Emotional Skills in Teens with Heart Defects

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

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

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

Teens can typically accurately name, identify, and describe basic feelings such as sadness, anger, disgust, and happiness. However, they may still need help consistently recognizng and responding to these feelings, both in themselves and others.

They are often still learning to understand more complex. They may still have trouble understanding feelings such as envy, shame, pride, nostalgia, and anxiety. They also may still struggle to recognize and interpret mixed emotions, such as if someone feels relieved, disappointed, and sad at the same time.

When teens are able to say what they feel more consistently and more accurately, they are better able to manage their feelings.

 Caregivers can help by:

• Reading and discussing books that teach about feelings, or that have characters with complex emotional lives

• Watching and discussing TV shows or movies that teach about feelings, or that have characters with complex emotional lives

• Naming their own feelings, explaining the cause of them, and modeling how they respond to them

• Asking the teen what they feel, and giving choices that might include mixed emotions

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

• Asking a teen how their behavior and actions may reflect or influence their feelings

• Asking the teen what thoughts are connected with a feeling

• Talking about what other people probably feel, and why

• Talking about what characters probably feel, and why

• Make connections among feelings, thoughts, and actions

By adolescence, most kids can learn and use strategies on purpose. Caregivers can help by teaching strategies, and showing teens how they use the strategies themselves.

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

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

These strategies help most teenagers:

• Think about something happy

• Practice grounding strategies, such as focusing on how their feet feel on the ground or body feels in the chair, and noticing what they can see, hear, smell, taste, and feel in the moment

• Practice deep belly breathing

• Take a break in a quiet space

• Have a cold drink

• Splash cold water on their face or take a cold shower

• Tense and then release their muscles

• Do a quick burst of exercise

• Wrap up tightly in a blanket

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

Learning a new self-regulation strategy takes time, practice, and patience.

Caregivers should start by teaching just one or two strategies. 

For example, a teen who is often frustrated could learn:

• Have a cold drink

• Take 10 deep belly breaths, and focus on how the breaths feel coming in and going out

Teens are not ready to learn when they are in the middle of a strong emotion.  So, caregivers should always teach and practice new strategies when the teenager is calm.  

Once the teen is skilled at using a strategy, they can start to use it when they are upset.

As the teenagers learns to use strategies, caregivers can discover which strategies are most effective for them.

Eventually, caregivers and teens can settle on a set of 5-10 strategies that the teen knows well, and can use as needed.

Once a teenager 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 teenager is getting upset, they can:

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

• Validate what the teen 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 teend has practiced (“Let’s take a deep breath focus on how the breath feels in our body. I will do it with you.”)

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

• Give the teen 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 your child is upset. But caregivers are most effective at calming their child when they can stay calm too. 

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

• Breathe slowly and steadily

• 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 adolescence, most kids 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 kids how to notice what they are thinking and feeling, and gives them practice controlling their thoughts and reactions.

Parenting teenagers can be stressful.  Parenting a sick teenager can be especially 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 their child.  They can help their child by remaining calm as much as possible in the teenager’s presence. 

Many parents of kids 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)

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

The task of adolescence is to set the stage for long-term emotional well-being, through a safe home, responsive relationships, and careful practice 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.