Managing behaviour in your young child when they have a health problem

This information has been written to help you respond to your child’s behaviour when they have a health problem. This leaflet gives you some ideas to try to help you and your child.

Coping with a health problem

The process of adjusting to a health problem in a child and managing the demands of their condition and treatment can be a challenge for any family. Children respond in different ways depending on their personality, on the illness itself and the support they are given. It is common for children to experience some kind of emotional or behavioural change in these circumstances.

Often families feel unsure about how to manage their child’s behaviour. It can feel difficult to maintain your usual rules and boundaries. Having a child with a health problem can disrupt your family routine and involves change for all the family.

Saying “no” to your child can feel especially difficult when they are unwell. However boundaries and routine can help make your child feel more secure and in the long term make life easier for you.

Behavioural reactions 

Nearly all children will respond to illness by behaving differently. Sometimes they act younger than their age, for example by crying more, wetting their bed, or becoming more clingy.

They might become anxious or panicky, or they might become more irritable and annoyed about things. Children might feel sad, angry, or frightened, or they might have sudden changes in mood which are hard to predict.

They might express their feelings by being angry or aggressive, or they might withdraw and not want to join in anything.

They might refuse or find it hard to go to school, have trouble sleeping and become very tired. Others react by getting too active and find it hard to relax. All these reactions can be a result of the child expressing their feelings, especially if they cannot understand what is happening to them or find words to describe how they feel.

It may be difficult to know how to respond to your child’s behaviour but it is always important to think about how they are feeling and not just respond to the behaviour this leads to. Changes in routine, boredom, frustration, being separated from family and friends, feeling worried, dealing with hospitals and meeting new people will all affect how a child reacts.

Although it can be hard to decide how firm to be, try to find a balance between keeping the “rules” for behaviour the same while making sure that you also have time to

listen, and talk with your child. Try not to excuse behaviour that you would have previously not allowed – even ill children need to know what is okay and what is not acceptable. 

There is some evidence that children cope better with illness if they are able to carry on with things being as normal as possible – keeping to the same routines, having the same rules and boundaries and doing the same kind of activities if possible. This includes education and joining in with their family as usual. 

Top Tips

Be positive

It is very important to notice when your child is being ‘good’. It is tempting when they are playing quietly to get on with jobs and not take the time to notice their good behaviour. We can fall into a trap of giving children lots of attention when they are misbehaving. When your child is behaving in a way you like, give them some positive feedback. For example, ‘Wow, you are playing very nicely’ or ‘That’s a lovely drawing’. Showing enthusiasm using the tone of your voice, facial expression, eye contact and physical closeness are important.

Giving praise to your child as soon as they begin to perform the desired behaviour works very well. Giving praise within 5 seconds of the positive behaviour is most effective especially when you are trying to promote a new behaviour.

Lead by example

Children copy adults. Your child watches you to get clues on how to behave in the world. You are their role model, so use your own behaviour to guide them. What you do is often much more important than what you say. If you want your child to say ‘please’, say it yourself. If you don’t want your child to raise their voice, speak quietly and gently yourself.

Show your child how you feel.Tell them honestly how their behaviour affects you. This will help them see their own feelings in yours, like a mirror. This is called empathy. By the age of three, children can show real empathy. So you might say, ‘I’m getting upset because there is so much noise I can’t talk on the phone’. When you start the sentence with ‘I’, it gives your child the chance to see things from your perspective.

Activities and structure   

Children need stimulation and parents and carers are the number one playmate. Try to spend some playtime with your children every day, for example, play games, sing songs, read stories. If you can, allow your child to be the one who decides the way the time is spent. Try not to direct them and try to let them be the one leading the play. Children generally benefit from being outdoors, so try to include walks or trips to the playground in your day. It also helps to provide a structure to your day. Your child will feel more secure if they know how the day is planned.

Consistency

Be clear

It is important that your child knows what you mean when you ask them to do something. Use short sentences with few words and try not to repeat yourself too many times. A long drawn-out explanation will just confuse a child.

