A Parent’s Guide to Helping Kids With Psoriasis
How to coach your child through any tricky social situation.
Pediatric psoriasis is difficult for kids to live with. Most notably because the red, scaly plaques that are the condition’s calling card can not only be physically uncomfortable but draw unwanted attention. And when you’re a kid, that’s the last thing you want—which may be why adolescents with psoriasis tend to have increased levels of depression and anxiety, according to research published in Anais Brasileiros De Dermatologia. “When attention is brought to an area, [a child] can feel embarrassed or ashamed, which can often lead to feelings of anxiety and isolation,” says Johanna Kaplan, Ph.D., clinical psychologist and director of Washington Anxiety Center of Capitol Hill in Washington, D.C.
As a parent it’s difficult to see your child struggle. But you might not always know what to do or say to help. Start with these expert tips on how to deal with the four most common scenarios your child may encounter because of their psoriasis, so you can coach your child to handle themselves with strength and pride.
First, Let’s Talk About You
As a parent, it’s common to feel a wide range of emotions, from anger and sadness to guilt and grief, as well as a strong need to protect your child. Know that you may have to manage your Mama or Papa Bear tendencies.
“Parents may feel like calling or going to the school to confront a teacher or an administrator, however, the child may not want so much attention drawn to them and so much discussion about their illness,” says Elena Mikalsen, Ph.D., chief of pediatric psychology at The Children’s Hospital of San Antonio in San Antonio, TX. “It’s also important for the child to get at least some choice about how their illness is discussed and to feel mastery over being able to handle these discussions. With chronic illness, you often feel a lack of control, so any chance we can give kids control, we prefer to do that.”
Therefore, Mikalsen encourages parents to discuss with their child whether mom or dad should intervene for them or if they prefer to handle the situation on their own. “Though parents can’t always control how people respond to their child’s skin condition, they can model how to react in public and educate rather than get angry and defensive,” she says.
Once you’ve talked with your child about ways you might (or might not) help, it’s time to prep your kid to take charge of any social situation that might arise. Here’s how.
Scenario 1: Your Child Gets Teased
The very first thing a child of any age should be advised to do if teased about their psoriasis is to let an adult whom they trust know. This person can be a teacher, a family friend, a babysitter, or even the parent themselves. “With an adult’s help, pre-planning comeback statements to use when they are teased by other children can help them feel more confident and less likely to be caught off-guard by bullies or insensitive students,” according to Whitney Casares, M.D., a pediatrician in Portland, OR, and author of The Working Mom Blueprint: Winning at Parenting Without Losing Yourself .
Children might need help practicing their comebacks and knowing when it is an appropriate time to use them vs. when it’s best to rely on other friend groups or adults to protect them. Workshop the various types of teasing—such as joking, name-calling, and bullying, so your child can decipher what route to take and when. By placing these actions on a continuum from mild to severe, it can help your child know what action to take.
For instance, if one of your child’s peers jokes with them during P.E. class that their pants (worn to cover plaques) will slow them down, help them draft a comeback—and it could be as simple as: the child sprinting to a finish line and saying afterwards, 'was that slow enough for you?' Pre-planning these exchanges could help build up your child’s confidence. For more severe types of bullying, discuss the role teachers play.
Scenario 2: Kids Comment on Your Child’s Clothing Choices
To help alleviate the anxiety they have surrounding their condition, kids with psoriasis often choose to wear clothes that cover their flare-ups, even when it’s not in season (pants and long sleeves during summer). If another child comments on your child’s psoriasis-concealing outfit, arm your child with the tools to make it a teaching moment about their skin condition, Dr. Casares says.
Give your child a script or talking points that they can use to briefly explain their medical diagnosis to their peers. “By increasing others’ level of knowledge, they’ll also increase others’ level of empathy,” Dr. Casares says. “When a child’s peers have a deeper knowledge base around a specific disease like psoriasis, they’ll be more likely to be supportive and less likely to tease or question the child’s choices or needs.”
Scenario 3: Kids Comment on Your Child’s Plaques
The plaques caused by psoriasis are red and scaly, especially when they’re inflamed, which can draw unwanted attention to your child’s skin as well as unwarranted comments from their peers. Support your child by role-playing situations that might arise, such as when other children ask innocent questions about their plaques, suggests Dr. Casares.
“When children with psoriasis are able to differentiate when they are being teased vs. when others are genuinely curious about their disease, they can more easily navigate uncomfortable conversations,” she says. “They’ll also develop more confidence and acceptance of themselves as unique individuals.” This is another situation that could become a teaching moment for your child and their peers. By educating your child more about their condition, such as its causes and symptoms, together you could create responses to the various comments they get about their plaques.
Scenario 4: Your Child Gets Called Out at a Pool
Unfortunately, this is a common scenario—one that you should definitely anticipate. “The pool can be one of the most intimidating environments for children with psoriasis given large portions of skin are exposed,” explains Dr. Casares. “When children are discriminated against at a pool—either by exclusion from entering the water due to concerns from uninformed staff or via exclusion from insensitive peers—it can be devastating and unjust.”
Coach your child to speak with trusted adults—such as a teacher, counselor, or parent of a friend, who can advocate on their behalf if other children discriminate against them. “Advocacy is important in this situation so that the discrimination is not perpetuated and so that kids with psoriasis are less likely to be discriminated against in the future,” Dr. Casares says.
And be proactive, suggests, Laurie Zelinger, Ph.D., a psychologist and parenting expert based in Cedarhurst, NY. Talk to summer camp and school administrators, pool management, or the head lifeguard before your child goes to the pool. This way they don’t have to hear any discussions about their condition with the gatekeeper, she says. And if that isn’t possible, pack a doctor’s note in their bag that states it is safe for them and others to swim together
Going through life with psoriasis and coping with the social fallout can be challenging for your family, but don’t think you have to do it alone.
Connect your child with others who have the same condition so that they can discuss their experiences. You can do this by signing them up for a support group via the National Psoriasis Foundation, or even asking your child’s dermatologist if they have a similar-aged patient who may be open and willing to connect with your child, says Marisa Garshick, M.D., a board-certified dermatologist at Medical Dermatology & Cosmetic Surgery (MDCS) in New York City. This can do wonders for your child’s self-confidence, self-esteem, and mood.
“Having a chronic condition during childhood can be significant and if you are noticing any changes in the mental health of your child, be sure to make your doctor aware so they can help identify and address the emotional impact of the disease,” Dr. Garshick says.
The Main Goal: Building Resilience
By taking the steps to prepare your child for the social challenges that they may experience because of psoriasis, you are creating a foundation for understanding and for tolerating the discussions surrounding their condition. This is important because it builds up their confidence and reminds them that they are not defined by this condition alone.
Increased Depression and Anxiety: Anais Brasileiros De Dermatologia. (2013.) “Assessing Depression And Anxiety In The Caregivers Of Pediatric Patients With Chronic Skin Disorders.” http://www.scielo.br/j/abd/a/NT6vxhcXngtqHgZnb3yk85s/?lang=en
Continuum of Teasing: Center for Parenting Education. (n.d.) “Teasing During the Preschool Years: Being a Good Friend Is Protection.” https://centerforparentingeducation.org/library-of-articles/handling-bullying-issues/teasing-during-the-preschool-years/