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.  

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

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.