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Responsibility is kind of like that gooey, green slime kids love to play with. It oozes around in a family and can slither off in all different directions. Parents can easily slosh, slip and fall when carrying ooze that should belong to the kids. It’s pretty frustrating to slip on ooze that someone else should have scooped up! The ebb and flow of slime, or responsibility, becomes very important when life and death issues are present in a child’s life.
Both of our children have cystic fibrosis. It takes a lot of effort to keep them healthy. Between them, they take eleven different types of pills each day, three inhaled medications, plus two chest physical therapy routines. In addition, they have special dietary requirements so there is plenty of responsibility that can ooze around and slither off in different directions. It can be very easy to get stuck in the muck!
Our kids are very good about taking responsibility for their medical requirements but it wasn’t always this way. I became quite an expert on what not to do because I tried it all! I have also learned from other parents who are having a hard time with their older kids now. Here are some things that don’t work; do any of them sound familiar?
• Telling a child what to do and when to do it
• Sheltering them from the realities of their medical condition
• Taking on all of the responsibility
• Showing anger and frustration when mistakes are made
• Giving praise instead of encouragement
Talk about frustration and sloshing around in the ooze of responsibility! So, what can you do to help your children take responsibility for their healthcare requirements? Here are some important concepts that I’ve learned while working with Foster W. Cline, MD, a child psychiatrist and co-founder of Love and Logic®:
1. Rather than telling a child what to do and when to do it, use choices and questions. Kids need to feel like they have some control over their bodies just like we adults do. What happens when we say to a kid: “Come here and take your medicine!”? Power struggle, arguing and complaining, right? Instead, try this: “Are you planning to do your breathing treatment before or after soccer practice?” or “Would you like to take your pills with apple juice or grape juice?” or “When will you do your physical therapy today?” Give choices as much as possible in all areas of life including homework, chores and medical requirements. The more you share control, the less you’ll fight over it.
2. Teach your children early on about their medical condition and be honest about the consequences of non-compliance. One of the most challenging things for parents is to have a difficult discussion about life-threatening content in a matter-of-fact manner. The key is to show curiosity and interest while outlining the consequences (of non-compliance) and show no fear and angst about the issue. Generally speaking, if parents don’t show fear and angst, then the child won’t become fearful. Children pick up on our cues. Usually we don't know exactly how to handle these issues with our kids, so if we ask questions, they actually end up guiding us. If that method is good enough for therapists, it's good enough for parents! Some good questions to ask are:
• “How much do you know about your illness?”
• “How worried are you?”
• “How are you handling it?”
• “What can I do to make things easier?”
• “Is there anything more you need to know?”
3. 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 allow our children to make their own decisions early on, they will grow in responsibility naturally. Jacob, at age six, stunned me by starting up his Vest (a mechanical chest physical therapy device) right out of the blue because he “wanted to get it done before his friend came over.” I didn’t even realize he knew how to work the thing! Since he was four, we have given him many choices around when, where and how he does his CPT.
4. Be sad when your child makes bad choices, not mad. When we give our children appropriate responsibility to handle their health care requirements, then we need to be prepared for mistakes. Kids are human. They will forget to take their medication at lunch. However, the way we respond to the mistake can make all the difference in whether or not our child learns from it. Responding with sadness is always more effective than anger. There have been times when our children have decided to put off their breathing treatments until later in the day but then forgot. Our response has been along the lines of, “Oh sweetheart, 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.”
5. Allow your child to experience the consequences of their mistakes when the price tag is small. Love and Logic parents raise kids who understand that their actions have consequences - both good and bad -which will affect the quality of their lives. Allow your children to experience the natural consequences of their non-life or limb threatening choices instead of rescuing them. It’s better for a child to learn about safe driving by crashing a tricycle than cracking up the family car at age sixteen! There’s no better teacher than the school of hard knocks. Start early; while the price tag for mistakes is much lower.
6. It is more effective to give encouragement than praise. When parents say things like “I’ll bet you’re really proud of yourself” rather than “I am proud of you” then they child give their child the glory when good decisions are made. 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 at the moment. And, of course, false praise almost always leads to disrespect. Questions are again very useful. Asking a child, “How do you always manage to remember your medication?” is much more effective than “Good job on remembering your medication.”
My last, and perhaps most important, thought for you is around parental self-care. Take good care of yourself. This includes taking the responsibility for meeting your own physical, mental, emotional and spiritual needs. When we take good care of ourselves, then our children learn from our example and are more likely to take good care of themselves, too. I know it isn’t easy but here is the good news: The more responsibility our children take for themselves, the less we have to do for them. Best wishes for a healthy, happy family!
Lisa C. Greene is the co-author, with Foster W. Cline, MD, of the book Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Special Healthcare Needs. Lisa is the mother of two children with cystic fibrosis and a parent educator.
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