Emotional Learning in Kids with Heart Defects

 All children must learn to recognize and manage big feelings, and to respond appropriately to other people's feelings.

This learning process is hard for many children. For some children with heart defects, learning to understand and manage emotions is even harder than is typical.   

However, with practice and teaching, children with heart defects can get much better at understanding, managing, and responding to emotions. These strategies can help.

Most school-age children can learn to name and describe their feelings. When they are able to say what they feel, they are better able to manage their feelings.

 Caregivers can help by:

• Reading books that teach feelings

• Watching TV shows that teach feelings, and talking about them

• Naming their own feelings

• Asking the child what they feel, and giving choices (example: “Are you feeling frustrated? Sad? Angry?)

• Helping the child describe how an emotion feels in their body

• Talking about what other people probably feel, and why

• Talking about what characters probably feel, and why

• Practicing matching face expressions with feeling words

• Make connections among feelings, thoughts, and actions

Children need to learn about what they are feeling.  Adults can help them by reflecting a child’s feelings in their own faces and behaviors.

For example:

If a child is sad, adults can:

• Show concern in their face and voice

• Say they notice the child looks sad

• Offer them child comfort

• Name and model a strategy, such as thinking about something happy

If a child is mad, adults can:

• Show concern in their face and voice

• Say they notice the child looks mad

• Offer a way to try to make the child feel better

• Name and lead a strategy, such as taking a deep breath and counting to four

If a child is scared, adults can:

• Show concern in their face and voice

• Say they notice the child looks scared

• Remove the scary thing, or introduce it more gradually

• Name and lead a strategy, such as asking questions to understand

• Offer the child comfort

If a child is surprised, adults can

• Show surprise in their face too

• Show interest in what surprised them

• Say they notice that the child is surprised

• If the child is scared, comfort them

• If the child is excited, act excited too

If a child is happy or excited, adults can:

• Smile back at the child

• Say that the child is happy or excited

• Talk in an excited voice

• Look at the child

• Show interest in what the child is noticing

By middle childhood, most children can learn and use strategies on purpose. Caregivers can help by teaching strategies, and showing children how they use the strategies themselves.

When they notice a child is having a big feeling, caregivers can remind the child of their strategies.

Some children like to make a book or poster with all their calming strategies.

These strategies help most school-age children:

• Think about something happy

• Take a deep breath and count to four

• Practice deep belly breathing

• Take a break in a quiet space

• Have a cold drink

• Splash cold water on their face

• Tense and then release their muscles

• Ask more questions to understand

• Give themselves a big hug

• Do a quick burst of exercise

Parents and children can make a list of other calming strategies that work for them.

Once a child has learned and practiced a calming strategy, caregivers can help them to use it when they are actually upset.

When a caregiver notices that a child is getting upset, they can:

• Use words to say what they think the child is feeling, and why (“You look like you are mad that you got the wrong answer on that math problem.”)

• Validate what the child is feeling (“I understand! It can be so frustrating when you think you did it right, but then you check the answer and it was wrong.”)

• Name and model a strategy that the child has practiced (“Let’s take a deep breath and count to four. I will do it with you.”)

• Ask the child if they want to use the strategy again

• Give the child a choice for next steps (“Good job taking a deep breath. Do you want to keep working on your math, or get a snack first?”)

It can be hard to stay calm when a child is upset. But caregivers are most effective at calming their child when they can stay calm too. 

When guiding a child to use a calming strategy, caregivers should try to:

• Breathe slowly and steadily

• Get down to the child’s level

• Smile gently

• Use a quiet, slow voice

Mindfulness means paying attention on purpose to what is happening right now, without judging.

Mindfulness can help people to relax and manage their thoughts and feelings.

 By middle childhood, most children are able to learn some mindfulness strategies.

Caregivers can work with children to learn and practice mindfulness practices such as:

• Sitting still and focusing on their breathing (“I am breathing in, I am breathing out”)

• Listening to a guided meditation

• Listening to a guided visualization

• Doing a body scan: focus on each part of the body, feel it, and then relax it with intention

• Finding 5 things you see, 4 things you hear, 3 things you feel, 2 things you smell, 1 thing you taste

 These strategies teach children how to notice what they are thinking and feeling, and gives them practice controlling their thoughts and reactions.

Taking care of children can be stressful.  Taking care of a sick child is very stressful.  But, if grownups can manage their own stress, they can help their child to manage emotions too.

Usually, adults should work on their own negative emotions and distressing thoughts away from a child.  They can help their child by remaining calm as much as possible in the child’s presence. 

Many parents of children with a heart defect manage their feelings and thoughts with:

• Therapy

• Support groups

• Respite time

• Medication to treat anxiety or depression (if needed and recommended by a doctor)

Sometimes, parents may become overwhelmed while they are with their child.  In those cases, the adults can model how to cope effectively with distress.

When an adult feels upset in front of a child, they can:

• Say that they are having a big feeling

• Name the feeling (“I am feeling frustrated.”)

• Say that they know a strategy to manage the feeling (“I know it will help if I take big belly breaths.”)

• Model using the strategy

• Say how the strategy helped

By modeling this process, parents can teach children that:

• Everyone gets upset sometimes

• Feelings are not scary or bad

• People can use coping strategies to manage big feelings

• Even when people have big feelings, they are still OK

While adults can do a great deal to support a young child’s emotional development, it is important to remember that it will not happen all at once. Children become better at understanding and managing emotions as they grow up, and continue to build skills into early adulthood. 

The task of middle childhood is to set the stage for long-term emotional well-being, through a safe home, responsive caregiving, and careful instruction in emotion regulation.

This content was reviewed by a psychologist at Boston Children's Hospital.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.