Truth is Ageless

It occurred to me the other day that while I mention our daughter (a/k/a Finally Five) quite frequently, I haven’t discussed her specifically in quite some time.

People thoughtfully inquire about her all the time. I’m so appreciative.

It still amazes me that some people ask “Have you told her what is going on?” Ahem…Y E S! I explain as calmly and as cooly as I can that…Of course I’ve told her because I firmly believe that there is a moral imperative to communicate and engage with ALL children…in a developmentally appropriate way…throughout the entire process.

Other people ask “How is she haaaaandling everything?” She’s doing as well as she possibly could, thankfully.  I happen to believe that a big component of her adaptation has been due to her incredible support system and the fact that we have engaged her in the process since the time of the diagnosis.

Additionally, I’ve received quite a few emails in the last week from friends and readers who (sadly) tell me that they are dealing with a health crisis in their lives…and wonder how to talk with kids.

So, I thought now would be as good a time as any to dig into my Child Development resources and experiences and share with you the best personal and professional techniques for informing and comforting children through the illness trajectory.

My philosophy, as you know by now, is that communicating with and including children in the process is imperative for buffering the stressors and cultivating resilience.

 

 

Children go through fairly predictable stages of growth and development.  Knowing what to expect at each stage allows you to be alert to problems, feel relaxed about expected behaviors, and respond in helpful ways. The best place to start is where a child is, emotionally, socially, and mentally.

Each child is unique.  Children think differently than adults, and the younger the child, the more cognitive divergence we see. Please don’t let this be a barrier to understanding a child’s perspective.

Children live in the present and tend not to make links between past and present experiences. The best thing that an adult can do for a child is provide information, comfort and support in a style that is best suited to the specific nature of a child.

Children take coping cues from their parents. If you’re calm, it’s likely that they will be calm.  If you flip out, it’s likely that they will flip out. It’s like holding a mirror up to your face. (And I’ll admit, sometimes it ain’t pretty!)

When circumstances are extraordinarily difficult, having a great support system in place helps immensely. Note I said a “great” support system, which is not necessarily a large system.  Having more people around is not necessarily better.  Quality support over quantity is the best bet. This support system (in the form of a neighbor, teacher, relative) can be organized in such a way to not only help with ADLs (Activities of Daily Living), but also to facilitate open communication with a child.

Prior to a developmental shift (or growth spurt) a child has a normal period of regression.  The “two steps backward, six steps forward” kind of thing. During these periods of transition, children have less ability to tolerate the stresses and frustrations associated with illness in their family.

Sometimes a child’s development may fall outside of described stages.  Not a big deal, but you do want to be aware of and pay attention to it, because it could be indicative of a problem or it could just be that your child marches to a different beat.  There are plenty of normal, healthy children who don’t follow described stages for one or more aspects of development.

There are gobs of charts and graphs that outline major stages of child growth and development.  I’m going to consolidate the information (which is soooo hard to do!) with hopes that you can use this information as a starting point if you or a loved one is coping with a crisis in your life.

Infant development is inherently tied to the progression of the infant’s relationship with caregivers.  Infants need adult partners who can help them negotiate the developmental tasks of maturation, e.g., regulation, attachment, play.

During this first year, babies learn to trust and depend on others.  They slowly become able to allow their mothers to be out of sight without rage or fear, trusting that they will return. Infants develop attachments and gradually gain control over motor skills.

The infant’s capacity to discriminate between sounds, colors, objects, characteristics of persons, and other differences develops rapidly during this first year of life. From birth onward, infants notice differences and similarities and remember them.

How to help? Infants need predictable contact with recognizable, loving caregivers who tend to their basic need for food, clothing, shelter and love. Consistency and predictability (e.g., eating & sleeping schedules) are the #1 priorities for an infant in general, but especially for one whose parent is ill.

Did you know that there is more growth and development between birth and 3 than any other period in a person’s life?  I was astounded and excited to learn this in graduate school.

The overall tasks of children in this phase of development is on balancing attachment and exploration, with increasing movement toward autonomy and individuation. During this stage, children begin to recognize the difference between “I” and “You.” There is a stubborness that stems from the separation and individuation that happens during this period, e.g. “I do it!” or “Me get it!” …and the dreaded “MINE!”

Their moods and cooperativeness may fluctuate as they adjust to new situations and build confidence.  Although children may begin to use symbols to represent things, their world is understood based on what can be seen directly, with these perceptions dominating judgments.

Also during this period, children internalize parental values and standards, e.g., children begin to be kind (relatively!) to others or put trash in trash cans.

Children need support to continue the work of gaining control over bodily functions and to feel more comfortable asserting independence. If developmental milestones are delayed, there is a potential risk of a child having feelings of shame, doubt, fear, and poor self esteem.

During this period, children put more emphasis on what they see rather than what they are told (about an illness or treatments, for example).  For example, children may find it difficult to believe that treatments are making you better if you appear sicker than you did before.  They also develop the ability to symbolize, through mental representation, play and communication.

How to help? Again, keeping a consistent schedule with a predictable routine is the #1 priority.  Additionally, simple, and precise information should be delivered, e.g., “The medicine is making me look sicker, but it will help me get better.”  Identify the obvious, then ask them if they have any questions or, in other words, what they wonder about. You can also use a doll (or stuffed animal) to role play illness and build a symbolic story around it.

Preschool children have something cool called magical thinking.  They weave together  fantasy and reality in their own creative way and believe that everything that happens is related to or caused by them. A perfect example of magical thinking occurred when Finally Five once said to me, “If I hug you, will it cause the cancer to get worse?”

