Parenting Kids With Extra Challenges
Dr. Kelly Fradin on helping kids through diagnoses, differences and mental health challenges.
Today I’m so excited to be running a Q&A with pediatrician Kelly Fradin, author of the wonderful new book Advanced Parenting: Advice for Helping Kids Through Diagnoses, Differences, and Mental Health Challenges. Even if you’re the parent of a typically developing, healthy child, you probably still regularly face concerns and questions related to their development, and it can be overwhelming to figure out what to do. Advanced Parenting is an essential guide for parents who want to learn how to approach various types of difficult parenting situations.
For today’s Q&A, which has been lightly edited for length and clarity, Kelly and I spoke about her inspiration for the book, where to find accurate medical information and supportive communities, what to do when your partner has a different idea of what’s best for your child, and more. There’s tons more useful information in the book, and you should also subscribe to her excellent Substack,
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Kelly, what inspired you to write Advanced Parenting?
As a child, growing up, I had my own health challenges. I saw firsthand how hard that was on my parents — their mental health, their physical health, their professional lives. Then, when I became a pediatrician, I was doling out diagnoses left and right in the clinic, and the parents left my office, despite my best efforts, kind of wide-eyed, trying to figure out how to incorporate this new information into the rest of their life. I felt like they were alone in that experience. It was to fill that need that that I wrote the book.
Who have you written it for? Who do you envision as your audience?
I tried really hard to make it an inclusive resource. Because the truth of the matter is that most children face challenges at some point. Some challenges are life-altering, and require a lot of resources and a lot of planning, and other other challenges are less overwhelming but still just as important to manage thoughtfully as a parent. We all love and worry about our children so much that sorting out whether or not something is part of your child's personality, or perhaps reflects a developmental disability or mental health condition and that would benefit from additional resources — things like that are decisions that are really important for parents to have confidence in making. So I think there's something in there for most parents.
One of the things you talk about is the value of considering what we as parents bring to the table when we're trying to support our kids — our strengths, and also our limitations or blind spots. Can you talk a little bit about how we how we can do this?
Give yourself some time to step back, and consider the bigger picture. Also give yourself some grace. Many parents want to be experts at managing their children and do the best parenting they can. But there's no one right way to be a parent. We're all unique in how we address the things that our children need. And that's okay. That's part of what actually makes you you as a parent.
But so often, we see that the experience of the child is directly impacted by the kind of parents they have. Take, for example, a child who has ADHD. Perhaps that child needs more structure and more routine and more predictability so that they can anticipate what's coming next. And they're less likely to forget things or to have behavior concerns, because that is the sort of environment in which that child will thrive. It turns out that ADHD is pretty heritable, and perhaps their parent has ADHD too. So, actually, for that parent — they may be the perfect parent to provide an environment to facilitate a lot of creativity and to have a lot of openness, and their default style of parenting would actually be great for a lot of children — but for their child, they might have a weakness in providing routine and organization. So to acknowledge that there's a gap there, or a potential to need help in implementing that routine, is really important.
What is your advice for parents whose partners might have different ideas about the best way to support their child? Often, one parent might be more concerned than the other. Or one parent might want to get their child evaluated by a professional, while the other may be worried that doing so would pathologize the child. How can parents navigate this?
This comes up all the time, and it can cause so much stress in the family dynamic. But I think what you just mentioned is a perfect example of understanding the roots of how two parents might approach a situation similarly. So instead of a partner saying “They didn't want to investigate it” and interpreting that as “Don't you see this need? Don't you care about our child?”, a parent might be able to see that the root cause of why their partner didn't want to do the same thing is because they had a different belief about the risk-benefit ratio.
