When a parent or grandparent has a stroke or other sudden health incident and has become fully or partially disabled, talking to children about it can be a delicate endeavor. The task can be especially challenging if the beloved adult no longer communicates or moves as s/he once did. How should this conversation be approached and what words should a caring adult use? I sat down with Los Angeles-based psychologist Dr. Bonnie Berman to get insights into the best approach.
Q: What should a parent consider before speaking to a child about a loved one who has had a stroke or other health incident that has left them partially or fully disabled?
Dr. Berman: I recommend five basic considerations. First, what is the child's relationship to the person who has become disabled? Has this person been instrumental in the child's life or is it a more casual and infrequent relationship?
Second, how old is the child? With a young child, use easy-to-understand and non-alarming language, but a teenager can hear more details.
Third, check in with your own feelings. If you feel too distressed to speak without breaking down, wait until a time when you feel more resilient and prepared to manage the child's feelings, questions and/or fears.
Fourth, reassure children that the concrete details of their own lives (friends, schools, availability of their caretakers) will not be disrupted.
Fifth, be prepared to respond to questions. Speak honestly, but adjust the length and complexity of your answers to the child's age and maturity.
Q: What are the main points to share in this conversation?
Dr. Berman: I recommend brief, simple explanations with correct medical terminology. For example, a parent might say, "Grandpa had to go to the hospital, because he had a stroke. The reason he had the stroke was because the blood flowing through his body was blocked, and it could not get to his brain."
A child may seem flooded or overwhelmed, and some might walk away or change the subject. Others want to know whether you or the child could also suffer a stroke or whether the stroke occurred due to an accident or argument. The parent can reassure the child that both s/he and the child are very healthy.
In addition, tell the child that arguments and accidents do not cause strokes and that it is never anyone's fault when a stroke happens.
Q: When should you first take a child to see the loved one?
Dr. Berman: I recommend waiting until the patient is medically stable. In many instances, patients are then transferred to rehabilitation facilities. These visits may be less traumatizing for the child.
Q: How can you help children prepare for changes in their loved one?
Dr. Berman: I strongly recommend that children be treated with respect and sensitivity and be given necessary information, as the situation unfolds, rather than in advance. Waiting to explain, especially poor prognoses that may change over time, may prevent unnecessary worry. A helpful "rule of thumb" is that anticipatory anxiety is generally worse than the anxiety a person experiences when facing the actual event.
However, do prepare children by letting them know that walking and talking may be difficult for their parent or grandparent right now. Children can also be encouraged to draw a picture or prepare a get-well card, so that they feel like a participant in the healing process.
Q: What else do parents need to know in terms of helping the child adapt to a disabled parent or grandparent?
Dr. Berman: Sometimes, upon discharge, the loved one's living arrangements change. Children should be informed, but only once all the plans are in place. It is important to stress to children all of the ways their lives will remain unchanged. This reassurance is essential for a child's understanding, acceptance and well-being.
Q: Is there anything else that is important to know?
Dr. Berman: It is critical to be sensitive to any changes in the child's behavior, including excessive questioning, trouble sleeping, school disturbances and sadness. If concerns arise, seek help from a mental health professional.
Finally, remember that children are resilient, compassionate, understanding and able to yield to family changes-particularly when parents are sensitive to their ages and personality styles.
Additionally, children often love being helpful, particularly to those who have been special, devoted and caring people in their own lives.