Introduction: Social Issues Affecting Children and Their Families: Merck Manual Home Edition

THE MERCK MANUAL MEDICAL LIBRARY: The Merck Manual of Medical Information--Home Edition

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	Introduction

Section		Children's Health Issues

Subject		Social Issues Affecting Children and Their Families

Topics		Introduction· Adoption· Childcare· Divorce· Foster Care· Illness and Death in Infants· Illness in Children

Introduction

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In order to thrive, a child must experience the consistent and ongoing care by a loving, nurturing caregiver, whether that person is a parent or substitute caregiver. The security and support that such an adult can provide gives a child the self-confidence and resiliency to cope effectively with stress.

To mature emotionally and socially, children must interact with people outside the home. These interactions typically occur with close relatives; friends; neighbors; and people at childcare sites, schools, churches, and sports teams or other activities. By coping with the minor stresses and conflicts inherent in these interactions, children gradually acquire the skills to handle more significant stressors. Children also learn by watching how the adults in their lives handle distress.

Did You Know...

Illness or death in an infant or a child often makes parents feel guilty, even when they are not at fault.
Sometimes children need to hear the same message about a difficult issue over and over.
Children who are bullied are often too frightened or embarrassed to tell an adult.

Certain major events, such as illness and divorce, may challenge a child's abilities to cope. These events may also interfere with the child's emotional and social development. For example, a chronic illness may prevent a child from participating in activities and also impair performance in school.

Events affecting the child may also have negative consequences for people close to the child. Everyone who cares for a sick child is under stress. The consequences of such stress vary with the nature and severity of the illness and with the family's emotional resources and other resources and supports.

Talking With Children About Difficult Topics

Many life events, including illness or death of someone close, divorce, and bullying, are scary or unpleasant for children. Even events that do not directly affect the child, such as natural disasters, war, or terrorism, may cause anxiety. Fears about all of these, rational or irrational, can preoccupy a child.

Children often have difficulty talking about unpleasant topics. However, open discussion can help the child deal with difficult or embarrassing topics and dispel irrational fears. A child needs to know that anxiety is normal and anxious feelings will lessen over time.

Parents should discuss difficult topics during a quiet time, in a private place, and when the child is interested. Parents should remain calm, present factual information, and give the child undivided attention. Acknowledging what the child says with phrases such as "I understand" or with a quiet nod encourages the child to confide. Reflecting back what the child says is also encouraging. For example, if a child mentions anger about a divorce, a parent could say, "So, the divorce makes you angry" or "Tell me more about that." Asking how the child feels can also encourage discussion of sensitive emotions or fears—for example, fear of abandonment by the noncustodial parent during a divorce or guilt for causing the divorce.

By disclosing their own feelings, parents encourage children to acknowledge their fears and concerns. For example, about a divorce, a parent might say, "I am sad about the divorce, too. But, I also know it is the right thing for mommy and daddy to do. Even though we cannot live together anymore, we will both always love you and take care of you." By doing this, parents are able to discuss their own feelings, offer reassurance, and explain that divorce is the right choice for them. Sometimes children, particularly younger ones, need to hear the same message repeatedly.

Sometimes a parent must raise a difficult topic with a child, such as telling the child about a serious illness in or death of a relative or friend. Although it might make sense to do so at the time, death should never be equated with "going to sleep and never waking up" because the child may become fearful of sleeping. If tragedy affects someone else, children may feel more confident, and less helpless, if they can contribute—for example, by picking flowers; writing or drawing a card; wrapping a present; or collecting food, clothing, money, or toys. When a child appears withdrawn or sad, refuses to engage in usual activities, or becomes aggressive, the parent should seek professional help.

A parent may also have to address a difficult aspect of the child's own behavior. For example, a parent who suspects the child or adolescent of using drugs or alcohol should address the issue directly with the child. A parent might say, "I am worried that you are using drugs. I feel this way because . . ." The parent should then calmly list the worrisome behaviors, limiting the list to three or four behaviors. If the child denies there is a problem, the parent should restate the concerns calmly and explain to the child that there is a plan of action in place (such as an appointment with a pediatrician or counselor).

Throughout any discussion, parents should reassure their children that they are loved and will be supported.

What Is Bullying?

Bullying is repeated physical or psychologic attacks that are performed to dominate or humiliate. Frequent teasing, threats, exclusion, intimidation, harassment, and violent assault are forms of bullying. Cyber-bullying is a newly described form in which bullies use e-mail and instant messaging to threaten their victims. Although bullying typically involves only two people, it can involve groups. Bullies often report that bullying inflates their sense of self-worth and creates feelings of power and control. Although bullying hurts and demeans the victim, bullies often unknowingly repel their friends and peers, thereby hurting themselves.

Even though they sometimes tell family members or friends, victims are often too embarrassed and frightened to disclose bullying to an adult. Teachers are often unaware that bullying is going on. Victims may refuse to go to school, appear sad or withdrawn, or become moody.

Victims need reassurance that bullying is always unacceptable. Parents can demonstrate ways a victim can respond to the bully—for example, telling an adult, walking away, changing their routines to avoid the bully, or engaging in counseling. Although it is usually not advisable (for safety reasons) to directly confront the bully, teaching the child to ignore and actually not be bothered by the bully will reduce the bully's satisfaction and eventually lessen the bullying. Praising the victim's courage for reporting bullying can begin to rebuild the victim's self-esteem.

If bullying occurs at school, parents should inform school officials. The victim's parents should also inform the bully's parents but should avoid confrontation, which could be counterproductive by making the bully's parents defensive. Victims may fear that telling the bully's parents will worsen bullying, but it often stops bullying, particularly if the discussion is positive and not accusatory, but instead focuses on the harmful behavior.

The bully's parents should make it clear to their child that bullying is not acceptable. These parents should insist that the bully apologize and make amends to the victim. Doing so can help the bully learn right from wrong, can make the bully more sensitive to the victim, and can make others see the bully more sympathetically. Adults should watch the child closely to ensure that bullying stops. Counseling is recommended for child who is doing the bullying. Often, bullies are expressing their unmet needs or modeling the aggressive behavior of a parent or older sibling.

Last full review/revision July 2007 by Moira Szilagyi, MD, PhD

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