Then, you can talk about the decision more objectively — go down the pathway of “If we do it, then we would have to deal with this and this and this,” and “If we don't do it, there's a potential for this and this.” You de-escalate it from feeling so personal, because you can understand that there's a difference of opinion. And it's not a difference in caring — or at least, it's more discrete than that, and sometimes it can be solved by having conversations with an expert. It may not actually be up to you, as the person who thinks an evaluation might be indicated, to convince your partner of the facts about the risks and benefits of the evaluation. That may be something that a third party could talk both of you through and help you reach a consensus about what you want to do next.
That's a really helpful framing — that when we have differences of opinion, it doesn't necessarily mean that one parent cares more or less. I'd love to talk about research and self-education a little bit. There's so much misinformation out there. Google and Facebook and Instagram can all give us medical information that's not accurate. What are best practices for gathering information to help your child?
There are a lot of different resources out there depending on the condition. A lot of the professional societies like the American Academy of Pediatrics or the American Orthopedics Association or the Child Mind Institute — these organizations tend to have really informative websites with a lot of resources. They’re a really good place to start because you can get sort of the bird's eye view.
Many parents turn to other resources because they're wanting more specific advice for their circumstances — they want to investigate the local schools, the local physical therapists — and for things like that, often the providers that are working with your family, or other parents of children in your community, can really be invaluable resources. They might have already navigated these systems.
Some of the research that I find most impactful that parents do is finding the right tutor or finding the right pharmacy that will handle the prior authorization paperwork appropriately and help you get what you need for your child. That research can be done from social networks, like Facebook groups or community groups of parents — you just have to know what you're looking for when you pick the source and let that guide you.
Where can parents find and connect with communities of other parents who are going through similar struggles? Is Facebook the best place?
It really depends on the diagnosis. When your child has a bigger diagnosis — say they have inflammatory bowel disease, or diabetes, or, or asthma — some of the organizations have really cohesive resource groups. Cerebral palsy is another one.
What we find is that a lot of children have stuff that doesn't quite fit into one of these categories neatly. And a lot of children have rare things. So sometimes there's a need for us to acknowledge that even when children have different diagnoses, a parent who's done advocacy work for their child can often relate to another parent who's done that, too. So even if my child had depression, and your child had acid reflux and GERD, we've both been doing all of the appointments, and the pharmacy navigation, and the doctor shopping, and so we can learn from each other's experiences in an important way. One great organization is called Family Voices. They have a lot of local chapters across the country where they connect parents with other parents.
The more we talk about our children's conditions openly, the more we can build those kinds of bridges in our communities, making parents feel less alone.
I'd love to talk about how to raise multiple kids when one child needs extra support. How do we balance our parenting so that we're giving each of our children the help and support they need but without making a child who has less complex needs feel less cared for or less loved?
This is difficult — to make children feel equally valued in their family dynamics when one child has significant needs that pull a parent's attention or family resources. It can be very stressful. I think one important piece of it is acknowledging that you can't do it all. You might need to ask for help either from your partners in parenting or your grandparents, your babysitters, your neighbors, your school counselors. Acknowledging that you can't do it all is an important way to fill gaps in your child care. Parents think “Nobody can do this but me,” but often there are other loving adults in the village who can support your children.
How do you suggest we describe our children's challenges to their siblings?
People generally hesitate to share information with children, whether it's about themselves or about their siblings. And as a pediatrician, it's sort of funny to observe, because, generally speaking, children know everything that's going on. They're very attentive. They know even very subtle differences in how their siblings are approached and in what their siblings are doing.
Sometimes, even though it might be uncomfortable, or you're not sure what to say, it's really a gift to give your children a framework by which to understand their experience. If you don't talk to them about it, they might invent their own reason — like, “Mommy is spending more time with my sibling because she loves him more,” not because he needs her help with X, Y, or Z. You want to control that narrative as a parent and you want to also make all the children feel connected to each other and the family unit. You can say that your child has needs that you're going to help support — that everybody has needs. And your child, the healthy child, can also partner with the parent in supporting the child who might need more help.
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And now for this week’s Parenting Advice Hot Take!
Today, I’m commenting on this Instagram post from @the.holistic.mother:
Here are my thoughts.