When a family is facing a child’s illness or a challenging condition, such as a learning disability, it can be helpful to ask how they have managed other problems in the past. While the problem they are now facing may feel unprecedented or overwhelming, they have usually managed other challenges, such as moves, changes in employment or financial setbacks. Perhaps there has been a parent’s broken leg, Alzheimer’s disease in a grandparent, or even the loss of a beloved pet. Find out how the family has managed communication in these circumstances, have they been clear and honest, in age-appropriate ways with their children? Have they been attuned to their children’s questions and concerns, and available to really listen? Have they tried to focus on protecting essential family time (remember mealtimes?) and their children’s routines both in and out of school? Listening to these past situations and responses is caring, respectful, and in and of itself supportive. As their pediatrician, you needn’t teach them these skills, but merely remind them of those that they already have.
If you have asked about mealtime and bedtime, you will have a clinical sense of what life is like for your patient and this family. You will look for patterns that generally support development – thoughtful planning, patience, empathy, and connectedness – and you will intuitively know whether this family would benefit from some health promotion. What you learn may be directly helpful concerning mealtimes or bedtime. Asking the questions communicates a precedent that you are interested in the family and how it functions. With experience, you also will be able to make inferences about the relationship between the parents, how the family handles stress, and what are the family’s expectations. All of this information will build attunement and trust. It will enable you to ask the right questions and make more effective interventions throughout your work with your patient and their family.
Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief clinical officer at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@frontlinemedcom.com.
This column, "Behavioral Consult," appears regularly in Pediatric News, a publication of IMNG Medical Media.