Social Skills in Young Children with Heart Defects

Families are young children’s first and most important social communities.  Through family structures, children learn how people can live and work together.  By forging strong relationships with their young children, parents can help children to learn how to connect with other people. 

Some children with heart defects have trouble with social skills. In these cases, parents can help them to make as much progress as possible. No therapy can substitute for a strong relationship with a caring family member. As families spend time with their young children, these activities and strategies can help them to build social skills: 

When a child has a secure attachment to a caregiver, they: 

• Seek comfort from their caregiver 

• Feel safe exploring their world  

• Become upset if they are separated from their caregiver 

• Are easily soothed by their caregiver 

• Feel generally safe in the world 

• Trust that their life is mostly predictable 

• Feel seen, loved, and valued 

Ideally, babies and their caregivers build a secure attachment during the first year.  However, caregivers can work on building a secure attachment with their child at any age. 

Caregivers can build a strong attachment with these five strategies:

Quickly comforting a child if they are sad, scared, or angry 

• Holding or hugging, chest against chest 

• Soothing words or sounds 

• Talking calmly, slowly, and quietly 

Responding to what a child says or does with interest 

• Looking at what they show 

• Talking about what they do 

• Responding to the meaning of what they say 

• Reflecting their emotions  

When interacting with the child:

• Smiling at them 

• Laughing with them 

• Touching them gently 

• Looking happy to see them and to be with them 

• Playing with them 

Helping the child to be able to count on:

• A schedule and routine 

• Rules that make sense and do not change 

• The same primary caregiver(s) from day to day 

• Responding to the child with love and comfort every time 

Every community has their own social rules.  Children need to learn these rules; they are not born knowing them.  Families can help children by showing and talking about social situations.  Through this process, they help children to become full members of their social community. These strategies can help: 

Read picture books or watch videos that have characters and relationships. Talk about the characters: 

• How do they feel? Why? How can you tell? 

• What are they thinking? Why? How can you tell? 

• Are they friends? How can you tell? 

• How do they feel about what the others did? Why? How can you tell? 

• Why did they say that? Why did they do that?  

• When they did that, how did it make the others feel? 

Before a new social experience, talk about what will happen.  Explain the social meaning of the experience.  Tell the child what behaviors are socially expected during the experience. For example, before a graduation you could say: 

“Cousin Addy has been going to school for a long time. She has learned a lot of important things.  We are so proud of her! We are going to her graduation to show her we are proud.  This is what will happen: 

• We will go to a big park that is next to a big brick school building. 

• There will be a lot of people, and a lot of chairs.  

• We will sit in a chair. It may be a long wait. We need to sit still and quiet while we wait. You can color or look at a book if you want. 

• A grownup will stand on a stage and talk about how well Addy and her classmates did at school. 

• A grownup will say each person’s name.  We will listen for Addy’s name.  We will clap for each person to show we are proud of them.   

• When it is Addy’s turn, she will walk across the stage and get a special piece of paper called a diploma. This paper says she finished her school and worked hard. We will clap and cheer for Addy. 

• When all the students are done, we can get up.   

• We will find Addy and give her a hug.   

• You can tell her you are proud of her for working hard and finishing her school.” 

In order to have social relationships, children need to be able to communicate with others.  Communicating can mean: 

• Language 

• Facial expressions 

• Gestures and body language 

• Sounds 

• Pointing and showing 

• Touching and responding to touch 

 Many children become better at social skills when they are better at communicating.   

Most young children communicate primarily with language.  They can use language for social purposes.   They use language to: 

• Say what they need 

• Say how they feel 

• Express interest 

• Share thoughts 

• Be funny and creative 

• Take turns with another person 

• Understand what others think and feel 

• Understand what is going on 

• Learn routines and rules 

• Connect with other people 

Parents can help to build language by: 

• Talking as much as possible with their child 

• Reading books every day to their child 

• Singing songs and reciting rhymes 

• Practicing turn-taking with games, songs, and rhymes 

• Asking the child questions 

• Describing what the child is doing 

• Listening to songs, podcasts, and audiobooks 

Some young children do not use language.  They might learn language later, or they might never use language.  Parents can still help them to communicate, and to be social.  These strategies can help: 

Talk with a speech and language pathologist about communication tools that might work for the child, and use them every day. 

