Made a child with cancer cry.

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I had an 8 yo pediatric patient who happened to be a cancer patient. He was a bit moody so asked him if he wanted to play with some lego-like toys he had. So I proceed to take his Legos to him so he can play in bed (nonmobile). He was having a great time laughing and no longer in his funky mood. About 20 mins later I check on him and he decided he was done playing. Instead of telling me if I can put them back in his drawer he begins to throw his Legos at me and on the floor. I firmly told him he can't be throwing his toys at nurses and asked him who is going to pick these up now? He began to cry and I feel horrible. How did I make a child with cancer cry? How do you deal/discipline(which is what parent is for but not sure what to call it)

children who are acting up when the parent isn't around?

I am a pediatric oncology nurse and also experienced childhood cancer myself. Kids with cancer get put on steroids A LOT. I am guessing this kid was on pred or dex and was having a tough time regulating his emotions (since you said he was moody and went from happy to mad to sad pretty rapidly). Also cancer sucks and makes you want to throw things sometimes. When I was on pred as part of my treatment I wanted to throw things a lot. I can pretty much guarantee your interaction with this kid was probably not what made them cry. It is hard to discipline kids the same when they are in the hospital or when their behavior is related to being on steroids, but I have learned a lot from the amazing parents on our unit and keeping as much of a routine as you can and reinforcing the behavior you want to see seems to work in the long run.

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I work in paeds onc. We tell all our parents, including parents going to transplant/BMT that their parenting style should not be altered by their child's diagnosis or treatment and that they should continue to enforce their usual limits and boundaries around their child's behaviour. Spending 3+ months in hospital with a child undergoing transplant, stuck in the one room with them, can be draining for these families and limit setting helps them cope during the experience and when their child is well enough to be discharged, or in remission. It also makes things easier and fairer on other children in the family.

If the child is well enough to throw toys, the child is well enough to have limits set around appropriate behaviour.

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Specializes in NICU, PICU, PCVICU and peds oncology.

And then there's the parent of a developmentally normal but chronically ill adolescent who treats the child like a 5 year old... and the nursing staff like they're all incompetent idiots.

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I had an 8 yo pediatric patient who happened to be a cancer patient. He was a bit moody so asked him if he wanted to play with some lego-like toys he had. So I proceed to take his Legos to him so he can play in bed (nonmobile). He was having a great time laughing and no longer in his funky mood. About 20 mins later I check on him and he decided he was done playing. Instead of telling me if I can put them back in his drawer he begins to throw his Legos at me and on the floor. I firmly told him he can't be throwing his toys at nurses and asked him who is going to pick these up now? He began to cry and I feel horrible. How did I make a child with cancer cry? How do you deal/discipline(which is what parent is for but not sure what to call it)

children who are acting up when the parent isn't around?

"Hold his hands from throwing the 'lego's' and say "let's not throw the lego's ok". He doesn't have to hear the 'don't throw toys at 'nurses' deal. Making a child with cancer cry to me sounds sick. You can be loving to that child.

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Specializes in NICU, PICU, PCVICU and peds oncology.

I SO disagree! Of course she's not trying to educate this child (replying to your unedited comment). She's setting limits, which are totally reasonable. 8 year olds should know better than to throw things AT PEOPLE, and they should also be able to exert some self-control. Kids with cancer don't get a pass from being civilized - age-appropriate behaviors aren't optional no matter what brings a kid into hospital. I've had a kid with cancer (and a laundry list of other illnesses) who spent a lot of time in hospital and I would have been appalled if he EVER threw a toy at another person NO MATTER WHAT.

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I agree with everyone above about the need for continued discipline and boundaries despite illness. I also agree that asserting rules, like you did, is absolutely appropriate.

I'm curious, though, if the patient could possibly have started crying, not because of the discipline, but because of the tone. "Who is going to pick these up now" sounds a bit too confrontational and aggressive, especially since he is immobile. I hope I am not making your guilt worse. I just know that tone really matters, and I thought I'd share.

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Specializes in PICU, Pediatrics, Trauma.
When kids realize that suddenly their parents arent disciplining them, they know something really scary is happening. Keep holding them to age appropriate standards. Remind the parents that this is an emotional security issue- keeping up with discipline is worthwhile to make the world feel controllable. Also, they have to live with these kids when the crisis is over!

Well said....and children cry out of frustration and anger and sadness and pain and...just like adults, but more so because they don't filter themselves as much. It is perfectly reasonable to cry over certain things. It's normal to cry. It's okay that he cries. It's a good release.

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Specializes in PICU, Pediatrics, Trauma.
"Hold his hands from throwing the 'lego's' and say "let's not throw the lego's ok". He doesn't have to hear the 'don't throw toys at 'nurses' deal. Making a child with cancer cry to me sounds sick. You can be loving to that child.

I don't see how she not loving. Discipline is discipline. It's okay to cry. He was frustrated and probably, sad, bored, and angry. You can say, "I'm sorry you feel bad. Can we think of something to help you feel better? What is upsetting you now?" Go from there, but setting limits is very important for all the reasons already mentioned.

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Specializes in Trauma ICU.

I realize this topic has been beaten to death, but I was scrolling and found it and noticed there's a different point of view which has not been mentioned. Maybe this will be useful for someone else one day who finds themselves in a similar situation.

If the child was immobile, especially acutely, then he may be adapting to this new realism. When you say, "who's going to pick this up," reinforces the fact that is incapable of a simple task that any other kid could do, pick up toys. While this was not your intent, the phrase could have had a subconscious effect. I would rephrase, "What if I miss one of the toys while picking these up and a nurse slips while helping you?"

Just another perspective which I wanted to toss out there. The fact that the op felt guilty enough to spend time with the pt afterwards and to share online clear demonstrates compassion for the patient and clearly would not intend to hurt someone on purpose.

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I realize I missed this party, but if someone else is reading, hopefully it could help the next kiddo.

The first thing I noticed was that you asked a "non-mobile" Peds oncology pt "who is going to pick these up now?"

Discipline issue aside for a moment, if he's non-mobile as a result of the malignancy or treatment...well, hopefully you can see where I'm going. Probably not the best choice of words for admonishing.

Second, as a previous poster stated, the steroids. The STEROIDS. Summed up pretty well.

And yes, discipline. Everyone has a different opinion on what is best, healthy or sick. And truth be told, I have a whiny and entitled 6 year old after 3 years of treatment for her own pediatric malignancy. And I worry about that. But you know, she's always been high strung with very little stress tolerance, even as an infant. Her sister the absolute opposite (baby jackpot! 😂💕)

Here's what I've found out through trial and error. Discipline doesn't mean punishment (or criticism or admonishing or etc...) It's a whole big ball of teaching them how to react and cope with their emotions and be responsible for their decisions.

I use this now to frame my response to "bad" behavior, and although we have a lifetime to go, I have a surprisingly insightful 6 year old emerging from behind a whiny and entitled facade...

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Hey everyone thanks for all the comments. I had posted this back when I was still a fresh nurse. I still think about this kid and since then learned so much. I still work with children and have learned to set limits when a child is being mean to another person. I usually don't get upset at them now when they have an attitude problem and are just not listening to directions. I now approach it in a more therapeutic way I guess you can say. I give much attention to children who are acting out to get to the root problem of their actions. (Most of the time they just need a hug and reassurance) Ahh yes saying "who's going to pick these up" was not the best choice of words to say to a non ambulatory pt. I was just so upset I was getting toys thrown at me. My go to words now are usually "you can't be mean to people that's not cool" which they usually understand and stop.

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