There are few more rewarding experiences than being a parent or grandparent! The simple moments of connection through play and activities of daily living often form the backbone of our relationships with our children or grandchildren. Brachial plexus injuries present particular concerns for a parent-to-be, parent or a grandparent as the injury impacts one’s ability to parent physically and at times, even emotionally.
At times, it can feel as though we do not have enough energy to accommodate the routine physical challenges of parenting—from dressing to bathing to playing to feeding to even holding a child. Also, a great deal of our interaction with children is non-verbal and occurs through physical gesture. Not having full use of one’s upper extremity presents a complex challenge when we are adapting to meeting our own needs, let alone a child’s. Whether the brachial plexus injury spontaneously recovers or requires surgical intervention, it will change how you interact with your children and grandchildren.
Teaching children to be careful and adjust how they interact with you to accommodate the injury and its healing process can be a prominent stressor in the relationship. Sometimes even the best intended and loving of gestures, such as when a child runs up behind you to give you a hug, can be a source of excruciating pain or concern when we are recovering. After speaking with your treating physician, it may be helpful to consult with your occupational and physical therapist to determine how to safely be physically interactive with your children. Your therapist may also inform you of physical adaptations and tools that may allow for more active participation.. Don’t forget to ask about ideas for how to adapt favorite sports, games, hobbies or swimming to stay engaged with your little ones!
When we are no longer able to care for or play with our children in the same way, we may feel a great sense of loss. Many believe this will negatively affect our relationship with our children and partner permanently. Depending on our partner to perform child-rearing tasks may bring forward a wave of emotions as you adapt to a new role in the family system. For those whom are considering starting a family or are expecting a child, this may bring into question how capable we may feel to care for an infant. Others may have feelings about how the brachial plexus injury will impact our children emotionally—especially the children who knew us before the accident—and whether we will unduly traumatize or burden them.
We forget that families are not a static system: we are constantly adapting to changes large and small in our family network. Some changes are easier and others are more complicated to embrace. Over the long term, how we integrate the change and create the space to have an open dialogue to process the change over time matters more than the actual change. Children will follow your lead: the more you are able to address, process and adaptively integrate the physical and emotional impact of the brachial plexus injury, the easier it will be for them to come to you with their concerns or needs. Remember that children are surprisingly resilient and adaptive and it is important to:
- Answer their questions
- Be prepared to repeat what is or is not okay to do around your injury as you heal
- Teach them how to help
- Let them know that there is no question to big or too small
- Let them know that they should talk to you about their feelings—even if they think their feelings may hurt yours.
For some patients having unexpected spikes in or chronic pain may greatly impact their ability to be emotionally present. Explain to little ones what a pain episode looks like and what is most helpful for you in those moments. When you are having a spike in pain, be clear about what is happening and what you need remembering to use as neutral a tone of voice as possible. It is essential to reassure children that even though how you interact may change and that you may be less able to be present in certain moments, that this has no impact on how much they are loved and cared for.
For some families it has been helpful to attend family counseling sessions to process what has happened and help the family learn how to communicate more effectively about the injury. Sometimes speaking with a professional about how to address changes in your child’s behavior or how to best communicate with your child about an issue that is tough for you may help resolve the issues more quickly and with less distress. This has been especially useful in situations such as when your child or family is involved in the same sports or activity that resulted in your brachial plexus injury. For example, if you are injured as a result of a skiing accident and your child is a gifted competitive skier, what would be the most appropriate course of action to ensure your child’s wellbeing? What if you and your partner disagree about what that decision should be?
Counseling is also a good forum to help families resolve concerning behavioral changes in their children following an adult caregiver’s brachial plexus injury. Some examples would be recurring nightmares, repetitive play that involves injury, change in academic performance, a social child becoming withdrawn or clingy, no longer wanting to engage in activities, and changes in how the child may act towards the injured adult. Again, most children and family systems are adaptable and resilient—sometimes we just need new tools to help us better process and work through significant change!
Zoe A. Landers, LCSW is a licensed social worker at the Center for Brachial Plexus and Traumatic Nerve Injury (CBPTNI) who evaluates and facilitates treatment for brachial plexus injury patients experiencing psychological and psychosocial stressors following injury. Ms. Landers has actively participated in research with the CBPTNI multidisciplinary team to develop a deeper understanding of the psychosocial and psychological impact of brachial plexus injury. Findings from this research have been presented at major hand and upper extremity orthopedic conferences.