• Tablet communication system? 

• Picture communication system? 

• Pointing and some signs? 

Learn how the child shows their feelings, and respond to their cues by giving them what they need or want (when possible). 

• Face expressions?

• Looking towards or away?

• Moving arms or legs?

• Making sounds?

• Tensing or relaxing body? 

Learn how the child shows interest. When they show interest: share it! Show, talk about, and interact with whatever caught their attention. 

• Looking towards?

• Making sounds?

• Walking towards?

• Moving arms or legs?

• Facial expressions? 

Interact back-and-forth with the child, as if in a conversation 

• Take turns making sounds 

• Take turns with movement or touching 

• Play games like patty cake that go back-and-forth 

• Pass or roll a ball back and forth 

Show pictures of what is going to happen so the child knows what to expect. Show pictures to explain what is happening now.  

 Play is how children learn.  Parents can help children learn social skills through play.   These strategies can help: 

• Do dramatic play.  Act out scenes and social situations with the child. Practice taking on different roles, and dressing, talking, and acting as those roles. 

  • Play restaurant 

  • Play doctor 

  • Play school 

  • Play house 

  • Imagine being scientists or explorers 

  • Act out a scene from a book or fairy tale 

• Play with dolls and figures.  Act out scenes and social situations using toys.  Use voices, and tell a story. Try switching up the stories, and talk about why characters are making choices. 

  • Run a stuffed animal school 

  • Act out daily life in a doll house 

  • Have a doll run a nursery or daycare 

  • Make Barbie visit the doctor 

  • Have toy dinosaurs go on an adventure 

  • Use action figures to act out a scene from a movie 

• Play turn-taking games.  Social communication involves taking turns, and turn-taking games can help. 

  • Simple card games 

  • Simple board games 

  • Taking turns on a swing or slide 

  • Rhymes, songs, and dances that involve turns 

In order to understand the social world, children need to understand emotions. Emotions often explain how and why people behave as they do.  By understanding emotions, children can feel more connected with other people.  Parents can help children understand emotions by: 

• Reading books and watching videos that teach about emotions 

• Saying the name of what the child feeling 

• Saying the name of what parents are feeling 

• Matching emotion names with pictures of faces 

• Talking about why characters act as they do, based on how they feel 

• Talking about what others might be feeling, why, and how someone can tell (ex: “I think Jeremy is feeling disappointed that you don’t want to play. His mouth is turned down and his eyes look teary.”) 

Most children with heart defects can safely be around other children.   They can: 

• go to daycare, school, and playgrounds 

• join classes 

• have play dates   

These early social experiences help children learn how to have friends and play with others. Families can connect with their local parent groups to find child-friendly events in their communities. In rare cases, children with heart defects may not be able to be around many children.  This could be because: 

• They are recovering from a transplant 

• They are waiting for a transplant 

• They are in heart failure 

• They have a weak immune system 

When a child must be physically isolated, families and the medical team can work together to find ways for them to connect.  This could mean: 

• Video calls with a classroom or daycare 

• Having a pen-pal, and sending drawings and photos back and forth 

• Online communities or games  

• Virtual support groups for children with chronic illnesses 

Most young children with heart defects can safely go out in their neighborhood.  Families can help young children to learn social skills by exposing them to their culture and community. This can mean: 

• Bring them on errands, and talk with customers and workers 

• Go outside and chat with the neighbors 

• Bring them to local events: festivals, parades, concerts, shows 

• Join a local team or class 

• Bring them to cultural centers or religious spaces 

• Invite friends over, and go to friends’ houses 

• Visit the public library, and join their children’s activities 

• Spend time with extended family 

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.