Parenting with a Traumatic Brain Injury

I have four children between the ages of 1 and 8. My husband was in a car accident several years ago and suffered a traumatic brain injury. When our children ask him to read books or play games, he has difficulty reading and processing. My husband wants to promote a positive relationship with our children. How do we do this while helping them understand their dad's limitations?

First of all, kudos to you, your husband and children. It sounds as though your family has gotten through the worst moments of a serious injury, and is now creating a new vision of family, co-parenting, and relationships.

As you know, positive relationships are built on shared experience, consistent nurturance, and loving interactions. Try to increase shared activities that are not impacted by your husband’s TBI. The goal is to have positive, engaging and joyful interactions each day. Children are pretty accepting of limitations in others if they’re not worried that their own needs will go unmet. And they do better with accurate information. Creating scripts that are acceptable to you and your spouse that grow more sophisticated as the children ages will be of benefit to you and to them.  "The way your dad's brain is wired makes it difficult for him to read the words but he can tell a great story with the pictures." Reading books or following directions may be difficult for your husband, but telling stories based on the pictures, building with Legos and other less structured play activities might work.

While the traumatic brain injury may not interfere with your husband’s ability to be a responsive father, he is at a higher risk for depression and feelings of inadequacy as a parent. You and your children are also at higher risk for depression. Honestly monitoring your own and your family members’ emotional health—and seeking treatment when things get off track—are crucial steps in ensuring healthy relationships.

Because parenting is often an on-the-job learning experience, your husband may need special support in acquiring the skills necessary to be successful. There are formal resources out there for parents with cognitive disabilities (such as www.lookingglass.org) that can offer ideas and strategies to help with common parenting dilemmas. I would also encourage the two of you to talk about future parenting decisions – bedtime, homework, friends, middle-school clothing choices—and come up with a loose game plan.

The rise in the number of returning service personnel with TBI means that there are more family support services available. You may want to contact the Veterans Administration in your area to see if there are support groups, parenting classes, and sibling groups that your family could join. There may also be parenting classes or coaches for parents with TBI.

Above all else, get consistent support. With a busy household of four children, enlisting parenting partners may ease the burden on you and your husband (a regular babysitter could help with homework while you cook dinner or vice versa.) Then give yourself a hug: your children and husband are lucky to have you as a mother and partner.  

Starting Childcare

 I’ve been home full-time with my daughter since she was born in May but now must return to teaching elementary school in September. I found a fabulous home-based childcare provider for our 4 month-old and we plan to have our first practice "drop off" this week. What should we do on that day to make our daughter’s experience positive? Should my husband and I stick around with the provider this time? Or do we drop her off and leave?

Congratulations on finding a childcare provider you trust, and good for you for designing a practice “drop off” plan. I advise you to follow your intuition as to what you and your spouse need and what your baby needs during your “practice run” – all are important considerations. If you want to spend an hour playing with your baby at the childcare home, do it. On the next visit you could start working on separation. For example, you could reduce your stay at the beginning to 15 minutes and only be away 30 minutes and then have your husband repeat the same routine.

These short practice sessions will allow everyone to build up to the full-day separation that is on the horizon. Your goal is for your family to feel comfortable with your new childcare provider and to help everyone get used to this new arrangement. If, for some reason, your provider is hesitant to work with you this gives you important information about your provider’s willingness to partner with you in the future.

I’m not a fan of the “drop and dash” plan. While many parents and providers assert that this method is easier for the child, it really only makes it easier on the adults. It makes no sense from the baby’s point-of-view: no baby wants to be left without warning in an unfamiliar place, with an unknown person, for an unspecified period of time.

Transitions are usually rough on everyone, but you should all feel settled by the end of the first month. Your new routines will become comfortable, your daughter’s transitions to the childcare home will become predictable, and your time together will satisfy both of you. If, however, worry or sadness characterizes her experience or yours after the initial settling-in period, you may want to re-evaluate. Remember, the most important consideration is the childcare provider’s fit with your daughter and family.