Love and Logic, a popular parenting program, teaches that curiosity and interest about self-care issues almost always trump worry and concern, just as ideas and thoughts trump advice, suggestions, and pleading. Questions give resistant children less adult emotion to manipulate but do show curiosity and interest. For example, asking a difficult child, “How do you always manage to remember to take your medicine?” is generally more effective than, “Good job on remembering your medicine.”

Descriptive phrases help children focus on and evaluate their accomplishments, treatment decisions, and results rather than provide the child with outside judgments. Resistant children can easily negate non-descriptive praise for a number of reasons. “I notice that…” is a good way to begin a descriptive phrase.

So use descriptive phrases, ask lots of questions, and keep your frustration from showing. Your children will feel good about themselves from the inside out rather than needing your approval to feel successful and encouraged.  
                                                           
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Visit www.ParentingChildrenWithHealthIssues.com for articles, Ask Dr. Cline, and free audio. The book Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Other Special Needs by Foster Cline, M.D and Lisa C. Greene is available online and in bookstores. 


Dr. Cline is a well-known child psychiatrist, author, and co-founder of the popular Love and Logic parenting program. Lisa Greene is the mother of two children with cystic fibrosis and a family life educator.






Tuesday, April 3, 2012

Successful Transitions: Focusing on Medical Tasks

We have been blogging for several weeks about how to increase the odds of raising children with special medical needs who are responsible, confident, and independent in all areas of life including around self-care issues. Now let's look briefly at the subject of shifting the responsibility of medical tasks.


Knowledge of Disease, Medical Requirements, and Medical Tasks


Happy Family Photo
Photo by PhotoStock
There are many medical details around managing a long-term, serious, chronic illness including nuances that can only be learned over time. Even medical professionals don't always know the "right" thing to do when things start to change.


In addition to medical knowledge, there are also the financial, insurance, and legal details that go along with it all. The average eighteen-year-old, unless properly trained for years, will not be prepared to manage it all without substantial help. That's why starting a phased, methodical training program at a young age is crucial.


Some medical clinics have "transition plans" written out to help you know what types of medical knowledge and tasks should be taught at the different ages and stages of your child's development. Others clinics don't or are working on it but it takes time, even years, for medical institutions to start a new program. In the meantime, your child is getting older.


If your child is age eleven or older, start working on this on your own. If your clinic doesn't have a transition plan, check around at other medical centers.  There are also good resources available for transition in general. Here’s a link to one of our favorites from The Institute for Child Health Policy at the University of Florida: 
http://hctransitions.ichp.ufl.edu/hct-promo/


With some planning and parenting education, parents can massively increase the odds that their child will be ready to move up and out into the adult world. Not only is this good for the child, but it's also good for parents and medical professionals.


Everyone wins when a hopeful, optimistic, young adult goes out into the world with confidence and says: "I can do it! I recognize this world because we practiced for it at home!"


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Many of these concepts are from the award-winning book “Parenting Children with Health Issues" by Foster W. Cline M.D, child psychiatrist and co-founder of Love and Logic, and Lisa C. Greene, mom of two kids with cystic fibrosis and parent educator. Visit www.ParentingChildrenWithHealthIssues.com.





Thursday, March 29, 2012

Successful Transitions: Harnessing the Power of Example

One of the easiest ways to help children learn responsibility, make good choices about their bodies, and pave the way to a successful transition/transfer is using the power of example. Kids learn far more from the examples we set than from the words and lectures we give them. The concept of example is so simple yet so powerful once we know how to use it properly. 


Children learn how to behave by watching and copying us just like we learned from our parents. Kids will do what we do, not what we say. So, as parents, we need to take good care of ourselves. This includes taking some time for ourselves, taking good care of our bodies, and making sure we are getting our own needs met. It’s not selfish to take good care of ourselves; it’s healthy and necessary. 


Along similar lines: if we want respectful, responsible kids who are pleasant to be around, then that’s how we need to be. We can never ask more of our kids than what we are willing to give of ourselves. 


This includes not only how we treat them but also how we allow them to treat us. So if we allow our kids to be disrespectful to us, then they are learning by our example to allow others to treat them badly. And they are not learning- from our example- how to set healthy boundaries with others. 


Many loving parents spend a lot of time concerned with: “How can I make my child happy? How can I make sure my child has a high self-image? How can I do more for my child?” Such parents often live in a child- centered universe where the atmosphere in the home becomes polluted by the entitled little kings and queens of the estate.  


Entitled children are often unpleasant to be around. Well, aren’t we all at times?! Yes, but we should certainly be pleasant most of the time and we have a right to expect that from others including our children. And when children are routinely unpleasant, many parents wonder what they can do to make their children more pleasant… how can they “happy the kid up?”

