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The Center for Grieving Children 555 Forest Ave, Portland *phone (207) 775-5216* fax (207) 773-7417
                        cgc@cgcmaine.org email * www.cgcmaine.org website



 HELPING CHILDREN COPE WITH SERIOUS FAMILY ISSUES

                           Kathleen McCue, MA, LSW, CCLS

   PRINCIPLES FOR COMMUNICATION WITH CHILDREN ABOUT FAMILY ILLNESS

           Children are part of their families. Any important events in the family affect all
           members.
           Children are individuals, with unique needs and reactions.
           Children are not just small adults. Development phases impact coping style and level
           of understanding.
           Children need honesty to retain trust. A trusting relationship between an adult
           caregiver and a child is the foundation for mastery of any stressful experience.
           Parents are the best to help children deal with confusing or stressful events.

   THE ULTIMATE DILEMMA WHEN THERE IS SERIOUS FAMILY ILLNESS

  Children need more support, more time, more attention, and more patience…
      And parents have less available personal resources, less time, and less tolerance.

               Therefore, parents feel the effects of being pulled in multiple directions.

   THE THREE MOST COMMON CONCERNS OF CHILDREN

                             1. How will my life be affected?
                                   2. Did I cause this?
                      3. Can I catch this? or, Will this happen to me?


  STRESS POINTS FOR CHILDREN

       Diagnosis
       Times of separation
       Treatment cessation
             - Due to control or cure
             - Due to disease progression
       Death
CHILDREN’S REACTIONS TO PARENTAL ILLNESS


               NORMAL NEEDS                   SIGN OF STRESS
               ♥Trusting relationships        ♥Upset, fearful behavior
               ♥Consistent routines           ♥Problems in eating or
Infants                                        sleeping

               ♥Parental guidelines           ♥Angry, acting out behavior
               ♥Opportunities to exert        ♥Loss of skills such as
Toddlers        some control                  ♥toileting, self dressing


               ♥Simple explanations for       ♥Sleeping, eating
                new or unexpected              disturbance
Preschoolers    situations                    ♥Being “too good”, quiet,
               ♥Identifications of feelings    withdrawn
               ♥Opportunities for play        ♥Clinging, baby-like
                about life events              behavior


               ♥Accurate information          ♥Worry and sadness
               ♥Reassurance about own
School Agers    health                         illness
               ♥Clear rules and               ♥Anger
                expectations                  ♥School problems
                                              ♥Isolation
               ♥Privacy and respect           ♥Unusual hostility and
               ♥Complete information           defiance
                and involvement               ♥Extreme mood swings
Adolescence     in family decisions           ♥Trouble with friends
               ♥Strong peer                   ♥Withdrawn and
                relationships                  significantly non-
                                               responsive
TO HANDLE SERIOUS FAMILY ILLNESS, CHILDREN NEED…


Preparation for what they will experience:

        ♥ Children handle change and disruption best if they have time to understand
            potential impact on their lives.

Education about the unfamiliar aspects of the situation:

        ♥ Material should be provided at the child’s development level.
        ♥ Avoid euphemisms.
        ♥ Use familiar experiences.
Opportunities to Express Feelings:

        ♥ Allow children to see adult expressions of feelings.
        ♥ Expect emotions to vary widely, and to cover a wide spectrum of possibilities.
Support and Guidance:

        ♥ Provide clear boundaries.
        ♥ Maintain normal expectations.



                   THERAPEUTIC PLAY MATERIALS
                                 FOR
                  CHILDREN OF SERIOUSLY ILL ADULTS

Basic                                          White paper, markers, crayons, scissors, small
                                               “medical” kit with real equipment, soft baby
                                               doll, assorted small animals, assorted small
                                               cars, cloth puppets, nerf ball, book of jokes and
                                               riddles, magic wand, mazes, several books on
                                               feelings, illness and parent/child issues

More Elaborate                                 Punching bag; doll house, tape recorder and
                                               blank tapes, Velcro dart set, tea party supplies,
                                               Legos or blocks
REFERENCES
Christ, GH; Siegel, K; Sperber, D; “Impact of parental terminal cancer on adolescents”, American
Journal of Orthopsychiatry, 1994, 64(4), 604-613.

