(no subject)

[rivka]

Alex has been complaining a lot about illness. "I'm sick. I don't feeeeeel good." It's been going on for a few weeks now.

She was actually sick, before Christmas. She doesn't seem to be sick now. She has the occasional sniffle or cough that just seems to go along with winter, but she's displaying no actual symptoms - no fever, no worrying change in her eating or sleeping habits, no changes in her appearance, no apparent activity limitations. Just complaints. When we ask her what hurts: "My whole body hurts." "Everything hurts." Even, she will insist if we ask more detailed questions, her toenails and her eyelashes. Every part. We've started asking "What do you think would make you feel better?" Sometimes she asks for medicine. Usually she doesn't know.

For a while it seemed like it was related to things she didn't want to do, or things she did want to do. "I can't put away my game because I'm siiiiick" and "I need to watch another video because I don't feeeeel good" are pretty easy to interpret and respond to. Or boredom-related "sickness" in the car. But more recently it's been different. Every morning this week, as soon as I mention school: "I don't feel good. I need to stay home." I will usually tell her, cheerfully, that we'll see how she feels once she gets to school. She's started asking: "WHY are you making me go to school when I'm SO, SO SICK?!"

She still doesn't seem to be legitimately sick at all.

I spent some time this morning talking with her about school. Why doesn't she like to go to school all of a sudden? Because she doesn't feel good, she told me. Is anything happening at school that she doesn't like - anyone being mean to her, any problems, anything scary? No, she said. Nothing is wrong at school, she just doesn't want to go anymore because she doesn't feel good.

This morning at dropoff, I spoke to her teacher for a while. The teacher confirms that nothing overt appears to be going wrong for Alex - no friend issues or anything like that. She will play happily for a while at school, and then come over and tell a teacher that she doesn't feel good and that she needs her mommy. The teachers have been treating this as a plea for attention. They offer her the opportunity to sit or lie down and rest when she says she doesn't feel good, but haven't been calling us or taking her temperature or anything.

I think that what may be wrong is anxiety. I think that my questions about problems at school were off-base, and that rather than worrying about school she may be worrying about separating from me. After all, that's the other thing that happens at going-to-school time. And anxiety certainly makes your whole body feel bad.

She knows that Niblet's arrival is imminent, and that I'm going to go into labor and go to the hospital and have the baby. She knows we've been making plans for who will take care of her. I'm pretty sure that she knows that it could happen at any time and we don't know when to expect it or when things will change. That's probably pretty anxiety-provoking. Also, I've started being too pregnant to do certain things: I can't sit in the back seat of the car to keep her company, I can't bathe her, I can't play active games. That might be anxiety-provoking in itself, if she's worrying about how much I love her or how much I'll be there for her.

I think this is a reasonable working hypothesis for what's happening now.

The sibling prep books we've read have focused on having a baby at home, not on the anxious weeks of knowing that major life changes could happen any moment. We're going to have a sibling's hospital tour and meet with a nurse for a while on Sunday, and I guess that could go either way - it could make her more anxious, or less.

My tentative plan: I'm going to tell her that I spent a lot of time thinking and reading about what might be making her feel bad, and that I think she has a sickness called anxiety. I'll explain that anxiety can be treated using exercises, kind of like Dad's physical therapy, and I'll try teaching her progressive muscle relaxation using some kind of PMR script for children. I'll try waking her up a little earlier so that we have time to do a PMR exercise before school.

Separately from that, I will try asking her whether she worries about leaving me or being gone from me all day, and whether she worries about what will happen when the baby is ready to come. I don't know if I'm going to get anywhere with questions like that, though. This is where you'd think that being a psychologist would help, but it doesn't, because I mostly was trained to work with adults and I have zero experience with interventions or techniques for kids this young.

I would appreciate any advice or theories that people have - especially people with lots of young-child experience, like mactavish, and people with new-sibling-prep experience. Also, if you have any alternative hypotheses about what might be causing these illness complaints, I'd be interested to hear them.

Comments

[eeyorerin]

Well, she gets to stay home with you (or Michael) if she's genuinely sick, and if she gets genuinely sick at school you (or Michael) come and get her. If she wants more time with you, then perhaps if she says she's sick...

