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.

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.  


  1. Thanks for the tips. Rachel (5) has been asking about CF off and on for a couple years now. I think I've done a fair to good job of answering her questions (age appropriate) but I will be using your sample questions in the future. They look very helpful.

  2. Thanks Sherry! It is a hard thing.... Take good care, Lisa


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