Working with Grandparents

By Ruth Nemzoff

February, 2009

When parents in our practices have a child with a chronic illness or disability, how can pediatricians help them work with the child's grandparents in a congenial way?

Parenting a child with an acute or chronic illness or disability is like parenting any child only more so -- more doctor's appointments, more decisions, and sometimes more laundry, more child-care and more diapers. This may make parents needier of both physical help and emotional support. And, since the generations are often each other's social safety net, the resulting larger work load creates tension between parents and their own parents, the grandparents. Parents need all the help they can get and they are often frustrated that their own parents cannot help as much as they need.

While the grandparents might be available to fly in for a day or two, they may not be willing or able to disrupt their own lives. Or if they live near-by and help out daily, the parent generation may be so overwhelmed that they do not feel their own parents are doing enough! Fantasies that mommy and daddy can cure everything with a kiss act to complicate this unrealistic picture of familial aid. Ultimately, this family aid can either cause more problems or be a source of great help.

In addition, there are many decisions to be made. Many of those decisions are best guesses yet they may have life time consequences. The parents and grandparents may disagree on the correct course of action. To operate of not, to medicate of not are questions often even the doctors grapple with.

Add to all this some of the complicated irrational feelings about the cause of the illness: her genes, his genes, grandpa's or grandma's genes. Tension may occur around issues of behavior, discipline and personal values. Everyone wants to make things better, but in the process of trying to make things better blame and conflict can erupt.

Paradoxically, parenting a child with an acute or chronic illness or disability is like parenting any child only with fewer resources. The parent may have less available income, since so much has already been spent in helping the child; they may not have friends willing to listen to the ongoing saga, and the child may not have many friends or a supportive network. Add to this mix, siblings may be jealous of the attention the disabled child receives, or concerned about the diminishing family resources.

Physicians can enhance communications by including both generations in discussions, if not in person, then by asking families about their relations with the other generations, maybe even suggesting ways that grandparents can be useful. In many cases, the older generation is giving more than they ever expected to, and may, in fact be being extremely generous with their time. However, because the needs are so great, it would not be unusual for the parents to feel that they still need more assistance and blame the grandparents for not doing more. Professionals must be aware of the fact that the blame game is frequently underlying emotional reactions, which need to be examined from both sides of the situation.

In cases of mental illness particularly, the older the person, the more parents or grandparents will have invested, and the more reluctant they may be to invest further. Often, parents or grandparents are out of the loop with professionals, as the person's privacy is tantamount in a clinical setting. It might help to pre-plan for inevitable crises by urging all parties to sign waivers for information to be shared at a time when things are not in control. Otherwise, parents are left on the outside of the equation and can offer very little to adult children.

Because it is a delicate balance between whether to intervene in the lives of our adult children, or not, it is likely that grandparents will overstep bounds that are acceptable to the adult child. It is incumbent on professionals to support the adult child in examining his or her feelings and possible anger at the grandparents and acknowledge that their love and concern may be the basis for the intervention. Encouraging both parties to negotiate and communicate will provide more adequate solutions.

I asked Ruth if she had any tips for pediatricians who want to be more successful in helping parents and grandparents. She suggested the following:

  1. Share information. A lot of the problems come from second guessing. The pediatrician should be honest when, we just don't know.
  2. Problems arise because parents make a decision for treatment on the best info available. Grandparents may not have that info.
  3. Many medical decisions are best guesses when there is not good science, e.g. to operate or not, to medicate or not.
  4. If the pediatrician can explain why and how s/he came to his recommendation that can allay fears. It can help grandparents understand that not everything is black and white but that we will all work together. That can reduce second guessing parental decisions.
  5. Finally, it can help the pediatrician and parents if they can view grandparents as members of the team rather than as people who interfere.

A final note from Dr. Howard King, Founder of CEHL.org:

Working with three generations is not very common for most pediatricians and will take some getting used to. However, if pediatricians are permitted to play a constructive role, it can be very helpful to all the members of the family system. By being so involved, pediatricians may find themselves increasingly gratified by intervening in this way. It will take a light touch on the part of the pediatrician to be successful.

Dr. Ruth Nemzoff is author of Don't Bite Your Tongue : How to Foster Rewarding Relationships with Your Adult Children, ( Palgrave/ Macmillan, 2008).

Ruth is also a Resident Scholar, Brandeis Women's Studies Research Center, Brandeis University

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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.

- Dr. Howard King, M.D.