The following information can be found in "A Tiny Boat at Sea" (Izetta Smith, M.A., CGT, 2000). This book was designed for parents and caregivers to help children who have a parent diagnosed with cancer, but the information is easily transferable to help families affected by other illnesses. The book describes the following developmental stages for children facing the illness of a family member, and offers tips for how you can help.
Infants
When an adult caregiver in a baby’s life is diagnosed with a critical illness, the baby may experience significant changes in his/her routine. Babies who experience these changes may become agitated. They may have difficulty eating and sleeping. They may be more susceptible to colds or indigestion.
How to help:
- Give or get help in providing a lot of physical contact and reassuring attention to the baby.
- Maintain a baby’s routine for physical needs as best as you can (i.e. feedings, sleep schedules, walks, playtime).
- Hold the baby gently if a baby is agitated and crying. While the baby cries, you can say in words or in your touching and holding of the baby, “I love you. I’m here. I am sorry it hurts.”
The young child (2-6 years old)
A young child understands the importance of the event when someone close is diagnosed with a critical illness, even though the child may not understand what the illness means.
How to help:
- Use the simple, truthful words (cancer, chemo, etc.) about the illness with the young child.
- Allow the child to ask questions over and over. When you don’t know the answer, say “I don’t know.”
- Allow the child to make choices about being exposed to the medical parts of your treatment. These opportunities may help a child learn about what has happened.
- Maintain structure and routine.
A child may have difficulty falling asleep, night sweats and/or dreams from which they may wake up crying. Young children often work to integrate a trauma while they are asleep. Listen to the images of their dream for this is an opportunity to hear a child’s feelings in their language.
- Tolerate a child’s temporary need to become “younger.” A child may lose ground with potty training. A child may return to sucking fingers or pacifiers. A child may become clingy or want to sleep with you or others. Allow for this process, and, when it is time, gently challenge the child to regain lost ground.
- Recognize that children’s daily frustrations – in dressing, eating, playing, etc. – may be more intense because they are fueled by their feelings about the diagnosis of their loved one. Hold and love a child as best you can in order to allow him/her to cry their way through their frustrations.
- Give a young child outlets for the big energy of their feelings (i.e. active play, yelling, sports). Designate an area of the house as the “big energy corner” for hitting and throwing pillows, yelling and being mad.
- Allow a child free and joyful fun. Children have a wonderful sense of taking breaks from their difficulties. Learn from them and try to do so yourself.
The school aged child (6-10 years)
A school-aged child is still processing the important events of his/her life through the body in her/her play. Yet language is growing as a tool for the expression of feelings and the gaining of understanding. The family is the basis of security for a school-aged child. Home is the major environment within which the child learns how to express feelings. However, peer relationships and school are becoming important influences in a child’s discovery of him/herself.
How to help:
- Continue to answer children’s questions honestly and as many times as asked.
- Offer to include the child in seeing some of the medical aspects of the illness. Always ask a child whether he/she wants to be involved and how.
- Find out when a child’s thoughts confuse them. For example the illness of a family member:
∙ is NOT a punishment for a child’s bad behavior;
∙ is NOT a monster that comes to get you;
∙ is NOT contagious.
- Lower your expectations, if need be, of your children’s schoolwork, because they are using a lot of their energy to cope with family changes. Work with school officials to tailor a child’s workload during difficult times.
- Read out loud books that have stories about the illness of a family member.
- Encourage sports and active play in order to lessen a child’s anxiety and physical tension.
- Create a “big energy corner” of your house for the expression of big energy feelings.
- Encourage art, music, dance, singing, crafts and other expressive processes.
- Offer lots of hugs and holding.
- Find peer support groups for your child and for you.
The pre-adolescent (10-13 years)
Language plays a larger part in the pre-adolescent’s life, although play is still important.
The pre-adolescent swings back and forth between the family and peer relationships for his/her primary support.
Emotions are heightened in the pre-adolescent’s life by the onset of puberty. Yet emotions are often perceived as a threat to this child because they represent being younger, a state the pre-adolescent is struggling to overcome.
How to help:
- Expect a child of this age to be in battle with his/her emotions. Respect this child’s efforts to control or conceal his/her vulnerability. Be available, but don’t push.
- Expect that the pre-adolescent may feel physically ill (i.e. headaches, stomach aches, colds).
- Encourage peer relationships and involvement. Look for peer support groups.
- Answer questions honestly and thoroughly. Be as detailed and scientific as you know how if the child asks for information. Stop explanations if a child shows loss of interest.
- Encourage physical outlets for the child.
- Let the child cuddle or cry in your lap as he/she did when younger.
The adolescent (13-19 years old)
Teens are fast developing their reasoning powers and use discussion as a primary form of learning and processing the significant events in their loves. They are beginning to discuss concepts such as illness, mortality and the meaning of life.
The peer group is becoming the primary support for a teenager. The family remains a significant resource, but the teen is ambivalent about dependency on the family. A diagnosis of cancer in an adult family member can present for a teen a conflict between his/her needs to focus on the critical matters at home and the need to assert his/her independence.
Teens are extremely self-conscious, especially about ways they are different from their peers. The adults in a teen’s life may not hear nor observe the teen processing his/her feelings about the traumatic events. A teen’s feelings may be well disguised or saved for special friends.
How to help:
- Make time for your teen, even if you are not taken up on it. Occasionally remind the teen of your availability.
- Expect to hear a teen discuss the illness amidst larger issues such as the meaning of living, the unfairness in the world, etc.
- Expect that a teen may exaggerate the importance of certain aspects of this experience. Strong feelings may seem out of proportion. Allow for and accept these emotions.
- Encourage peer support for the teen.
- Expect that a teen may want to be out with his/her friends at important times during the illness.
- Expect that you may not know parts of what the teen is thinking and feeling about the illness.
- Expect and encourage a teen to have relationships with other adults.
- Expect periods of prolonged sleeping and inactivity, as well as periods of highly charged and frenetic behavior.
- Expect eating habits to fluctuate. Provide a structure for eating appetizing food.
- Friends can help get a teen involved in physical outlets for his/her feelings (i.e. sports, dancing, working out, etc.)
- Friends can help get a teen involved in expressive outlets for his/her feelings (i.e. choir, drama, crafts, etc.)
- Watch for drug and alcohol use and get professional help immediately if you suspect it.
- Allow a teen his/her defensive behavior in hiding feelings, as long as it doesn’t hurt him/her or others.
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