Accountable Kids
Teaching children to take responsibility for health issues.
Responsibility. While parents want their kids to take more of it, kids generally don't want it.
Responsibility is kind of like that gooey, green slime children love to play with. It oozes around in a family and can slither off in all different directions. Parents easily slip, falter or fall when confronted with ooze that belongs to the kids. And it's pretty frustrating to slip on ooze that someone else should have scooped up! But the ebb and flow of slime, or responsibility, becomes essential 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 alive. Our children require a collective 11 types of pills each day, three inhaled medications, plus two chest physical therapy routines. Our kids also have special dietary requirements. In sum, there is plenty of responsibility that can ooze around and slither off in different directions. It's a cinch to get stuck in the muck.
While our kids are now great about taking responsibility for their medical requirements, it wasn't always this way. I became an expert on what not to do to encourage responsibility, because I tried it all. 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 children from the realities of their medical condition
- Assuming 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. What can you do to help your children take responsibility for their healthcare demands? Here are important concepts that I have learned while working with Foster W. Cline, M.D., 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 as if they have some control over their bodies. When we say to a kid "Come here and take your medicine," power struggles, arguments and complaints result. Instead, try asking a question like: "Are you planning to do your breathing treatment before or after soccer practice?, "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 children's 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 tasks for a parent is to have a difficult discussion about life-threatening scenarios in a matter-of-fact manner with a child. The key is to show interest while outlining the consequences, such as of noncompliance, and to show no fear or angst about the issue. Often, if parents don't show fear and angst, then the child with a health problem won't become fearful because children pick up on our cues.
We don't always know how to handle serious health threats with our kids. However, if we ask questions, children 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 your concerns?
- What can I do to make things easier?
- Is there anything more you need to know?
3. Lovingly lay the responsibility for compliance on your child in small, age-appropriate increments as early as possible. When we offer choices and allow children to make their personal decisions early on, children naturally become more responsible. At age 6, Jacob stunned me by suddenly starting up his Vest— a mechanical chest device used for physical therapy. Jacob said he did this because he wanted to get it done before his friend came over. Before that moment, I didn't even realize Jacob knew how to work the device. Yet, since Jacob was 4 years old, we have given him many choices concerning when, where and how he does his chest physical therapy.
4. If your child makes a bad choice, be sad, not mad. In giving our children appropriate responsibility to handle their health requirements, we need to be prepared for mistakes. Kids are human. They will forget to take their medication at lunch. And the way we respond to each mistake can make all the difference in whether or not our child learns from it. Responding with sadness is more effective than anger. There have been times when our children have decided to put off their breathing treatments until later in the day and then forgot. Our response has been along the lines of: "Oh sweetheart, what a bummer. We won't be going out to Chuck E. Cheese for dinner now because we won't have enough time to do both."
5. Give encouragement. It is more effective to give encouragement than praise. When parents say things like "I bet you're really proud of yourself,." rather than "I am proud of you," parents 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, false praise almost always leads to disrespect. Questions are again useful. Asking a child, "How do you always manage to remember your medication?" is much more effective than "Good job on remembering your medication."
6. Take good care of yourself. My last and perhaps most important point involves parental self-care. This includes taking the responsibility for meeting your personal physical, mental, emotional and spiritual needs. When we take good care of ourselves, then our children learn from our example and become increasingly likely to take good care of themselves, too. It may not be easy, but here is additional good news: The more responsibility our children take for themselves, the less we have to do for them.
Lisa C. Greene is the co-author, with Foster W. Cline, M.D., of Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Special Healthcare Needs (Love & Logic Press). Greene is the mother of two children with cystic fibrosis and a parent educator. For more information, visit www.loveandlogic.com and www.parentingchildrenwithhealthissues.com.