One morning in New York City public clinic, a mother sits down and tells me her 4 month old son has been vomiting his formula for the past 3 months. The boy’s weight and height were adequate. Enough formula was being digested. Maybe the child needed something other than the standard formula. “What did the doctor tell you?” I asked. Mother told me she had not told any of this to her son’s pediatrician. I was concerned because chronic vomiting can corrode her child’s esophagus, throat and vocal chords.
Mother told the pediatrician nothing about the vomiting because of something going on between her husband and herself. Father, in her opinion, was chronically anxious for their first child. It appeared as if when Father thought his son needed more care, Mother reacted by thinking their child needed less. The child was caught in the crossfire with a possibly damaging condition.
Children benefit from differing opinions and parenting styles when the discussion increases the child’s options. One grownup’s strengths can balance out the others weaknesses when conversations succeed and an agreed upon or a new idea arises. In destructive disagreements children get lost in a parent’s emotional dance.
During the meeting, two more communication challenges arose. The first was a language problem. Mother spoke Spanish only. As her comments became more detailed, my intermediate Spanish was no longer sufficient. The vocabulary associated with the increasingly personal details made it hard for me to understand. I asked one of my native Spanish speaking colleagues to help with translation. I asked her to help me find out more about the parents’ disagreement. I wondered what role the disagreement played in keeping the child from care.
My colleague translated for me in the past. She knows my usual questions. Sometimes, she proceeds without me and I follow along. My workmate asked about some topics I had neglected to ask about such as how the powdered formula was diluted, in case the problem was human error. Mother told us she made the formula correctly. After a while, I interrupted my colleague to remind her that I also wanted to know why the mother and father disagreed. I had to interrupt my colleague a few times to get the question asked. There are many reasons parents avoid the pediatrician and I wanted to learn the facts in this case. It turned out that Mother decided when the son received healthcare and really was mostly reacting against Father’s concerns. Until Mother could begin to see the reasons governing her own behavior, the child would not have is stomach and throat examined.
To add to the parents’ unresolved inner and outer conflicts, a second challenge arose. Mother’s situation was being replicated right in front of her. A male, I, was having a disagreement with his female coworker, about how to proceed. My colleague and I were replicating the very problem I wanted to resolve. We soon got on the same track. We modeled a constructive disagreement because I let my colleague proceed with the basic questions, politely waiting to ask my questions about the family life.
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Mother now offered more details about how she resented father’s concern to the point where their son’s needs got lost. Their love for their child was lost in the struggle. Father’s worry about his son’s vomiting was lumped in with Mother’s view of Father’s, possibly, anxious general concerns for his son. He was not present to speak for himself. A working father seeing a mother ignore a child’s vomiting might have good reason to be concerned about how his wife cared for their first child. After Mother spoke more about their disagreement, we calmly discussed the effects of vomiting on her son apart from her relationship with her husband. I hoped that Mother could begin to separate her feelings about her husband from their child’s need for an examination. I changed the child’s formula and Mother agreed to a pediatric visit.
Mother returned ten days later, more than two weeks before her next appointment. She had taken her son to the emergency room for a fever. This action demonstrated a wish for professional care. While there, she mentioned the vomiting. The physician told her that degree of vomiting in her son was normal and not to worry. This kind of diagnosis is common. The pediatrician wanted her to return to the original formula I had replaced as a stopgap. I praised mom for taking her child to the doctor. She told me, in turn, that the fever forced her to take her child for medical care, not our conversation.
Was our initial talk a waste? In fact, Mother took advantage of the emergency room visit. She voluntarily asked the question and got the answer. She did not have to ask the question.
Perhaps, our conversation made some space for Mother to take the necessary extra steps once she was in the emergency room. That space, made with an impartial, wondering approach, helped Mother separate the child’s health from her struggles with her husband.
Our meeting created two more openings by a mix of chance and counseling experience. First, my colleague and I inadvertently modeled a constructively settled disagreement. I asked for help to solve the problem that needed two people of different genders to understand. On the one hand, I deferred to someone who spoke Spanish better than I, demonstrating concern. In addition, I politely asserted myself as well further modeling a constructive disagreement.
Second, the persistence to get to the facts instead of commenting on the mother’s seeming neglect established a space for Mother to talk about the latent issues surrounding the parents’ care/no care debate. The neutral arena gave Mother a place to explore her reactions to her husband apart from the needs of their son. She had already begun to separate by coming in the nutrition office and raising her concern for the first time.
Dietetic clinicians have to provide a neutral counseling context for parents when something surrounding the child’s symptoms needs exploration. The neutral counseling context helps us help parents.