Avoid a Power Struggle With a Sick Child

Practical Tips for Effectively Communicating With Ill Children

Jul 6, 2009

Learn Effective Communication Skills for Kids, Katrena Wells

Young children who are sick may tend to challenge authority. Learn practical tips about what to say and do to produce a healthier relationship.

Some young children may challenge authority, especially when they are sick. Deborah Hewitt’s So This is Normal Too? Teachers and Parents Working Out Developmental Issues in Young Children [Redleaf Press, 1995] offers practical advice in avoiding power struggles with children, many of which are mentioned below.

Recognize Positives

Avoid solely focusing on negative interactions with a child.
Give him feedback if he follows directions or is being cooperative.
Help him to see that you do notice when he is being helpful
Reward positive times with a hand stamp, sticker, extra attention, etc.

Look at Patterns

If you can see a pattern of behavior, you will be more likely to anticipate a negative response and avoid a conflict.
Children are often less agreeable if they are hurting, hungry, frightened, or tired.
If the child tends to be less agreeable at certain times of the day, plan harder activities during times when the child will be more likely to respond favorably.

The Child Automatically Says “No” to Everything

Ask him to choose rather than to give a yes/no answer. “Would you like for me to take your blood pressure in this arm or in this arm?” will probably work much better than “Can I take your blood pressure now?”
Make play areas as user-friendly as possible so that the child does not constantly hear “no.”
Substitute the word “stop” for “no.”
Phrase responses in a positive manner. “You may play with the blocks after she changes the dressing” works better than “You can’t play with those blocks right now.”

The Child Refuses

Ensure that the child is able to do what is asked. She may think she cannot move her arm because she has an IV in it. Physical, mental, or emotional stress can cause a child to regress. The child might be physically weaker than normal.
Avoid the tendency to do everything for a sick child if she can do things for herself. Encouraging independence can increase her self-esteem and affirm a sense of normalcy.
Reduce distractions, such as the television, radio, or activities.
Move closer to her and make eye contact before giving a directive. Asking her to do something when you are standing on the other side of the room tends to be ineffective.
Talk directly to her, using simple, short, and understandable words with only one or two directions. For example “Put the markers in the bucket and close the lid.”
Have her repeat the directions back to you. “Let’s review: markers in bucket…close lid.” “Now, you tell me what you’re going to do.” Wait for the child to repeat the directions in order to commit it to memory.
Give her a choice such as “Would you like to do this yourself or do you need some help?” This may produce a quick action in an independent child that is capable of completing the activity.
Encourage the child to ask for help if needed. Observe to see if she is struggling. You may mention times when you also need help and that it is acceptable to ask for help if she appears frustrated.
Provide practice using a prop like a stuffed animal before performing the activity.
Mention a future activity. “After you finish your breathing exercises, we’ll do a craft.”

The Child Does Not Want to Stop an Activity

Keep a predictable schedule. A calendar showing activities may help him to see what to expect. Avoid mentioning activities too far in advance, especially if it is something that might elicit feelings of fear, such as a scheduled test.
Give a warning of when an activity will end. “You have two more minutes to play that game.” You may wish to dim the lights or use some other way to get his attention before announcing the time limit.
Be consistent about expectations such as cleaning up and treating others with respect.
Help him to begin an activity if necessary.

The Child Argues

Ensure that you are setting reasonable limits and expectations.
Be consistent.
Do not reward lengthy protests. This will teach the child that if she argues long enough, she will get her way. If you need to think about a matter, tell the child that you are considering options and request that she give you a moment to think. If you reconsider, mention your reasons.
End an argument with a statement such as, “I see that you are trying to get me to change my mind and that is not going to happen. You need to stop asking now.”
Detach from further arguments and ignore further protests.
Mention consequences for choices that she makes.

Caring for a sick child can be exhausting, but it does help to try to maintain a sense of humor despite the challenges. Ignoring boundaries can result in confusion and may produce unhealthy habits. By using some of these practical tips, you may be able to avoid a power struggle with a child during times of illness and when the child is well.

The information in this article is not intended to be medical advice. If you have questions about your child's health or effective communication skills for your child, you may wish to consult with your pediatrician, guidance counselor, or therapist.

The copyright of the article Avoid a Power Struggle With a Sick Child in Caregiver Support is owned by Katrena Wells. Permission to republish Avoid a Power Struggle With a Sick Child in print or online must be granted by the author in writing.