Davis, B “sibling Bereavement: Research-based guidelines for nurses”; Seminars in Oncology
Nursing, 1993, vol. 9,no2, 107-113.

Lewis, FM; Ellison, E; Woods, NF; “The impact of breast cancer on the family”, Oncology
Nurse, 198, 1:206-213.

Lichtman, RR; Taylor, SE; Wood, JV; “Relations with children after breast cancer: The mother-
daughter relationship at risk”, Journal of Nursing and Social Oncology, 1984, 2:1-19.

Morgan, J; Sanford, M; Johnson, C; “The impact of a physically ill parent on adolescents: Cross-
sectional findings from a clinic population, Canadian Journal of Psychiatry, 1992, 37, 423-427.

Norris-Shortle, C; Young, PA; Williams, MA; “Understanding death and grief for children three
and younger, Social Work, 1993, 38(6), 736-742.



LITERATURE

When A Parent Is Sick, Edna LeShan, Atlantic Monthly, 1986. Written for older school-agers and
young adolescents, this book identifies the many responses a child might have to a parent’s
illness, hospitalization or death. Special focus is given to living with a chronically ill parent and
to mental health problems.

Why Me? Coping With Family Illness, Ann Kosef, F. Watts, 1986. For the older child, this book
presents interviews and case examples of various young people who are coping with serious
illness, either their own or a member of their families. Several good summaries of responses to
parental illness are included.

Helping Your Child Handle Stress. Katherine Kersey, Acropolis Books, 1988. Gives excellent,
practical examples of how parents can help children who exhibit signs of stress. There is a good
example of an intervention with a three year old whose mother has been hospitalized with a brain
tumor.

Moms Don’t Get Sick. Pat Brack with Ben Brack, Melins Publishing Corp., 1990. An excellent
description of one woman’s reactions to the diagnosis and treatment of breast cancer. It includes
multiple comments by the author’s 10-year-old son. Emphasis is placed on emotional reactions of
all members of the family to the major illness, and various coping styles and techniques are
highlighted.

How To Help Children Through A Parent’s Serious Illness. Kathleen McCue with Ron Bonn, St.
Martins Press, 1994. A practical guide for helping children at each stage of a parent’s illness.

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602 c sylvester mccue handout

