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Putting the “Difficult Parent” of Pediatrics into Perspective

David Epstein, MD, discusses the "difficult parent," a term that is sometimes used when conflict arises between parents and the medical team.

The term, “difficult parent” is not uncommonly used in pediatrics. But, what does this term mean or imply?

It is used when a parent is not treating the medical staff or physicians nicely, not listening to medical advice, arguing about a treatment plan, not cooperating with the nurses or physicians, and likely many other descriptive terms that result from conflict with the medical team.
But, what does the term, “difficult parent”, really mean?

When someone is “difficult”, it implies that that person is problematic, demanding, challenging, stubborn, unmanageable, trying, or just simply hard to deal with.

However, as a parent, these attributes are likely stemming from something. I don’t believe that there are truly so many “difficult parents” out there and I do believe that people are not inherently “difficult”, for the most part.
There has to be something more.

When we see families in pediatrics, we are evaluating the health of the children of those families.

Whether it is a well-child visit, a visit to the urgent care for a “cold”, or an admission to the hospital or pediatric intensive care unit with a more serious health issue, a parent has a very biased perspective of their child’s health.
That view is that their child should be healthy and have no medical issues.
That biased perspective is based on love and caring for their child.
While it is not an unfortunate reason to cause a biased perspective, it is a reason to stir a host of emotions when there is a concern for the health of their child.

Fear, anxiety, grief, sadness, anger, and panic are likely just a few emotions that a parent feels when they are faced with a health concern for their child.

Whether the health issue is benign or life-threatening, different parents react differently.
I have seen parents react calmly while their children were in critical condition in the intensive care unit and others react hysterically while their children had an earache just as often as I have seen the reverse reactions for similar circumstances.
It doesn’t mean that one family loves or cares for their children more than another family who reacts differently in the same situation or under similar pressures.
It just means that different parents respond differently to conditions that affect their children.

As parents, there is an inherent desire to make their children feel better.

If a parent is told that their child doesn’t need antibiotics for ear pain or their child needs chemotherapy for a newly diagnosed cancer, a parent will have questions.
If a parent is told that a cast is required for 6 weeks to heal a broken bone or their child’s ankle injury is just a sprain and doesn’t need an x-ray, a parent will have doubts.
If a parent is told that their child’s fever is nothing to worry about or their child’s fever is something to worry about, a parent will have concerns.
These are all normal responses.
But, if you mix a myriad of different emotions with the fact that their children have a medical issue, the manner in which parents express these questions, doubts, or concerns may be exhibited very differently.
Even trust in the medical system or staff can be overpowered by this mix.

The mix of emotions and a child’s health, especially if there is a degree of uncertainty, makes for a combustible combination of possible responses and interactions with the medical team.

Some parents may respond by educating themselves about their child’s medical issue, but not understand the entirety of the medicine behind a decision, and come into conflict with the medical decision-making of the medical team.
Other parents may respond by becoming overly protective of their children and decline medical procedures for concern of undue pain or fear of complications.
A number of parents may not believe that a particular treatment is futile in the end-of-life care of their child because they believe that a miracle is possible.
While all of these instances can lead to conflict with the medical team and result in a parent being identified as a “difficult parent”, the medical team may not understand why the parents feel the way that they do or may not have explored the reason behind the parents’ decisions.

People are not usually “difficult”.  It is the situation that is difficult.

If one explores the basis of a parent’s behavior or decision-making, one may be able to understand why a certain behavior is manifesting.
If we can understand why a parent is responding a certain way, we can assist, educate, care, and intervene in a manner that avoids conflict and helps promote the most collaborative and effective medical decision-making.
We are all human and are subject to the same array of emotions and mental constructs that manifest when a loved one has a health concern.
Once we understand that, we may be less inclined to label anyone “difficult” when conflict arises, especially parents.
Do you believe that parents can be inherently “difficult” or is it situational?

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