Pacing Your Child’s Recovery: Part 1
Brought to you by CHYP’s Parenting Blog
August 16th, 2021
By: Samantha Levy, PhD
Welcome to another installment of Backwards Parenting your Child with Pain.
For this week and the following week, I’m posting a two-part series dealing with the importance of “pacing” when your child starts to improve.
Normally, we like to have children jump right back into things—get back on the horse, so to speak. And that’s typically a good idea.
However, as usual with chronic pain, we have to do things backwards. We need to encourage them to re-engage slowly but surely, like the tortoise in “The Tortoise and the Hare” fable.
Since it’s back-to-school season, “Pacing Your Child’s Recovery: Part 1” deals with…
Getting Your Child Back to School
School reintegration has to be done at a slow, steady pace.
Schools are notorious for expecting either no on-campus attendance (putting the student on “home hospital”) or full attendance on campus. They always insist that you cannot do both. But I have found that with persistence and a good explanation, they usually find a way to bend.
The way I explain it to the administration is that the student has to return on a rehabilitation model. I compare returning to school with recovering from knee surgery.
In that situation, the physical therapist would have the patient slowly build up to more and more exercise. The patient would not run a mile on the treadmill right after surgery (which would be the equivalent of returning to campus full time, right away). Nor would he refrain from all exercise because the knee would get stiff and weak (the equivalent of home hospital and no on-campus classes). The knee surgery patient would start small and build up – which, in this analogy, would be the equivalent of attending more and more classes gradually.
I explain to administrators that kids with pain tend to be worse in the morning, so we usually start by eliminating at least first period. Then, we ask the student which class feels easiest to attend—sometimes it’s an elective, and sometimes it’s something that is difficult to learn at home, like a language or a lab science.
If the child is motivated by seeing friends, we start with just coming for lunch, and maybe staying for the period right after lunch (once they are there for lunch, it is easier to get them to stay). Then we build towards staying longer. Once they are staying from lunch until the end of the day, we build backwards to include periods just before lunch, and then earlier and earlier classes.
This can be flexible and individualized. For example, I had a client who loved choir so much that she was willing to go to campus for choir at 7:30 a.m.! After a while, we had her stay for one period afterwards, and then slowly built up from there. Another client who loved choir had it at the end of the day, so she’d go to choir and then started coming to school earlier and earlier.
Sometimes there’s a period between the ones they will be attending in person. When this happens, I have the school arrange a place (e.g., library, resource center, dean’s office) where they can do their work independently, whether it’s an online course or homework from a teacher.
For the classes that the student is not yet attending on campus, he can either take those online, have a home hospital teacher come to tutor him, or just get the work from the teachers, do it at home, and then turn it in when he’s on campus for other classes.
Your child may also not be able to make it to school 5 days per week at first. Set a reasonable goal and then reward that goal. It may be that your child starts by staying for a set amount of time, 3 days per week, and then gradually adds in a day at a time.
If you have a child who will only do the minimum possible, reward her for going in more days or staying longer on any given day than expected. If your child tends to push herself, then limit the time at school to what was preset and reward her for pacing herself.
Another way to implement pacing and decrease the stress of returning to school (therefore making it more likely that your child will actually go) is to start with the goal of just making it into the classroom and sitting through class.
I even tell my clients not to worry about paying attention, as long as they are there, in class. Once they succeed with that, then they start taking notes and doing in-class work. The last step is adding in homework. This has to be done with the school’s approval, but it is an effective way to get kids back to school.
There are so many ways to get your child to re-engage in school, but schools can be very rigid. It takes persistence and education on your part. Teach the school counselor and/or school nurse about the rehabilitation model. They can be helpful advocates for you.
Connect with friends before going back to school.
One of the primary reasons that kids hesitate going back to school is that they’re out of the loop socially. That’s why you must encourage your child to start connecting now with classmates, before going back to school. This can be tough if your child has been out of touch for a long time. She can start by texting the old friend who she feels the most comfortable with and saying that she is hoping to get back together again.
The other main social obstacle is the discomfort of not knowing what to say when kids ask your child where he’s been. The good news is that because of the pandemic, many kids have not been in school in person. Schooling for the past year and a quarter was so disjointed, that it might not even be obvious that your child was out of school.
But if it is obvious — especially if your child has been out of school and out of touch with friends since before the pandemic – some kids will invariably ask your child where he’s been and/or what was wrong with him. I suggest keeping the answer short, simple and don’t make it sound contagious (especially now!). Have your child refrain from using the word “sick” or from giving medical details.
For example, if your child has CRPS, he can say something like, “I had this bad problem with my leg that I was dealing with, and I had so many appointments that I didn’t have time to come to school.” If he had headaches, he can say, “I was dealing with really bad headaches, and I never knew when I was going to get them. It was hard to come to school consistently, so I just did online school instead.”
Make sure to get a 504 Plan for your child.
A 504 Plan provides accommodations for your child within the standard instructional environment, such as turning in assignments late without penalty, not being penalized for missing class, sitting in a special chair, or being able to leave the classroom to use the restroom at any time without asking for permission.
First, list the accommodations your child would benefit from and then request a 504 meeting to review the accommodations and put them into a formalized plan.
One beneficial accommodation is having the school ensure that your child has a buddy in each class that can give her notes and homework assignments on the days that she misses class.
Make sure to include the accommodation that your child is not penalized under the “participation” part of the grade for missing class, and that she has one day to make up assignments for each day that she missed class.
A 504 Plan is fairly easy to get, and is a much less involved process than an IEP (Individualized Education Plan) because it does not require special instruction.
The school may imply that your child has to start coming full time ASAP, but it’s rarely the case that they enforce that.
If your child is in elementary or middle school, it’s very rare that they do not pass a student on to the next grade, as long as she meets the basic grade level proficiency, even if she missed a lot of school.
If your child is in high school and needs 5 years to graduate, it will not affect his or her life in any way in the future. That’s just what your child needs to succeed.
Whatever happens at the beginning of the school year, don’t lose faith. The year is long, and there is time to slowly get used to being there and doing work. Don’t forget, summers can also be used to catch up on missed work.
[Don’t miss next week’s “Pacing Your Child’s Recovery: Part 2” for the importance of pacing your child’s recovery while re-engaging at home and in extracurricular activities.]
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.