  • 1. The Center for Grieving Children 555 Forest Ave, Portland *phone (207) 775-5216* fax (207) 773-7417 cgc@cgcmaine.org email * www.cgcmaine.org website HELPING CHILDREN COPE WITH SERIOUS FAMILY ISSUES Kathleen McCue, MA, LSW, CCLS PRINCIPLES FOR COMMUNICATION WITH CHILDREN ABOUT FAMILY ILLNESS Children are part of their families. Any important events in the family affect all members. Children are individuals, with unique needs and reactions. Children are not just small adults. Development phases impact coping style and level of understanding. Children need honesty to retain trust. A trusting relationship between an adult caregiver and a child is the foundation for mastery of any stressful experience. Parents are the best to help children deal with confusing or stressful events. THE ULTIMATE DILEMMA WHEN THERE IS SERIOUS FAMILY ILLNESS Children need more support, more time, more attention, and more patience… And parents have less available personal resources, less time, and less tolerance. Therefore, parents feel the effects of being pulled in multiple directions. THE THREE MOST COMMON CONCERNS OF CHILDREN 1. How will my life be affected? 2. Did I cause this? 3. Can I catch this? or, Will this happen to me? STRESS POINTS FOR CHILDREN Diagnosis Times of separation Treatment cessation - Due to control or cure - Due to disease progression Death
  • 2. CHILDREN’S REACTIONS TO PARENTAL ILLNESS NORMAL NEEDS SIGN OF STRESS ♥Trusting relationships ♥Upset, fearful behavior ♥Consistent routines ♥Problems in eating or Infants sleeping ♥Parental guidelines ♥Angry, acting out behavior ♥Opportunities to exert ♥Loss of skills such as Toddlers some control ♥toileting, self dressing ♥Simple explanations for ♥Sleeping, eating new or unexpected disturbance Preschoolers situations ♥Being “too good”, quiet, ♥Identifications of feelings withdrawn ♥Opportunities for play ♥Clinging, baby-like about life events behavior ♥Accurate information ♥Worry and sadness ♥Reassurance about own School Agers health illness ♥Clear rules and ♥Anger expectations ♥School problems ♥Isolation ♥Privacy and respect ♥Unusual hostility and ♥Complete information defiance and involvement ♥Extreme mood swings Adolescence in family decisions ♥Trouble with friends ♥Strong peer ♥Withdrawn and relationships significantly non- responsive
  • 3. TO HANDLE SERIOUS FAMILY ILLNESS, CHILDREN NEED… Preparation for what they will experience: ♥ Children handle change and disruption best if they have time to understand potential impact on their lives. Education about the unfamiliar aspects of the situation: ♥ Material should be provided at the child’s development level. ♥ Avoid euphemisms. ♥ Use familiar experiences. Opportunities to Express Feelings: ♥ Allow children to see adult expressions of feelings. ♥ Expect emotions to vary widely, and to cover a wide spectrum of possibilities. Support and Guidance: ♥ Provide clear boundaries. ♥ Maintain normal expectations. THERAPEUTIC PLAY MATERIALS FOR CHILDREN OF SERIOUSLY ILL ADULTS Basic White paper, markers, crayons, scissors, small “medical” kit with real equipment, soft baby doll, assorted small animals, assorted small cars, cloth puppets, nerf ball, book of jokes and riddles, magic wand, mazes, several books on feelings, illness and parent/child issues More Elaborate Punching bag; doll house, tape recorder and blank tapes, Velcro dart set, tea party supplies, Legos or blocks
  • 4. REFERENCES Christ, GH; Siegel, K; Sperber, D; “Impact of parental terminal cancer on adolescents”, American Journal of Orthopsychiatry, 1994, 64(4), 604-613. Davis, B “sibling Bereavement: Research-based guidelines for nurses”; Seminars in Oncology Nursing, 1993, vol. 9,no2, 107-113. Lewis, FM; Ellison, E; Woods, NF; “The impact of breast cancer on the family”, Oncology Nurse, 198, 1:206-213. Lichtman, RR; Taylor, SE; Wood, JV; “Relations with children after breast cancer: The mother- daughter relationship at risk”, Journal of Nursing and Social Oncology, 1984, 2:1-19. Morgan, J; Sanford, M; Johnson, C; “The impact of a physically ill parent on adolescents: Cross- sectional findings from a clinic population, Canadian Journal of Psychiatry, 1992, 37, 423-427. Norris-Shortle, C; Young, PA; Williams, MA; “Understanding death and grief for children three and younger, Social Work, 1993, 38(6), 736-742. LITERATURE When A Parent Is Sick, Edna LeShan, Atlantic Monthly, 1986. Written for older school-agers and young adolescents, this book identifies the many responses a child might have to a parent’s illness, hospitalization or death. Special focus is given to living with a chronically ill parent and to mental health problems. Why Me? Coping With Family Illness, Ann Kosef, F. Watts, 1986. For the older child, this book presents interviews and case examples of various young people who are coping with serious illness, either their own or a member of their families. Several good summaries of responses to parental illness are included. Helping Your Child Handle Stress. Katherine Kersey, Acropolis Books, 1988. Gives excellent, practical examples of how parents can help children who exhibit signs of stress. There is a good example of an intervention with a three year old whose mother has been hospitalized with a brain tumor. Moms Don’t Get Sick. Pat Brack with Ben Brack, Melins Publishing Corp., 1990. An excellent description of one woman’s reactions to the diagnosis and treatment of breast cancer. It includes multiple comments by the author’s 10-year-old son. Emphasis is placed on emotional reactions of all members of the family to the major illness, and various coping styles and techniques are highlighted. How To Help Children Through A Parent’s Serious Illness. Kathleen McCue with Ron Bonn, St. Martins Press, 1994. A practical guide for helping children at each stage of a parent’s illness.