Backwards Parenting Blog #4
Brought to you by CHYP’s Parenting Blog
July 5th, 2021
By: Samantha Levy, PhD
Welcome to my next installment of “Backwards Parenting” your child with pain.
As I’ve said before, parenting goals are different when your child has acute pain (from a recent injury like a broken arm) — where there is identifiable damage to the body — from when she has chronic pain — where there is no longer identifiable damage to the site of the original injury (e.g., the arm has healed from the break, but has developed a central nerve issue and now has Complex Regional Pain Syndrome (CRPS)).
The overarching goal of helping your child heal from chronic pain disorders is to help bring him out of the “sick role” and away from the identity of being sick or disabled.
If your child has an acute injury or illness, you may ask how she is feeling to determine if you should give her medication, bring food to her in bed, let her watch TV all day, take time off work to care for her, and so on.
But when an illness or injury becomes chronic, you have to parent backwards to help pull your child out of his predicament. The goal is for your child to see that he has pain, not that he is a pain patient.
The lesson of the day: DO NOT ask your child how she is feeling.
When you ask your child how she is feeling (“Are you in pain? What is your pain level? What does it feel like? Does it feel better or worse than before the medication?”), it focuses her attention on her pain. If she happens to be distracted from her pain at the moment, and then you ask about it, she will scan her body and draw attention to the pain again.
The goal is to treat your child like he is as normal as possible in order to break the focus on the pain/illness, help pull him out of the identity of a disabled or fragile person, and promote healthy functioning. (You don’t ask your child without a pain disorder if he is in pain!)
Most kids are very relieved to hear that their parents will not be asking them about their symptoms anymore. For those who feel it means their parents don’t care, we explain the reasoning behind it and let the kids know that they can express that they are in pain. They just won’t be prompted by their parents to do so.
You know how your child is feeling.
Some parents ask me how will they know if a medication or treatment is working without asking their child. I tell them, “You’ll know” — based on the child’s affect, complexion, and behavior.
Evaluate how your child is feeling based on what he is doing, not what he is saying. If he says he is still in just as much pain as usual, but now he’s suddenly able to walk upstairs, he is improving!
Resist the urge to point this out, though, but note that the treatment or medication is helping. Always look at the behavior changes, rather than the reports of pain level (as Dr. Paul Z. always says, “Watch the feet, not the mouth!”).
Justin was a 12-year-old 6th grader when he came to me with chest pain. As the team worked with him, he continued to report a 10 out of 10 pain level. Yet during the time we worked with him, he went from completely isolating himself — not going to school or anywhere else — to being a very social kid in full time school and activities. Yet, until the end of treatment, he continued to report 10 out of 10 pain levels.
Break the cycle of fixation on pain.
Asking about pain levels also keeps the focus on the pain disorder and therefore reinforces the child’s identity as ill or fragile. Ideally, we want to expand on their identity in other ways and work on steps toward strength and resilience.
Part of CHYP’s mission is to foster identity as an artist rather than just as a kid with pain. But the more you ask about your child’s pain, the more they see themselves – as one parent put it — as a “professional patient.”
Julia worked with me as a 15-year-old with CRPS. She complained that ever since she developed chronic pain, the “only thing” her mom talked to her about was her chronic pain – i.e., medications, her pain level, and doctor’s appointments. She had fully taken on the identity of a disabled person, and it was clear that her mother’s questions and discussions focusing on medical issues were reinforcing this identity.
We decided on a time each day (right after dinner) that they would review appointments and other medically-related topics. All other times were reserved for topics not related to pain.
On the flip side, if your child complains about pain 24/7, it’s important to find ways to help “unstick” him from his preoccupation with pain, because this hinders his return to healthy functioning.
It could mean that your child is not feeling heard or is fixating on the pain. In this case, we develop specific complaint times during the day which are the only times she is allowed to complain of pain.
Andy was a 14-year-old who had abdominal pain, and he complained to his mom all day and night. He seemed unable to focus on anything other than his pain. It was very difficult for his mother to handle — despite feeling terrible for him, her tolerance was waning.
We told Andy he could only complain about pain three times per day. During those pre-determined times, he could complain for 10 minutes straight with his mom’s full attention.
If Andy started complaining at another time, his mom would gently remind him that he had a complaint time coming up soon and would have to wait until then. Andy ended up never using the entire 10 minutes because that’s a long time to complain uninterrupted!
After about a week, he got the hang of it and started engaging in other activities. He turned his focus away from his constant preoccupation with his pain and only needed about 2 minutes per complaint time. Eventually we were able to decrease to two complaint times, and so on.
For the child who complains periodically — but not so much that complaint times are necessary to implement – it’s difficult not to indulge her when she is in pain. However, with chronic pain, it’s important to be sympathetic, but then quickly move on to another topic instead of dwelling on the pain complaint. This may mean making a brief, caring statement, and then using distraction to take her mind off her pain.
Reinforce “well behavior.”
For those who have developed secondary gains for being unwell (and most have), there are very obvious ways to change the behavior reinforcement pattern.
Jane was a 9-year-old client of mine with headaches. Both her parents worked full time. When Jane had a bad headache, the school would call her grandmother to pick her up from school early.
When I asked Jane what she and her grandmother did after that, she said, “We go out to lunch.” So we changed that sequence – after early pick-ups, grandma starting bringing her straight home. Jane got nothing fun if she came home before the end of the school day. But if she stayed all day at school, she and her grandmother would stop for a snack or treat on the way home. Therefore, the “well behavior” was reinforced instead of the “sick behavior.”
Pay more attention to your child when she is not in pain than when she is.
We are all so busy. It’s easy to ignore your child when she is not complaining and then attend to her when she is—the squeaky wheel gets the grease. However, it is very important to notice when your child is not complaining of pain and/or is behaving with more normal functioning.
This is the time to give lots of attention, such as increased eye contact, a spontaneous hug, the offer to spend time together, etc. It’s a subtle and effective way to help reinforce “well behavior” as opposed to “sick behavior.”
Your goal as a parent is to help your child get well and one step is to help him or her see the benefits of climbing out of the sick role.
Samantha Levy, Ph.D. is a clinical psychologist who received her Ph.D. from Georgia State University in the Child and Family specialty track. During her clinical child internship at UCLA in the child track, she became involved with the Pediatric Pain Program (PPP). Subsequently, she obtained her postdoctoral training with the PPP. Depending upon the case, Dr. Levy works either with whole families, individual children/teens, or parents. She employs an array of psychological orientations (e.g. CBT, play therapy, mindfulness, meditation), to help the children/teens with their pain and any accompanying emotional issues. She helps the parents and patients understand the connections between the physical pain and emotional difficulties (mind/body connection). She teaches parenting skills and helps parents make plans to facilitate change in their children, such as in their difficult struggle to give their children the courage to begin functioning more fully in the world once again. Dr. Levy is open to conducting child, teen and parent support groups when there is interest. Dr. Levy is a member of CHYP’s Clinical Advisory Board.