Wednesday 21 March 2018

Dear David: How can we help our toddler cope with shock of Alopecia?

A child will grow up having always had Alopecia
A child will grow up having always had Alopecia
David Coleman

David Coleman

Advice from the clinical psychologist and parenting expert David Coleman on treatment for Alopecia and on how to explain to chidren why they have no contact with their granddad.

Q. Our son has just turned two and lost his hair very suddenly a couple of months ago because of what turned out to be Alopecia Areata. Naturally, it has been a shock and although there is nothing more serious underlying, we are devastated for our son. He has become very aware of his lack of hair and is asking us questions. Also, other children have started making comments and we are unsure as to what's the best way to discuss the whole issue with him. We want to help him deal with the potential cruelty of other children.

David replies: I am not a doctor, but my understanding of Alopecia Areata is that it is a condition in which the body's own immune system mistakenly attacks the hair follicles, (the place where hair starts to grow in the skin).

As a result, hair falls out, either in clumps or patches, or, as in your son's case, entirely. Sometimes the hair loss is temporary and sometimes it is permanent.

Thankfully, as you are aware, it is not painful, it does not make you feel sick, and it does not result in serious health problems. It also can't be spread to other people. In theory, it shouldn't interfere with school, work, or recreation.

However, it is the self-image issues that are often most problematic. Your son, as you rightly recognise, has to come to terms with how he himself looks with no hair, and how other people may react to him.

Research suggests that people with Alopecia experience feelings such as self-consciousness, jealousy, loss of attractiveness and embarrassment and that it can affect their self-esteem, body image and/or self-confidence.

Many people, will go through a grieving process, dealing with the loss of "normality" or the loss of their "sameness". In some ways, your son's age is protective for him. He will grow up having always had Alopecia. He will not remember a time when he didn't have it and so may not experience that sense of loss.

You are right to talk to him about the condition. He does need to know that his skin "doesn't let" hair grow, or however you feel best describes it to him. He also needs to know that he will always have the condition.

As with any chronic medical condition, where there is no cure, the only long-term resolution comes when we can accept the condition and accommodate the impact it has on our lives.

Your focus with your son may need to help him combat this potential negative impact on his self-esteem. You need to help him feel good about himself and all the positive things that he does and the lovely and attractive qualities that you see in him.

You need to help him see that he is both lovable and capable. If you can support his self-esteem in this way, and continue to give him a really positive self-image, despite his hair-loss, then you will make it easier for him to shield himself from any possible teasing that may come his way.

You cannot entirely protect him from, as you say, the potential cruelty, or even simple insensitivity, of other children. You can just give him coping skills.

The most successful way to deal with teasing or mocking comments, is to acknowledge them, but also show that you are not bothered by them. At age two this may be an almost impossible thing to do.

As he grows up you can help him to find the right words to respond to other children, showing his assertiveness, but not rising to the "sting" of any comments made to him. For now, though, you need to be the ones who do your best to shield him.

Other children his age just need to be told that their comments are not nice or not friendly. Once small children learn that certain things are not acceptable to the adults around them they tend to stop doing them! They are usually more motivated to seek approval rather than disapproval.

As he gets older, his self-esteem will hopefully be high enough that he just gives off the aura of being accepting of his own hair loss. His friends will accept him if this is how they too have always known him.

If you treat him as "normal" then he'll act "normal", further reducing his susceptibility to teasing.

How do I explain to my children why we have no contact with their grandad?

Q. My father was an abusive bully. Now, as an adult, I have cut him out of my life. My dilemma, however, is that I have three children, who have no awareness of his existence. My eldest, aged five, is mad about my father-in-law and I feel it is only a matter of time before she becomes aware that her other grandad is missing from her life. I am loath to tell her because I feel that this is an "adult" issue and don't want to burden her. But I think it would be irresponsible of me not to have something to tell her when the time comes.

David replies: I think you are correct that it is only a matter of time before your children discover that they have a second grandad, who is alive and well. Depending on their age, when this occurs, they may have any number of feelings, such as being shocked, confused or upset that he had been "hidden" from them.

Family secrets can often feel very burdensome and can cause all sorts of complications in life, as we get older. You may find, yourself, that it becomes untenable to keep your father's existence a secret from your children.

The older your children get, the more they too, are likely to be puzzled, and maybe feel hurt, that they were never told about their grandad.

Even if they don't get to see him, because you have no contact with him, they may still feel that they were "cheated" of even knowing that he existed.

By telling them proactively, that you too have a father, who is alive, but with whom you have no contact, you unburden yourself of the "secret" you carry.

If you tell them about him, while they are young, then they will feel that they have always known about their grandad, even if they don't actually know him. All in all, talking to them about him seems like a good idea.

If you do tell them about your father, you can expect that they will have questions. If you are telling them at this stage in their lives, then any questions are going to be quite concrete, like, "where does he live?", "what does he look like?" or "why do we never visit him?"

It will help if you do have an explanation, for your children, of why you choose to have no contact with their grandad. But the extent of that explanation can be modest, since they are so young.

The concept of a person as an "abusive bully" will, naturally, be hard for your children to understand at their age. But, you do need to give them some indication that your father acted meanly, or aggressively, towards you.

So, you might want to use phrases like these to describe your relationship with him: "I don't talk to my dad anymore because he has always said mean things to me, when I was growing up." Or, "My dad wasn't fair or nice to me when I was a child".

If the nature of the abuse was physical, then you can also say: "My dad used to hit me. Hitting someone is never right, so now I choose not to spend time with him or bring you to meet him."

You might also want to explain your decision not to introduce your children to him, by saying something like "I don't think my father is kind to children, so that is why I never bring you to see him".

While I fully respect your decision to have no contact with your father, you may find that in the years to come, your children might want to develop their own relationship with him. This will be another issue that you may have to think about, and to decide about, down the line.

Your rationale for having no contact may make sense to you, but it may not make so much sense to them. While your children are this young, they are unlikely to question your rationale, but you may find they present more of a challenge when they come of age themselves.

Telling them about him, while they are young, still gives you lots of time to formulate, and process, your own thoughts and feelings about your relationship with your dad. This ongoing consideration that you give to your circumstances will guide you when, or if, your children have more challenging questions about your position.

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