So how do you help your patients and their parents reestablish some balance? You can start by figuring out if they are overscheduled. Ask if their school-age children have as many free afternoons as scheduled ones? Do they have recurring play dates as well as Russian and math classes? Do they have time for senseless fun with friends, siblings, and parents? Ask teenagers how much sleep they are getting? How often is the family able to have dinner together? When is the last time they had time to read a book for pleasure or to explore a new interest? Some children and teenagers may be very busy, but will report feeling like their battery is charged by all of their activities. Although they are busy, their schedule may be a good balance for them. But when children or teens report feeling drained by the end (or middle) of their week, they are likely overscheduled.
If parents resist some easing, you should begin to wonder if the child is the one who chose the activity or it represents a parent’s interests instead? Some parents may have strong feelings about what activities made a difference in their lives, and may not be paying attention to how their child’s temperament is different from their own. Sometimes, parents who are working might feel guilty that they are not as available as they’d like to be. They may sign their child up for many activities, hoping to make up for what they worry they are failing to directly provide their child. Parents may need a gentle reminder that a happy, calm dinner with mom and dad often is more developmentally productive than a rushed drive between two practices and a violin lesson.
Find out if specific activities are born of interest or obligation. Demanding obligatory activities should have important meaning for the child, such as Hebrew lessons prior to a Bar Mitzvah. There should be only one demanding activity that is not fun for a child at a time, though. The balance may come from fun or less-structured activities. Asking a child in front of the parents what activities are (or would be) the most fun or interesting for them can help the family to think through how to prune activities when a child is overscheduled, and remind parents of the value of play.
It also can be helpful to consider a child’s temperament when talking with a family about finding greater balance. If a child is very shy, there can be greater developmental value in activities that promote social skills, even though that child might not naturally seek those activities out. Teens who are struggling to fulfill basic responsibilities may need to have their schedules streamlined, but it is important to preserve an activity that may aid in cultivating their discipline and organization (such as a sports team or a job they value). Highly driven, ambitious adolescents sleeping only 4 hours a night to fulfill their many responsibilities would benefit from making time for relaxation and sleep, and hearing this from a pediatrician may be the critical factor in making it happen.
Finally, ask parents how drained they feel by facilitating their child’s (or children’s) schedule. When parents are so busy with their children’s activities that family time is nonexistent, or one child is receiving a greatly disproportionate share of the parents’ time, it is worth examining. Reminding parents that time spent together around the dinner table and helping with homework or in a shared activity – time that may leave them feeling more charged than drained as parents – is critical for the well-being of the whole family.
Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. E-mail them at pdnews@frontlinemedcom.com.