I don't think she's necessarily being deceptive -- I just think that she's bright enough to have figured out that being sick equals more parental time and attention, and to try and use that logic to get the attention that she wants because she is anxious about the big changes hanging over her head.

Do you think that perhaps she equates you going into labor/going to the hospital with you being "sick" and is worried about what might happen to you, and this is a way of expressing that concern as well?

[ckd]

Do you think that perhaps she equates you going into labor/going to the hospital with you being "sick" and is worried about what might happen to you, and this is a way of expressing that concern as well?

Alex might also be remembering the second pregnancy, which would add to her anxiety about you being "sick" and something happening to you. (NBHHY NBHHY NBHHY)

[ailbhe]

If you have any access to an indoor pool you can probably still go swimming with her despite your advanced stage of pregnancy. Just for something special you and she can do together.

My preferred response to a plea for attention is to give lots of attention. Can the teachers do this?

You could try "It will be great when the baby is out of my tummy [or whatever you say] and I can sit on the floor and play tigers again, won't it?" or walk to the park and take her in the swing, or whathaveyou. My own late-pregnancy experience included SPD so it was a little extreme but I was definitely much more mobile after the section.

[sashajwolf.livejournal.com]

"Everything hurts" in the context of having had a real sickness not long before made me think of post-viral syndrome (I think you may call it chronic fatigue syndrome in the States). Alex is a little young for it AIUI, but I've known a girl who developed it at the age of nine. However, your explanation is also plausible, especially if Alex doesn't seem unusually tired. I think the main thing we did to prepare our kids for the arrival of siblings and how it would affect me/my time with them was to offer lots of information about what would happen when I went into labour, what if the older kids weren't at home when it happened, was it going to hurt me a lot, etc.

[rivka.livejournal.com]

I think that if she had post-viral syndrome/CFS she would look more "not right" to us, although I might be misunderstanding the disease. In the past I've been able to tell when she was genuinely sick even if she didn't have visible, or expressed, symptoms, because of changes in her color and energy level, dark circles under her eyes, etc. Her teachers haven't noticed changes in her energy level either.

[sashajwolf.livejournal.com]

I think I looked normal to my family when I had it, but yes, lower energy levels are absolutely characteristic, and that would be noticeable to caring parents such as yourselves. Probably not that, then :-)

[chargirlgenius.livejournal.com]

Henry’s been doing something like that for a few weeks now, though not to the same extent. We’ve all been sick a lot lately, so he’s noticed that sick people get special things like Jello, and extra attention. He’s started saying that he’s sick, wants Jello, wants TV, etc. Mostly, I’ve been trying to make sick less attractive to him, like not getting other good food, or having to sit on the couch and not play (only when I know he’s just pretending, natch’).

Some of it could be her age, but then it’s just magnified by the situation.

[kate-schaefer.livejournal.com]

I wouldn't tell her that she's sick, and I wouldn't label how she feels anxiety (although I might call it "feeling anxious"). I would give her a set time every day until the Niblet is born when she gets to choose what you do for ten or fifteen minutes. Life might be easier if Michael is the one Alex gets to boss around, even though you're the one she really wants to boss around.

If you have a spare grownup who could do this for continuity during labor and recovery could be maintained, that would be ideal. I did this for one grandchild during the last few scary months of pregnancy, and then slacked off after the baby was born because the crisis was over, right? Nope. Some of us have to get whacked upside the head a few times before we learn these things.

[(Anonymous)]

Personally, I wouldn't tell her she has a sickness called anxiety, and I wouldn't question her with my specific ideas about what she might be worried about. In my experience, a young child hearing such suggestions from a parent will likely believe, agree, and act on the parent's conclusions. I would probably make general and off-hand positive statements about everyone being healthy and the baby's exciting arrival, and also give Alex extra one-on-one time. Best of luck to all of you! B.K.

[minnehaha.livejournal.com]

I strongly agree with the Anonymous poster.

K.

[rivka.livejournal.com]

I would probably make general and off-hand positive statements about everyone being healthy and the baby's exciting arrival, and also give Alex extra one-on-one time.

We have been doing quite a bit of that, as well as providing factual information, reading books, and so forth. She still really seems to be experiencing distress.

[papersky.livejournal.com]

I wouldn't label it, but I think doing exercises, and possibly taking vitamins, when she says she hurts, can't do any harm.