This omnipotent magical thinking can potentially lead to a sense of responsibility for the parent’s illness, which can cause or exacerbate anxious behaviors. Children during this period further develop the use of symbols but still draw conclusions about their world based on what can be seen directly or by what they can understand.

The preschooler handles the need to learn about the “real world” by assimilating reality into fantasies driven by her wishes and needs. During this period, children develop play as a vehicle for exploring reality.  Toward the end of this period, they will make a transition from viewing the world based on egocentricity and magical thinking to a more logical and reality-based view.

How to help? The three most important things to tell children during this age is:

1. No one caused cancer. I consistently remind Finally Five that she is not responsible for my fatigue or crankiness.  Sometimes ask her to tell me what she imagines caused my cancer.  She says, “No one knows, Momma.  I know I didn’t cause it.” Music to my ears.
2. It is not contagious.
3. You will be taken care of while I’m sick.

Additionally, it is important to help children communicate what they are feeling and thinking and to encourage social interactions with others.  The use of play and fantasy are great tools to ease anxiety.

It is imperative to make sure that a child’s school – including teachers, counselors, and school nurse – know what’s going on.  These people will be allies in watching over children’s emotional health and looking out for signs of problems.  They need to be on board from the time of diagnosis.

 

The school-age child seems calmer, somewhat more serious, and less spontaneous than the preschooler.  During these years, children learn from others as well as by self-exploration. They develop real-world skills and a sense of competence.

Friendships begin to develop outside the family, with “best friend” relationships and same-sex peer groups becoming an increasingly important part of their world. Healthy self-esteem develops as they build on their fund of knowledge and repertoire of skills and enjoy success with relationships outside fo the family. Without these, children are at a risk of feeling inadequate or inferior.

This period of childhood is also characterized by a child’s capacity to maintain states of self-control, calm, pliability, and educability. Good self-regulation is essential to the to the developmental tasks of school age, including a sense of her capacity to work, to learn skills through practice, and to develop feelings of competence and self-esteem based on how she compares with peers.

How to help? School-age children benefit from opportunities and encouragement to explore the world and develop friendships outside the home.  When a parent needs treatment that is prolonged or away from home, try to engage the support system that includes friends.

It is important to keep in mind that a school-age child’s conceptions of time and space are still developing.  If a child seems to see everything in an all-or-nothing terms, try to encourage more flexible ways of thinking.  For example, help them understand that toxic cancer treatments can be life-saving.

 

Adolescents work towards independence from their families and search for their own identities.  Their bodies undergo sexual development, and their body image changes.  As they sort through the difference between how they appear to others and their own self-image and as they clarify their self-identity and social role, they often display unpredictable and varying mood swings, ambitions, desires and levels of dependence or independence. I know, I know. This is an understatement, right?!?

During these years children develop a scientific understanding of cause and effect and an ability to use reasoning.  Their fund of knowledge and repertoire of skills continue to expand, as does their creativity and wasy of thinking abou tthe world around them.

No one knows how a teenager will respond to a parent’s illness.  In fact, a teenager facing a parent’s illness may go off in all different directions, and that’s normal.

How to help? Teens benefit from encouragement and support as they continue to gain knowledge and skills, explore self-identity, and integrate into the world outside of the family.

Most adolescents seem to need a huge amount of information.  In addition to basic information about the disease, they will likely ask for the technical terminology and even statistical information on survival rates. Those teens who want detailed explanations about a parent’s illness do better when this information is provided to their satisfaction, truthfully. For those who don’t need to know the particulars, forcing information on them can be harmful.

Adolescents may or may not talk with their parents.  What’s important is that they have someone with whom they can talk.

Teens need the opportunity and support to develop healthy friendships or love relationships.  Difficulties may arise when they feel conflict between the demands at home and the desire to be the same as their peers and when all family decisions seem to revolve a parent’s illness.

Teens try on adult behaviors and can assume some adult responsibilities for short periods of time.  When parents are stressed by serious or chronic illness the distinctions between teenagers and adults may become blurred. It is important to remember that teenage children are still children.  Please don’t ask them to be surrogate parents to younger children or surrogate partners for the well spouse.  Burdens should be shared with other adults, not the adolescents.

It is important to acknowledge the inherent conflicts of having a family member who is ill.  Whenever it is possible, it is a great idea to give teenagers choices and help them maintain a sense of control over aspects of their environment, a principle that applies to children of all ages.

 

 

 

Children who have had difficulty such as anxiety, depression, difficulty making or keeping friends, challenges with schoolwork, or had conflicted relationships with close family members prior to diagnosis, may be at greater risk for trouble in coping with the changes and challenges currently faced. This is another example in which the support system can be exceptionally useful.

Because children are affected by everything that happens in the family, it is imperative to always tell children the truth.  The more serious the situation, the more they will be impacted.  Lying, in any way, will inevitably make things worse.

One very important thing to keep in mind is something D.W. Winnicott pointed out in 1965….and happens to be one of my favorite & most poignant things that I learned in graduate school. Winnicott said that parents do not  need to be perfect but rather “good enough.”  Although “good enough” parents make mistakes and may at times be inconsistent, overall they carry out the normal functions of parenthood.  “Good enough” parents are able to see their children realistically, have expectations of those children that are consistent with their actually developmental level, and have the capacity to empathize with the children’s point of view. In other words, parents do the best that they can for their children, given what they have (Silver Lining).

I hope that this information is helpful to you or to someone you know.  Unfortunately, challenging life circumstances abound (e.g., illness, divorce). No one is left untouched.  The Silver Lining, though, is that there are tools…ways to communicate with and include children so that it is possible to not only survive, but sometimes even thrive!

The truth is appropriate for all ages. Children need to know.

– The HOTY (a/k/a Husband of the Year)