Thursday, August 19, 2004

Playing Sick

How often have you heard your kid say "I can't go to school today, I have a stomach ache!" and wondered whether to be concerned? Children have very fertile imaginations when it comes to excuses, including imagining themselves ill. Most such cases are no more than a simple lie to avoid an unpleasant situation. How you should respond as a parent depends to some extent on the age of the child as well as the situation he is avoiding. For a 3 -5 year old avoiding day care or school your best strategy is to distract them instantly, by just a tickle or a mock fight. Then make brushing and dressing sound exciting. For an older child who usually enjoys his routine and is acting out-of-character, it is important to first get them to leave the bed and freshen up. Then ask indirect probing questions to learn the reason for this act. Be sure never to ridicule the child or openly call his bluff. Play along and win his confidence. His concern may be a notebook he can't find, or a bully who has challenged him. These simple things can overwhelm young children. Try to resolve the real issue. This way you would have given him an important coping tool he can use all his life.
Gaining the confidence of a malingering child is critical for another reason -a closely related condition technically known as a "psychosomatic disorder". Extremely young, sensitive or reserved children are more likely to develop psychosomatic illness. Here too the kid is complaining of, say, a stomach ache for which there is no "medical" reason. But this is not the same as malingering. The difference is that the child is in fact truly experiencing physical symptoms like pain, even though there is no physical reason for it. This kind of behaviour is not routine and must not be taken lightly. How can you tell if the child has a "real" illness or his problem has a psychological root? There may be small signs. Most important one being, does this illness at this point, serve some purpose for the child? Has the situation around the child changed lately? This may be the birth of a sibling, parental discord or move of residence/ school. Does it start when he needs attention desperately or when he is supposed to do an unpleasant activity? Has the child observed a patient of the same condition? Does having this symptom save him from an anxiety producing situation?
Obviously such behaviour is as much a cause of concern for a parent as any other type of disorder and a paediatrician must be consulted. Once we know that it is indeed a psychosomatic disorder, treatment consists of change of environment and lots of emotional support to reduce anxiety. Most importantly, remember that just because a symptom has a psychological reason behind it does not mean it will go away on its own!
Bringing up physically and emotionally strong children is no easy task. But a good dose of attention, affection and criticism along with a trusty Paediatrician can go a long way. :)

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