Coping with separation while children are undergoing rehabilitation

I have been a play therapist at The Children's Trust since 2004.

During that time, I've provided play therapy to support many children during their residential placements for acquired brain injury rehabilitation.

In this second of my blogs, I'll talk through ways to cope with any separation and support the attachment between parent and child during a residential placement.

Time away from home

Be they ‘tiny tot’ or ‘big teenager’, telling your child they need to spend a period away from the family home for residential rehabilitation can be very stressful, both for parent and child.

If your child has recently been injured, the whole family may still be reeling emotionally from the trauma and shock of what’s happened.

You may – entirely understandably – be feeling very anxious about what lies ahead. Going to a rehabilitation centre is yet one more medical setting, with more strange new professionals to contend with!

So worrying about how to keep the attachment going between you and your child when they may be a long way from home can pile on yet more worry.

You might also be feeling nervous about all the equipment and the skilled care your child now needs. You may worry you’ll no longer be ‘the expert’ on how your child is feeling or what needs to be done for them.

So what can you do to help yourself and your child stay feeling close to each other when they’re away from the family home?

Your child may be feeling frightened about going away. And an injured, frightened child especially needs to feel that they are still loved and wanted and haven’t been forgotten about.

Keeping in contact

You might find these simple measures help your child with a sense of safety and security.

Try to pack one or two special items from home that will hold a special emotional meaning for your child and will be a constant reminder of you.

A small child might value an item of clothing from you that carries your scent. They may already have a comforter such as a baby blanket or cuddly toy that they like to have with them.

These items should be clearly labelled with your child’s name, and their importance to your child emphasised to the staff at the centre.

Even if you feel your child should have grown out of needing such things, try to remember that frightened children (especially those with a brain injury), often seem to go ‘back in time’ for a while.

They may need to do the things they did when they were younger, both to help them relearn skills, and to feel emotionally ‘safe’, and free from too many demands.

Also pack some items to decorate their room at the rehabilitation centre. Again, think about posters, toys or ornaments that will ‘keep home alive for them’ while they are away.

It will be very much up to you (and perhaps also your child) as to whether or not you put up photos of them before they were injured. Remember there is no right or wrong answer here. It is a decision for you as a family to take together.

It can be very supportive for your child, regardless of age, if a parent is able to stay at the rehabilitation centre while they are ‘settling in’. This, of course, will depend on whether or not the centre permits this, and whether or not it has accommodation available for you.

But if this is not possible, it can be helpful to stay at least close to the centre for a week or two (and for longer if your child has significant memory difficulties because of their injury).

After those first couple of weeks, the decision as to whether you continue to stay at the centre or close by is one only you can take. You and your child have unique needs, so there is no hard and fast rule.

But you might also like to consider what might also be best for the age your child is.

a) A child under three is at a stage of growing up when they need to develop a secure attachment to only a few very special people.

So if you are the person most important to them, then your being able to stay with them at the centre as much as possible throughout their entire residential placement will help them feel emotionally secure.

b) For a child aged between three and 10, it can also help if a family member is able to stay in the centre or nearby during the child’s rehabilitation.

But with siblings, jobs and everyday life to think about, this simply isn’t possible for everyone.

c) Teenagers are at a stage in their lives when they want to prove they’re able to do things for themselves.

Nevertheless, they still need to know they belong to their family unit and are accepted.

Again, if you can stay for the first week or two while they settle in, this may reassure them. After that, they may need you to give them the space to show they can cope without you being around (maybe only seeing you at weekends).

But again, you should aim to be in regular contact with them by text or phone during the week too, so they know they haven’t been forgotten.

There will of course be times when, regardless your child’s age, you are not able to be with them.

So before you have to leave them, do try to be clear and reliable about when you will be back (and tell the staff too). This will help your child to worry less when you are away.

Try to keep regular and reliable contact with your child. For example, if you say you’ll ring to talk to your child at a particular time, try to keep to that time. If you say you’ll be visiting, give the day and the approximate time, and try to stick to it. If anything changes (as things sometimes do!), let your child and the staff know.

It’s worth emphasising the points above, not only because it’s good parental advice for all children, but because these ideas are particularly important when we think about children with acquired brain injury.

They have had the trauma of going from a ‘well state’ to having an acquired brain injury, and they can be very much more prone to worry, both about themselves and about those they love.

For example, if a parent is late for a visit, they may be fearful their parent has ‘suddenly’ had an accident or fallen ill, because that might have been what happened to the child themselves.

Indeed, for all of you in your family, there will be a big emotional challenge over the months ahead in re-discovering a sense of optimism, and that life can be good.

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