Legal and General partnered with Clinical Psychologist Dr Angharad Rudkin to explore the importance of having difficult conversations with children, including that about organ donation. Dr Rudkin discussed how to approach the conversation appropriately and provided some useful tips for parents wanting to engage their child in such conversations.
Important conversations to have with children
There’s a whole range of difficult conversations that need to be dealt with sensitively, depending on the family context and the age of the child. For example, when there is a family change such as a divorce or a bereavement, a number of tricky conversations have to be had. As children move towards teen years, parents need to engage in conversations about consent and sex. Some parents want to sit their child down to tell them about the “facts of life” – this can be a fun and awkward conversation for both the parents and the child! Conversations about gender and gender identity as well as sexuality are ones that need to be treated carefully, as children will be very sensitive to criticism or judgment. I know parents also find conversations with their child about being a bully quite difficult to have.
When to have these conversations
“When it comes to big topics like organ donation, parents need to regard it as a series of conversations rather than a one off.”
Ideally, this process would start when a topic naturally arises in a child’s life, for example when a child hears about someone donating an organ, or they see a related story on the internet. If a child hasn’t brought it up themselves by the age of 6-7 years, you can make the most of the significant cognitive changes that happen at this age, to bring it up. Children move into a stage of more logical thinking around this age and have more ability to think about things in the abstract. Talking about organ donation inherently implies death and children will be able to understand and manage this information more from the age of 6 or 7.
As children grow and they hear more about the world, the conversation can be revisited. Children process big information like this in bite sized chunks so they will have to return to it again and again. Children’s brains grow so rapidly that they are likely to have a different perspective, a new question or a deeper understanding every time they return to this conversation. As a parent, you need to have patience and understanding as you move through this process so that you don’t get frustrated and annoyed if a child keeps asking more questions or wanting to talk about it again.
“The stage of development a child is at will determine how much they will understand, helping parents to frame the conversation appropriately”
Tips for having difficult conversations with children
|Time||How long a child can focus on a conversation like this changes with age. The basic rule of thumb is 1 minute per year of their life (i.e. 5 minutes for a 5 year old child). This may seem very short, but knowing his helps a parent focus the conversation and optimises their child’s chance of taking it all in.|
|Language||The younger the child, the simpler the language that should be used. Don’t assume your child knows what things mean, instead ask them if they understand certain words. For example, start by asking if they understand what the word “organ” means, and then what the word “donation” means.|
|Pace||Older children (aged 10 years and over) prefer a quicker pace of conversation with more facts and adult words.|
|Examples||Children struggle to understand abstract notions until they are quite a bit older, so use examples from your child’s life (either a personal experience, or something from a book, TV, or game) to illustrate what you are talking about.|
|Responding to questions||Respond to any questions openly and honestly, and don’t be worried if you can’t answer a question. If you don’t know the answer, let your child know you will find out and come back to them, or tell them you haven’t quite figured out the answer to that yet either. They will appreciate your honesty and lack of defensiveness, and will respond in a similar way.|
|Check back||At the end of the conversation, ask your child to say what they have heard and understood. This isn’t a test but is a way for parents to know what gaps need to be filled next time, what misconceptions the child may still have, and what hasn’t been clear.|
|Listen||Listen more than you speak. Rather than thinking about the next thing you want to say, work hard at really listening to what your child is saying. You can then tailor the conversation to meet their needs more effectively.|
|Choose the right moment||Choose a good moment when children aren’t too tired or hungry. Also choose a time when you are not taking them away from something they really enjoy, whether that be reading, gaming, or playing outside. This means they will be more amenable to listen.|
|Check in||As you’re talking to your child, keep checking in with how they’re feeling. Ask questions such as ‘is this okay?’ ‘would you like me to stop?’ ‘how are you feeling?’. If a child is feeling very anxious, arrange a time with them when you will return to the topic so that they know there is another opportunity to talk.|
|Behaviour||Understand that children take in as much from what you do as what you say. If you are behaving in a calm, relaxed way then your child is more likely to respond in that way too.|
|Don't judge||Don’t judge or criticise during the conversation. Let your child ask whatever question they would like, even if it does make you worry as a parent.|
|Move on||After the conversation is done, move on to an activity together, e.g. make lunch, go for a walk, or watch a TV programme together. This will ease the transition back to everyday life and reassure the child that life will go on as usual.|
Dealing with negative responses from a child
Children love to talk about things related to their world and the things that really interest them (ask any parent who’s had a 2 hour conversation with their child about Pokemon Go or Frozen!). But talking about adult things can easily feel like a lecture, a burden and a bore to children. Picking your time so that it’s convenient for them, where you have their focus and attention and where they’re amenable to talking is key. If no obvious time appears, make an ‘appointment’ with your child to have the discussion so that they can be prepared for it.
“Just because you as a parent want to talk about something, it doesn’t necessarily mean your child wants to.”
Different children have different sensitivities and cut-off points (just like us adults). Some may be able to sit and absorb complex information for a long time, others need to take it in bit by bit. Some children listen better while moving (bouncing on a trampoline or walking the dog) whereas others like to sit in a quiet environment. Use your knowledge of your child to plan your conversation. If you have children of different ages, it may be worth having the first conversation separately so that you can tailor to their developmental stage and needs. Then you can have a family conversation where you can all share and learn about one another’s perspective. If a child is letting you know the topic is too much, don’t force them to listen. Accept that they need to leave the conversation and plan with them when would be a good time to return to it.
As they move towards teen years especially, children become naturally more rebellious and questioning of adult authority. They may tell you they don’t want to listen or that it’s boring or respond that it isn’t up to them anyway. Take a breath and thank them for listening, acknowledge that it is a difficult topic and can bring up all sorts of feelings, and then let them know you can chat about it another time instead. For children at all ages, but especially teens, relating the conversation to their life will make it more relevant and meaningful to them.
The effect on mental health
It is unlikely that conversations about difficult topics such as organ donation will create a mental health difficulty. But, if a child already has a mental health difficulty, such as high anxiety, then a conversation like this may exacerbate their anxiety. However, it is important not to avoid the conversation entirely, so if a parent is concerned about their child’s well-being they may need to delay the conversation until the child feels more settled and has some effective strategies for managing their anxiety.
Having a conversation about death (which is the underlying fact of a conversation about organ donation) may unsettle a child for a while, and it may lead to questions about when a parent is going to die and how. Around the age of 6-8 children become more aware of their parent’s immortality and can become very upset thinking about their parent dying. After having this conversation with a child of that age, parents may need to provide more reassurance and comfort, and will also need to work harder to distract the child from the subject after.
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