When children are unpleasant to be around, many parents resort to demands focused on the child’s behavior. So what comes out of the parents’ mouth is something like, “Stop it” or “Quit that” or “Shape up” or whatever. If only it were that simple but you know better. Here’s where setting an example comes in.

Setting the example means that in a loving way we take good care of ourselves. We talk about ourselves (not how bad the child is behaving) and we focus on what’s good for us.  We show that we feel good for our children when they succeed and make wise decisions. And we respond lovingly but firmly when they make bad decisions. Our message is always: “Sweetheart, I love you no matter what but I won’t allow you to treat me badly.” When we set that type of example, the child grows and, in a healthy way, focuses on what’s good for him or her. They become more immune to peer pressure and less likely to tolerate unwise relationships.

Here's an example: If things aren’t going well, after a brief exploration of the situation (keeping in mind that all children have a right to protest until it slides into downright obnoxiousness), a fed-up parent might say, “Stop it!”  


But it’s so much more effective to set the example and take good care of yourself by lovingly saying something like: “Honey, I’m not feeling very good about the way you’re behaving right now. I can understand why you’re frustrated but your whining and complaining about checking your glucose level is hurting my ears. Why don't you go hang out in your bedroom for a little while. Feel free to come back as soon as you can talk nicely.”


You might be thinking: “What?! Are you saying that I should dismiss my children from my area simply because they are not being pleasant to be around?!!!”


We are. And so will your child’s first spouse if that behavior doesn’t change. Isn’t it better for children to learn that life lesson from loving parents?


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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


Parenting Children with Health Issues Book



Wednesday, March 21, 2012

Successful Transitions: Building Hope and Resilience with Encouragement


In our last couple of blogs in our transition series, we have talked about how to respond to children with medical issues when they make mistakes or poor choices. This week, we’ll talk about how to respond to children when they make good choices and decisions particularly where their bodies are concerned. 

When children do something well, most adults respond with praise: “Good job!” or “Good girl (or boy)!” While this sounds fine on the surface, praise like this can cause problems. 

The challenge is that praise is really an external judgment of the child’s performance and can backfire if a child is resistant, doesn’t feel like being judged, or doesn’t particularly like the parent (or praiser) at the moment. And, of course, false praise almost always leads to disrespect. Children tend to catch on pretty quickly when adults are giving undeserved praise or trying to manipulate with praise or flattery.

So use encouragement instead! Be specific and positive with encouraging phrases when you speak to children. Encourage them to evaluate and think about their choices and the consequences of their actions. Encourage them with questions so that they are proud of themselves for making good choices.  This motivates them to continue to take good care of themselves.
Don’t say, "I'm glad you listened to me and didn't go camping with a cold." Or “Good job staying home and taking care of yourself!”
Do say: "Do you feel good about your decision to stay home and take care of yourself?" or “How do you feel about your decision to stay home?”
Don’t say: "I am proud of you for remembering to take your medication on time.”
Do say, "Wow! You must be proud of yourself for remembering to take your medication." Or “How do you manage to remember to take your medication on time?”
Of course, a big part of encouragement is having a positive “You can do it!” attitude ourselves, as parents. Remember the importance of example or modeling. 

Are we saying that you should never use praise? Of course not! Praise can be effective with young children who are learning a new task or good habits. However, don’t overdo praise or you risk turning a child into a praise junkie! 

Effectively showing encouragement will help your children better cope with their health issues, make good choices and build hope. Your children will feel good about themselves from the inside out rather than needing your approval to feel successful. 



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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


To learn more about encouragement, see the book "Parenting Children with Health Issues" on pages 88-93

Tuesday, March 13, 2012

Successful Transitions: How Do You Raise Wise Children?


All parents want to raise wise kids. But where does wisdom really come from? 

Intelligence is not the same as wisdom. Our children may have good information about their medical conditions. However, even when they have enough education and intelligence to drive good decisions, that does not always translate into the wisdom needed to take good care of themselves especially with an illness like cystic fibrosis, hemophilia, or diabetes where the results of poor care may be decades away.

So where does wisdom come from? Don’t we hear that “Wisdom comes from trial and error?” There are plenty of sayings: “Wisdom comes from experience” or “Wisdom comes from the school of hard knocks,” etc.

Unfortunately, wisdom only comes with trial and error if the error is accompanied by negative consequences that can be correlated. The correct way of stating that, as unpopular as it may be in modern-day America, is: “People have to suffer the consequences of their mistakes and poor choices.”

This means that when our children make a mistake, we don’t just automatically always rescue them.  Instead, we respond by loving them, talking it over with them, and providing ideas about how they might get themselves out of a challenging situation.

Parents who raise children without wisdom usually do it by making two common mistakes. First, they try to make sure their children don’t make mistakes. Secondly, when their children do make mistakes, the parents try to fix it. They do something outside the child’s skin to make it better.