[erbie.livejournal.com]

I think you're spot on about what's going on. I'd give her lots and lots of attention and talk to her about what to expect in the coming weeks. She may be worried that she will go to school and you'll go into labor while she's there and she won't get to see you for a while. Lots of reassurances about her place in your life and concrete things that will happen over the coming weeks and when you go into labor might help her feel less anxious.

[naomikritzer]

FYI, there's a series of books for children on mental health issues -- "What To Do When You Worry Too Much" is for kids with anxiety. There's also an OCD one and an anger-management one; I've read both of those and they're excellent. (The OCD one would've been incredibly helpful to me when I was four or five and obsessed with the fear that I would absent-mindedly drink poison and convinced that only my weird rituals were keeping me safe....I had no clue, nor did my parents, what was really going on.)

[rivka.livejournal.com]

Alex seems to be a bit anxiety-prone in general, although I know that age 3 is also a likely age for kids of all temperaments to develop fears and worries. She's recently been worried about whether Michael and I have locked the doors at night, for example. And she has a lot more nightmares than the average kid, although - fortunately, given my current poor sleeping habits - we aren't in a nightmare phase right now.

I'm inclined to feel that progressive muscle relaxation and other anxiety management techniques would be beneficial to her in general, even if anxiety is less of a driver for her current "illness" than just wanting attention.

[johnpalmer.livejournal.com]

Just off the wall... I remember a friend who, as a child, had a "feeling board" and she was frequently asked to pick a feeling. She felt it was helpful to start to label how she felt.

I have no idea if she's old enough to try that. But I think if she understood that this bad feeling was not sickness, and had a name, it might help.

[johnpalmer.livejournal.com]

Oh: the "feeling board" was felt, and had areas where different feelings were represented, and she'd put a felt marker (representing herself) on the area of the board that felt most appropriate.

[drelmo.livejournal.com]

The first thing I thought, about a sentence into the second paragraph, was that she was worried about the baby coming. It's a major change, and she'll certainly have picked up from you that change is imminent, and that in the short term, things are going to be very different indeed.

Like anything else new, her busy, but inexperienced, little brain is working hard to figure out what a major transition like this feels like and how to handle it. And she's looking to everyone around her for cues on what the "normal" way to handle this is.

Reassurance and routine and personal calmness are what I'd try for, and maybe a little coaching on coping skills, like your PMR. Although, routine is really tricky because she's also got to be prepared for routine to become a lot bigger in scope and more flexible once the Niblet comes home. So maybe focus on doing the routine now, but ask questions to get her thinking about how the routine is going to change.

"And now we put on our socks. Very good! When the baby comes, do you think we're going to put on our socks any different?" And maybe she says no because she sees that it's a silly question, and maybe she says something about Mommy being able to see over her belly again, but then you go from the bedroom to the breakfast table and you can ask her how breakfast is going to change, and that's a substantial discussion.

[ailbhe]

I adore this idea.

[library-lynn.livejournal.com]

Hi, you don't really know me (I'm Chaz Baden's wife).

Have you told you'll be going to a hospital? Does she know what hospitals are for? Hospitals are for sick people and hospitals are to have babies. Could she want to go with you?

Just another suggestion to add to the mix.

[johnpalmer.livejournal.com]

I think you have it pegged, she's a bit confused, and a bit anxious, and needs to learn some ways to cope. But, I'll note that I showed symptoms of inattentive ADHD early, and the tiredness/lack of focus could easily have been described as feeling sick, as well.

[puzzlement.livejournal.com]

I am a more than bit hesitant to raise this because I don't know a lot about your family, but no one seems to have brought it up yet: have you considered the possibility that she's lying to you, at least about the sensations in her body?

This was the first thing that sprang to mind for me because of my younger sister who was very very ill as a baby and toddler. Some years after that occurred, but while she was still receiving regular attention from specialists and so on, she started complaining to my mother of intermittent headaches. She was taken to several doctors and I think even evaluated by a couple of neurologists. (The original illness was very rare and family doctors were usually not confident to assess any unusual symptoms once they heard her medical history.)

And her adult memory of this period is that she was deliberately lying the whole time. She got trapped after a while: how can a young child confess a lie to a parent who has worried and worried and cried and taken her to doctor after doctor? (And I think, also directly asked several times if she was lying, my mother was not totally without suspicion, but not confident enough to disbelieve her quite young daughter.)