Follow through

It is important that you mean what you say. If you provide your child with a consequence, then you must follow this through. Children need to know that you mean what you say, or they will stop listening and stop believing you. Try to make consequences reasonable and immediate. Don’t use a consequence that is a punishment for you too as you will be more likely to change your mind or be grumpy about it.

Be consistent

It is important to stick to the same rules as much as possible. Children need to learn what is expected of them, and to do this they need practice. If they are allowed to do something one day but not the next they will never learn how to behave appropriately. It is also important that all those who care for a child have the same rules. Children will become very confused if one parent allows them to do something that has not been allowed by another parent. They will soon learn to work these situations to their advantage. If you disagree with a rule that someone else in your family suggests try to discuss the difference of opinion when your child is not able to hear you. Back each other up in front of the child even if you do not completely agree.

Distraction

If your child becomes upset or wants something they are not allowed the first thing to do is to try and distract them. Show them some other toy or point out another activity, for example, “It’s not time to do that now, why don’t we play a game instead” or talk to them about their favourite topic.

Picking your battles

Before you get involved in anything your child is doing – especially if you are going to say ‘no’ or ‘stop’ – ask yourself if it really matters. By keeping instructions, requests and negative feedback to a minimum, you create less opportunity for conflict and bad feelings. Rules are important, but use them only when it’s really important. There may be days when you don’t have the energy to cope with the battles. For example, there may be a day when you allow your child to have sweets at the supermarket. So long as you say yes straight away, this is fine. Difficulties arise when you say ‘no’ but then give in after five minutes of your child having a tantrum. 

Ignoring

If distraction is not effective and tantrums begin, try to see if you can ignore the behaviour. Ignoring gives the message that the behaviour gets no rewarding attention. If you use this technique alongside the technique of praising good behaviour your child will get a very powerful message. Ignoring can be very difficult when you are out in public so remember to pick your battles and use the support of others when you can.

The three Rs – Regulate, Relate and Reason

Understanding dysregulation: How to Support a Highly Emotional Child.  

Dysregulation occurs when the brain responds to sensory input in a manner that triggers the alarm state. When a child is dysregulated, it is harder for them to listen, comprehend and cope.  

Regulate

Focus on soothing your child.

• ‘You’re not in trouble’
• ‘You’re safe’.

Make them feel  calm, safe and loved. 

Relate

Validate their feelings with your words and tone of voice.  

• ‘I know you’re very upset right now’
• ‘This is very hard for you’ 

Focus on connecting with your child. 

Reason

Once your child is calm, now it is time to talk about alternatives to behaviours while reinforcing limits you set before.

You can reassure them you love them but that the behaviour they’re exhibiting is not ok. Until a child is regulated, they are unlikely to relate to you (feel connected and comfortable). And until a child is related they are unlikely to have the mental capacity to reason with you.

Rewards

A good way of motivating children and avoiding tantrums is with rewards. Rewards do not need to necessarily cost money or be something material. Some examples of rewards are:

• Social rewards include verbal praise.
• Allowing your child to make a choice, for example, choosing what to have for tea or what DVD the family will watch together.
• At home, a sticker chart is a great way of encouraging good behaviour. Each time your child is good, give them a sticker. Points mean prizes – enough stickers get them a treat. Mini sticker charts can also work when you’re out. Sort out a treat bag putting in small inexpensive gifts. When your child has collected the agreed amount of stickers let them choose a gift from the treat bag.

Remember that rewards need to be dependent upon your child displaying the behaviour you want to encourage. Children need to achieve success to be motivated, so start with small goals that your child can achieve and build on their success. Remember that once a child has received a reward or sticker do not take it away. This reward was given for a good behaviour and is not related to any behaviour that follows.

Summary

Having a child with a health problem can disrupt your family routine and involves change for all the family. Often families find it difficult to know how to manage their child’s behaviour during this time. It can feel difficult to maintain your usual rules and boundaries. Following the suggestions about strategies listed in should help you to cope with difficulties in your child’s behaviour.