Wise parents who raise wisdom-filled children respond to the situation by talking it over with the child so he or she learns from the mistake. They put all their energy into what’s going on inside their child’s skin.

When children are ill, this is a difficult concept because parents of ill children are normally overprotective. They have to be in the early years. But as the child grows older, it is essential for the parents to back off, put less energy into making sure the environment responds correctly to their child, and spend more energy into ensuring their child can cope with all environments.

In other words, parents put less energy into fixing things outside the skin and more energy into growing a child with the wisdom to handle what the environment throws at him or her.
So, instead of trying to prevent or fix mistakes, allow children to experience the natural consequences of their choices (as long as they don’t result in serious or irreversible harm). It’s better for a child to learn about safe driving by crashing a tricycle on the lawn and skinning up knees than cracking up the family car at age seventeen!

There’s no better teacher than the school of hard knocks. Start early; when the price tag for mistakes is much lower.
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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.  

For more tips about how to use consequences to raise wise kids, check out the book “Parenting Children with Health Issues”.  


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

Wednesday, March 7, 2012

Successful Transitions: What Do You Do When Your Kids Make Mistakes?

Photo by Photostock

One of the big challenges that we face as parents of children with special medical needs is dealing with the extra stress and frustration that comes with the territory. When our kids make mistakes, especially around their medical care, it’s so easy to fall into a pattern of nagging, lecturing, yelling or punishing. Brain research shows that these are not effective responses. Think about it. How would you feel if you made a mistake at work and your boss yelled at you? You’d be polishing up your resume to find a new job. Our kids are no different except they don’t have the luxury of finding new parents!

When we start giving our children some of the responsibility to handle their health care requirements, then we need to be prepared for mistakes and poor choices. Kids are human. They will forget to take their medications. There will be times that they choose not to do medical treatments for a variety of reasons. However, our children will either learn or not learn from these mistakes and poor choices depending on the way we respond to them. 

So instead of getting mad when your child makes a mistake or a poor choice, be sad for them. Responding with empathy, or sorrow, prior to imposing consequences is more effective than anger, punishment, nagging, lecturing and "pushing." Anger and punishment cause fight or flight responses; its fear and guilt based. Lectures and nagging cause children to become annoyed or tune out. Pushing a kid a kid to do it right causes increased resistance. Empathy and consequences teach children to think and are more likely to result in a learning experience. Plus, you up the odds that you will have a good relationship with your children over the years.

There have been times when Lisa's children decided to put off their breathing treatments until later in the day. Then they forgot altogether. Mom and Dad's response has been along the lines of, “Oh sweetie, what a bummer. We won’t be going out to dinner (at your favorite restaurant) now because we won’t have enough time to do both.”

This type of response makes a much bigger impact than lecturing, nagging, yelling, or threatening. For success in parenting, use few words and meaningful action instead.


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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.  



For more tips about how to use empathy, check out the condensed version of “Parenting Children with Health Issues”.   


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

Tuesday, February 28, 2012

Successful Transitions: Start Early, Little by Little


Transition should be a step-by-step process starting as early as possible; preferably when our children are toddlers. You've all seen the milestone charts we get from our pediatricians at well-baby visits, right? Children reach milestones in how they play, learn, speak, behave, and move.

For children who have special medical needs, there are also milestones for their illness including the self-care skills they should be doing independently. Many illnesses have transition plans which provide a step-by-step plan for keeping a child moving forward in areas they should be growing and taking responsibility.

One of the most common patterns of transition mismanagement is that of a parent who does it all even past early childhood. Then, the kid becomes a teenager and parents suddenly want the child to do more and take more responsibility.  Of course the teen resists getting dumped on and everyone is set up failure. 

So instead of falling into this pattern, wise parents lovingly lay the responsibility for medical adherence on their child in small, age- appropriate increments as early as possible. When we use choices and questions and allow our children to make their own decisions early on, they will grow in responsibility naturally. Lisa shares an experience:

At about age six, my son surprised me by putting on his vest (a mechanical chest physical therapy device) and loading up his nebulizer with medication right out of the blue because he “wanted to get it done before his friend came over so that they could play longer.” At the time, I didn’t realize he was ready and capable of starting up his own treatments. Since the toddler years, we have given Jacob many choices around when, where and how he does his treatments. Notice we don't give him the choice IF he does his medical treatments. We set firm limits around treatments being completed within a certain time frame.  

When we teach our children early on and empower them to make choices, they might surprise us with what they can really do! When we become a watchful manager, rather than doing everything for our kids, it makes our lives easier, too.


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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.  

Tuesday, February 21, 2012

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.  


Tuesday, February 14, 2012

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.  

Tuesday, February 7, 2012

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

Tuesday, January 31, 2012

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. 

Thursday, January 26, 2012

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

Tuesday, January 24, 2012

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

Tuesday, January 17, 2012

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