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Together is a new resource for anyone affected by pediatric cancer - patients and their parents, family members, and friends.
Learn MoreWhen children are too young to tell you how they are feeling, it can be difficult for you as a parent. If your baby or toddler has a serious illness, it’s especially tough.
Active reflection, or reflective functioning, is one tool that can support parents. It can help children feel safer and more confident. And you may already be doing it.
Reflective functioning is the act of reflecting on or imagining your child’s internal world—their thoughts and feelings. And when you notice certain actions or behavior, you reflect on what thoughts or feelings led to those actions. Then you put your thinking into words as you talk to your child.
Watching a child go through treatment for cancer or other illness can make parents feel helpless. But there’s a lot you can do. Through your words and actions, you can help your child make sense of their thoughts, feelings, and resulting actions. You can make them feel safer and more connected and help ensure that they have healthy social and emotional development.
To practice your reflective skills, watch your child’s behavior—the way they act. Then, reflect on what you think it means. Finally, share your thoughts about it with your child out loud.
This interaction is the most important part. It doesn’t matter if your thoughts are right. Just respond based on your own thoughts about how your child may be feeling or what they’re thinking. It may help to frame your ideas in the form of a question that you ask out loud.
Here are examples of parents using reflective functioning:
Sally is getting ready to take her 24-month-old son Charlie to the hospital. It’s treatment day. Sally and Charlie have a two-hour drive to the hospital. Charlie refuses to get into the car. Sally wonders if it could be because treatment days always make him cranky or because he must stop building with his favorite blocks for the car ride.
Sally: “I wonder if you are cranky because it is treatment day?”
Charlie seems to zone out, like he doesn’t hear her. He continues building with blocks.
Sally: “Or maybe it is hard to stop playing with your favorite blocks?”
Charlie says “Play. Blocks. Play!” and continues building with blocks.
Sally: “It’s hard to stop playing. I will set a timer for 2 minutes. Then we will put the blocks somewhere special until we get home."
Charlie continues building until the timer dings. Then Sally says “the timer dinged. Let’s put the blocks in their special spot.” Charlie slowly starts picking up his blocks. . Sally tells him what a good job he is doing and lets him choose where to put the box of blocks. Then, as soon as he is buckled in his car seat, Sally says “I am so proud of you for getting in your car seat.” Charlie smiles.
See how Sally connects Charlie’s actions to his thoughts and feelings:
| Actions and Feelings for Charlie | Mom reflects on possible meaning for the actions |
|---|---|
| Charlie refused to stop playing to get into the car. | Sally wondered aloud whether coming to the hospital makes Charlie anxious. |
| Charlie ignored this comment and kept playing—but he heard that his mom thinks about how he feels. This showed him that his feelings matter. | Sally knows these blocks are currently Charlie’s favorite toy. She wondered aloud whether it is hard to stop playing with them. She notices that she feels sad and frustrated that treatment interrupts his play. She feels guilty that his toddlerhood is so different from his older brothers’. |
| Charlie confirms by saying “blocks” and “play.” | Sally acknowledges that it is hard. |
| Charlie feels understood. | Sally gives him time to prepare for his transition to the car with the 2-minute warning. |
*Had Charlie not complied when the timer sounded, Sally could have calmly said “You can choose where the blocks go, or I will put them on the table.” If Charlie had begun to verbally protest Sally could have calmly put the blocks on the table and then said: “It is hard to do things we don’t want to do but it is time to leave. You can walk to the car or I will carry you.”
Sally is aware of her own feelings of frustration and guilt, as well as her son Charlie’s feelings. Using reflective skills means being aware not only of your child’s thoughts and feelings but your own.
Let’s look at some situations you may have already experienced and how you might practice your reflective skills.
It’s the day of a doctor visit and you’re picking up your child from preschool to go to the appointment. You go to the office and ask if she’s ready. When they call her from class, she doesn’t come for another 10 minutes. After reaching the car, she sulks, saying “I don’t want to leave!”. What do you do?
Example response: “It’s hard to leave friends. You get to see them again tomorrow. But I know it is still hard.” or “I wonder if you feel scared about the doctor? Sometimes I worry when I see new doctors. But I’ll be with you the whole time.”
Yesterday your child finished the first round of treatment. It made him feel nauseated. This morning, he vomited a few times. And this afternoon he started throwing some of his favorite toys. What do you do?
Example response: “I think you are upset that you feel sick today. It’s ok to be upset. But toys are for playing. If you throw another toy, I will take it away. Maybe we could teach your bear how to take belly breaths together? Or, we could watch a movie?”
Through your words and actions, you can help your child make sense of their actions as a result of what they’re thinking and feeling.
It’s natural to try to understand each other and to make sense of how we behave. If your child touches her mouth or bangs a spoon against her highchair, your first thought goes to what they want: food. So, you’re already wired to search for meaning when you observe a behavior.
Experts think our reflective skills help us develop social relationships. The more we can understand thoughts and feelings, the more we’re able to have productive and lasting relationships. We can not only connect better with others but also feel like separate, independent people.
Do you see why practicing reflective functioning can help kids like yours early in their childhood? Making these connections early on helps children develop socially and emotionally. Even a three-month old baby learns about thoughts and feelings by watching their parents.
Parents who practice reflective skills use their understanding of their child’s inner world and resulting actions to guide their own actions. They’re aware of the main feelings they have as parents, such as guilt, anger, and joy. And they don’t deny these feelings. They also understand that thoughts and feelings can change and be hard to understand.
Everyone, from babies to adults, enjoys validation. The connection and acknowledgement of your child’s thoughts, feelings, and actions help them feel connected and heard. And when they feel connected, they also feel safer and more confident.
This confidence gives them the ability to develop in other areas. They’re better able to learn, take healthy risks and trust the world around them, including health care providers. Practicing your reflective skills also enhances the personal feelings of connection between you and your child.
You can use your reflective skills any time, from your everyday interactions to your outpatient clinic visits or inpatient hospital stays. These skills give you the power to help your child feel safe and connected during a time when so much is out of their control—and yours.
*This story about Sally and Charlie isn’t real. We just used it to show some common feelings of parents and the awareness they have of their child’s feelings.
Setting appropriate limits and being consistent also helps young children feel safe and secure.
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Reviewed: March 2021