Backward Parenting a Child with Pain (2)

As I mentioned in Part One, parenting a child with chronic pain may feel counterintuitive. But there are reasons for all of the “backward parenting” suggestions when trying to lift young people from their sick role—which is the main goal in resuming normal functioning.

This parenting style is very different from what you would do if your child has an acute injury or illness. In that situation, parents should be helpful, nurturing, and coddling. With chronic illness or injury, though, your job as a parent is to get your child back on her feet—literally and figuratively.

Do not comment when your child seems happy to play or facetime with a friend, but too unwell to do homework.

Leyla is a 12-year-old girl with belly aches. She often complains of pain when it’s time to log onto Zoom school or do homework—but then she “seems fine” when her only friend asks her to play Roblox together.

Her parents told me they’re confused by this discrepancy. It makes them wonder if she’s faking her pain to get out of doing things she doesn’t like.

Unfortunately, they’ve started commenting on this to Leyla.

Resist the instinct to point out this discrepancy to your child!

When you’re in pain, don’t you find it easier to do something fun than something difficult or boring? If you have a headache, you may still go to the basketball game you’ve been looking forward to but hesitate sitting at the computer to do more work.

You can still have expectations of your child. Just don’t comment on how he complains of pain “only” when there is something he doesn’t want to do, like homework or chores.

There are two significant reasons why you shouldn’t point this out:

• 1: It’s important for kids to participate in activities that are distracting and that put their pain in the background.

This break in focus on their pain is helpful in eventually permanently breaking the pain cycle. Even more importantly, it increases their willingness to engage in life, even before their pain resolves.

If parents point out this “discrepancy,” it encourages their child to avoid pleasurable activities in order to keep parents from expecting them to do things that feel too hard when they’re in pain.

The tough part about treatment for pain is that functioning has to precede pain relief—another “backward” concept. This means that your child has to actually participate in the world before the pain will resolve. In other words, your child should not wait until the pain stops to start doing stuff—because the pain won’t stop until she starts doing stuff!

That’s a hard sell, but it’s easier if the activities are enjoyable and distracting. Once your child is engaging in pleasurable activities more regularly, the pain will improve enough that you can then gradually add in more difficult activities, such as schoolwork and chores.

This doesn’t mean that your child should be watching Netflix all day just because he says it distracts from his pain. While screen time distraction is helpful in moderation, it doesn’t promote functioning in the world like socializing does.

It’s also important to figure out why certain activities are difficult for your child or cause him pain. That way, you can work together to resolve the issues.

With Leyla, we determined what made Zoom school difficult for her. She has limited eyesight, so online school was particularly tiring. We had the teacher institute many mini breaks throughout the hour and include some times when Leyla could choose which subject to focus on. These accommodations were helpful to her, and she complained less often about belly aches during school hours.

• 2: If you point out to your child that she “seems fine” when doing a pleasurable activity, then your child will think you don’t believe she is in pain.

She’ll think you don’t understand that it’s easier for her to tolerate her pain when she’s distracted. This will almost always lead your child to regress in functioning.

In addition, she will increase her pain complaints in order to prove that she is not well. This doesn’t mean that she’s faking. But if Leyla’s pain is actually at a level 5—and her parents comment that she seems fine playing with her friend—she will have to act like her pain is at a level 8 in order to prove to them that she is not fine. She’s not faking the pain but may feel she has to exaggerate the level so that her parents believe she has any pain at all!

On the other hand, if you acknowledge that pleasurable activities are easier for her to handle when in pain, your child will less likely feel the need to regress to prove her pain.

In turn, you can increase your expectations of her, and add incrementally more difficult undertakings. Once your child accomplishes a challenging task, it is vital to make sure you continue to acknowledge that she is in pain, struggling, or not feeling well. If you don’t, your child will believe that you think she’s all better or pain free.

So, be sure to end all praise with an acknowledgement of how difficult the activity was for your child. For example, “I am so proud that you pushed yourself to do some homework, even though you aren’t feeling well,” or “That is really wonderful that you got to school today, even though you are in pain.”

These strategies are a win-win because less pain complaints and greater functioning lead to reduced pain and your child getting her life back!