Cultivating Resilience in Your Chronically Ill Child (2025)

I’m in my office with a family describing their 11-year-old’s struggle with inflammatory bowel disease (IBD)—a chronic gastrointestinal (GI) condition: “You and your peers are all carrying a backpack to school,” I say, “but we all also have an invisible 'stress backpack.' Your 'stress backpack' is heavier than your classmates'. It’s important that we acknowledge that you are carrying an extra burden.”

Talking About a Child's Condition Is Protective

I use this framing because acknowledging the extra stress of having a disease allows an open discussion. Yet, if a child’s condition makes them stand out from their peers, they may feel exposed and vulnerable. How can we best support them?

Note: While my examples focus on GI disorders, the tenets apply to any childhood chronic disorder.

Another true example: “Sam” has a rare GI disorder called Hirschsprung’s that causes unpredictable loud and smelly flatus. Since entering elementary school, Sam and his mother start each year with a classroom presentation. They describe the surgery he required. They introduce the stuffed animals that accompany him to medical visits. They review the fragrance sprays he has available to share at his school table. They welcome questions.

By fourth grade, Sam feels comfortable presenting independently. During middle school, he ditches the class presentation but feels empowered to educate whenever necessary. Lesson learned: My experience is informative and not shameful.

Not all children are as extroverted as Sam, and some, even with parental support, may feel too vulnerable to openly discuss their medical issues. Instead, the introverted child may benefit from a connection to an older peer who shares their condition and can provide tips on how to manage worrisome issues. My article "Teaching Kids the Art of the Comeback" offers direction if peers are insensitive.

Utilize Accommodations and Advocacy

When a chronic condition causes symptoms that interfere with daily functioning, small accommodations can be reassuring.

Children with certain GI conditions, for example, need unrestricted bathroom access at school. Sometimes teachers don’t read or remember the accommodation provided; if there is any push-back, some parents have found it helpful to email teachers educational materials about the child’s diagnosis.

If it isn’t clear what modifications a child might need, the child’s clinicians or a non-profit for their specific illness may provide guidance. Or, ask the child directly what could make their life a bit easier, referencing the heavier “stress backpack” they are lugging around.

Involving the child in the solution may be unexpectedly illuminating. Several young patients have told me that the taste of their medication is a troublesome aspect of their medical care. It is easy for adults to assume what is stressful, but it is always best to ask. A meaningful intervention may be as simple as following a medication with a candy chaser of choice to sweeten the deal.

Finding Alternatives to Activities

Sometimes, the child’s condition may limit their ability to participate in beloved activities. A chronically ill teenager who loves pick-up basketball may not be able to tolerate the grueling practices of a high school team. Coping with physical limitations at a young age is understandably disheartening.

I know of one young man who faced this quandary during high school. At first, it was difficult and painful to change course, for he had imagined playing for the school’s basketball team for months. After some soul-searching, he recognized that being a part of the squad, even if he wasn’t playing on the court, would provide a similar sense of belonging, so he became the manager of the junior varsity basketball team. Before practice, he spent time at his school weight room, participating in another athletic community where he could control the intensity of his workout.

It’s also emotionally protective if a child has a preferred activity they can access even if their body isn’t cooperating. What is interesting but can be accomplished sitting down? Popular collectable card or online games? Knitting? Art? An instrument?

When a child can identify multiple interests and passions, resiliency increases. The ideal is to both recognize the diagnosis and define the child in complex terms; their illness is only a fraction of their identity.

Low Threshold for Mental Health Support

Chronic illness is a risk factor for mood and anxiety disorders. The heavier weight of the “stress backpack” takes an emotional toll.

It is protective to add mental health support when a child is struggling medically; psychotherapy, support groups, self-care, yoga classes, meditation, or psychopharmacology can be helpful.

Years ago, as a trainee, I worked with a high school senior soccer captain who was diagnosed with severe IBD, causing bloody diarrhea that required hospitalization. Her weekly psychotherapy focused on grief and resilience.

A few months after she moved to California for college, she sent me a note I will never forget. It forever changed my view of psychopharmacology for chronically ill children: “Dr. Bender, I really appreciated our work together. I started on a new treatment that has been very helpful, and I wanted to let you know so you could consider it for other patients. It’s an antidepressant called Lexapro. “

This young woman’s message to me was crystal clear. Why hadn’t I considered psychotropic medications as a treatment option for her? Because she seemed to be managing her anxiety well and was working in therapy to process her experience, I hadn’t even considered medications as an option.

This experience changed how I approach my medically ill patients; antidepressants deserve consideration for individuals struggling with a persistent medical illness, even if they are resilient. In fact, there is data supporting the use of antidepressants in patients with IBD; it may lead to a lower relapse rate. Bolstering mental health with psychotherapy and/or medications may be physically protective.

As parents, teachers, or clinicians supporting a child with a chronic illness, we provide a mirror; how we approach the illness is internalized by the child. Our message can provide support and empower: Even with a heavier stress backpack, you can grow, build strength, and navigate the world effectively.

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