Given my own memories of the period and the fact that she has memories of it herself she would have been a couple of years older than Alex, though and I know that at Alex's age (or any age even) exaggerating real symptoms or wholesale inventing symptoms would still be a cause for concern and attention and care. Furthermore at her age in particular she's suggestible and the line between making something up and feeling it is not very wide at all. And I am very familiar personally with real physical symptoms with mental origins. But nevertheless, I wondered if it was something to consider given that it would possibly merit a different type of response of some kind.

[jinian.livejournal.com]

This is really just a tangent:

From about age 12 on I've had atypical migraines -- not a lot of pain, but disorientation and seeing sparks -- and I remember sometimes saying my head hurt when it didn't really, and not having to go to school. I thought of this as lying, but a few years ago my mom told me that she really did think something was wrong by how I looked; maybe my eyes didn't track quite right or something, but she was sure I was really having a headache.

So did I or didn't I? I guess there was probably some correlation with when I didn't want to go to school and when I felt bad in a way I didn't know how to describe, but I don't really know. Moms are wrong occasionally, after all.

Anyway, I doubt this is Alex's problem. Anxiety seems more likely to me than malingering, though it may be worth considering.

[rivka.livejournal.com]

have you considered the possibility that she's lying to you, at least about the sensations in her body?

Yes, definitely. Being a health psychologist, I'm well aware of the differential diagnosis tree for "physical complaints with no apparent medical basis."

There are essentially three options:

1. She has real physiological symptoms, but is misinterpreting them - i.e., interpreting anxiety, or stress, or normal variations in physiological function, as illness.
2. She is feigning physiological symptoms because she likes being in what we call "the sick role."
3. She is feigning physiological symptoms for what we call "secondary gain" (e.g., an extra video, Jello, permission to not put her toys away).

Honestly, we'd probably approach any of these options with the same basic package of parenting techniques: not freaking out, giving her plenty of non-illness-dependent love and attention, not bending basic family rules, and gently explaining that we don't think she's physically ill. I think teaching her relaxation techniques "as a way to feel better when you feel this way" probably works with any of the three categories as well.

Your sister's story is interesting, and it makes a lot of sense that someone whose early childhood was so thoroughly medicalized would easily slip into keeping up "the sick role." And it would've been pretty much impossible for your parents to not to play along, too. Poor them.

I started first grade when I was only about a year older than Alex is right now. I remember having lots of "headaches" and "stomachaches" at school which required trips to the nurse to lie down. I don't remember if I truly thought I was having physical problems, or what, but it seems clear to me in retrospect that it was a way to escape the stresses of the classroom environment.

[a-c-fiorucci.livejournal.com]

My son (who will be 4 at the end of March) kept complaining about nightmares and wanting us to stay with him at night etc. etc. What seems to be helping him is making a "happy list", right before bed (after potty, teeth, bath, stories & a song or two and just before lights-out). We sit down and talk about (prompt, really) things he did that day that made him happy, and write 5 of them down in a blank book I had lying around. Perhaps something like this can re-direct her thoughts, not to deny that she might be anxious but sometimes just not thinking about that can help?

Good luck!

[pecunium.livejournal.com]

That seems a pretty reasonable set of reactions. It's not disconsonant with my recollections of my little sister beng worried when my brother was on the way.

I don't know, but the thing I'd recommend is talking to her about what is going to happen, so there is more concrete expectation on her part, and less vagueness.

I do know that when my mother miscarried, my sister (who was about four) had a very traumatised reaction (mommy went into the toilet, and disappeared into an ambulance), so looking to see that sort of thing doesn't happen is probably a good idea.

[(Anonymous)]

Have you tried play therapy where you act out scenarios with her toys? I'd suggest your modeling with some quite silly scenarios.

Another suggestion is to let her try various "treatments" to see which one helps best, i.e. does eating 3 orange M&M's and 1 green one work better than something equally implausible?

[elusis.livejournal.com]

I'd suggest one of those charts with faces on them, labeled with feelings, and when she says "I feel sick!" offering her the chance to pick out other feelings she might also be having. "Sick" is sometimes a catchall for "I feel bad but don't have the words for the other feeings."