Child Development: An essential guide to… regression

The Covid-19 pandemic has taken a toll not only on lives, but also on the emotional well-being of many young children. Parents and carers might have noticed their children having disturbed sleep, a decline in their language skills, increased clinginess or a lack of independence. They may appear to have gone backwards.

One mother, Lisa Tolin, described her son’s response: ‘Around the time of coronavirus, my five-year-old started climbing in bed with me every night. His excuses got increasingly baroque: bad dreams, a spider, hundreds of spiders, a black hole. He started playing “baby”. He sucked on comfort blankets he had previously abandoned. Finally, he said he wanted to climb back into my tummy. What I was witnessing was a slow-motion regression, all the way back to the womb’ (today.com, 8 April 2020).

A COMMON RESPONSE

Regression is a process that occurs when a child revisits an earlier stage of development and behaves accordingly. It is very common in young children and usually happens when they feel overwhelmed by an impulse or life event. Regression is a useful response that allows the child to take refuge in a place that feels safe and comforting.

Michela Biseo, a child and adolescent psychotherapist and deputy head of early years at the Anna Freud Centre in London, stresses that ‘regression is a very ordinary response to a challenging situation. It is important not to pathologise it.’

An example of ordinary regression is when a child who is well-established on solid foods only wants to drink from a bottle after an illness. Likewise, a post-viral adult may want to eat soups or scrambled eggs for comfort and nurture. These periods are usually transient and resolve themselves quite naturally. They are not cause for concern.

How to respond

Ms Biseo is clear that regressive behaviour is not something that a child should be rebuked for. Adults should respond with understanding and sensitivity. ‘If a toddler wants to suck on a dummy at the birth of a new baby in the immediate or extended family, I would say to let them do it,’ she says. ‘The return to babyhood needs to be allowed a bit.

‘They may, at some point, need help in realising the benefits of not being a baby. An adult might say something like, “Little babies can’t do much with their mouths yet. But bigger and stronger children can eat strawberries, blow bubbles or sing a song.’”

Part of the child wants to return to an infantile state. That way, they can avoid the conflicts they feel so daunted by. Yet there is also a part of them that wants to get on and continue to be big. The adult may need to remind them of this and, indeed, celebrate it.

The spectrum of regression

As with most things of an emotional or psychic nature, regression is on a spectrum. If a family upset or disruption were to have multiple effects on the child for a sustained period, then it would be more of a concern.

For example, imagine that a child not only wants to suck on a dummy or use baby talk, but also refuses to eat and stops being able to sleep or use the toilet. That is not an ordinary and transient regression. The child and family may need professional input from a psychological service. (See ‘Professional work with regression’, page 38.)

ORDINARY REGRESSION IN THE NURSERY SETTING

Dealing with transitions

Helen Currie is the head teacher at Low Hall and Church Hill Nursery Schools in the London Borough of Waltham Forest. ‘We often mis-use the term regression,’ she says. ‘Just because a child manages to do something one day or for a short period of time, we expect that they will always do it. This can be a common expectation, for example, during the settling-in process.

‘If a child who had appeared to have settled is crying and holding on to their parents two weeks later, it is often said they have regressed. They were fine before, so why not now? In reality, however, settling and transitioning to an entirely new way of life can take up to six months.’

Ms Currie is acutely sensitive to the demands on young children in new and changing situations. ‘It is only to be expected that their behaviour can change when they are overwhelmed with feelings that they are unable to verbalise,’ she says. ‘When settling in, they have a huge number of new things to deal with and try to work out. It must be absolutely exhausting.’

She finds that taking the time to stop and listen is critical. This allows the child enough time to make sense of their new environment. ‘We must remember that children need time and space to develop ways of processing their emotions,’ she says. ‘We can’t impose unreasonable adult expectations or expect them all to do it at the same time and pace – development is not one-directional and linear.’

Being allowed to regress

This importance of adults allowing children to regress is reiterated by Ms Biseo. ‘We all have times when we manage better or worse in response to external stresses,’ she says. ‘We travel up and down. Children need an adult to hold them up on the “ladder” and keep them steady. If this adult is absent through illness, for example, we would expect the child to regress temporarily and lose their foothold. They need to step down a rung to steady themselves a bit.’

A common misunderstanding

Both Ms Biseo and Ms Currie emphasise a defining aspect of regression which is often misunderstood. A child can regress only if they have firmly reached a later stage of development. Unless this is the case, what is happening is not regression.

For example, if a child has been using the toilet reliably and then stops, it is regression. However, it is not regression if they had started potty training but didn’t continue in the ‘right’ direction. Regression is nothing to do with what they should be doing at a particular age or stage, nor is it anything to do with adult expectations.

COVID-19 AND REGRESSION IN EARLY YEARS SETTINGS

Renegotiating relationships

This is a time that has been extraordinary for us all. The much-used term ‘the new normal’ says it loud and clear: what we knew as normal is no longer the case.

Ms Currie says, ‘Our children have been at home for a long period. We must help them to renegotiate their relationship with others outside of their home, in an environment that is quite different from the one they left in March. They may return with new fears, apprehensions, stresses, anger, exhaustion, and more.

‘They may not be able to verbalise these things, so may well regress. This is okay. They will be okay if they can be given time to resolve whatever is going on. That needs to happen in an environment with people whom they trust and who listen to them and offer them care and love.’

Spectrum of responses

Of course, there is no ‘one size fits all’ in terms of how children (and adults) respond to extraordinary situations. Some children show great resilience, and some who we might have expected to be delicate on return to nursery surprise us. As always, it is important for practitioners to wait and see, rather than be on the look-out for an expected reaction.

Children with an ASD

AtRonald Openshaw Nursery Education Centre in the London Borough of Newham, a large number of children have an Autistic Spectrum Disorder (ASD). Head teacher Alison Lentz explains, ‘It is common for children with an ASD to experience the smallest of changes as distressing.’

One such child is four-year-old Raju. He is in his last term at Ronald Openshaw, was well settled, in a good routine and making steady progress. Soon after closure, however, his father was concerned about him.

He thought that the loss of his daily routine was having a negative impact on his behaviour and development. He was keen for his son to return to nursery as soon as possible, but Raju’s mother was anxious about the virus and his safety. His parents decided, however, that Raju would be better off in nursery – he would benefit from having some of his previous routines.

Ms Lentz explains, ‘We were able to offer Raju his usual classroom, familiar staff and something close to his regular daily routine. However, this was with reduced equipment and lots of hand-washing.

‘Raju has coped really well with this and has quickly re-established himself in the new normal of our nursery. The only thing he has found difficult is that his father can no longer come into the nursery as before. He has shown a bit of regressive behaviour in the form of aggression and refusal to come in, but it has only happened twice so far.’

Ms Lentz thinks Raju has taken so well to returning to nursery for two main reasons: ‘He is quite a solitary child. He seems to enjoy having a quieter nursery with fewer children present,’ she explains. ‘This would be common for many children with an ASD. Also, he was in a very well-established routine before the closure and changes, and this seems to have enabled him to reconnect quite easily.’

Bereavement

AtCollege Green School in the London Borough of Brent, the staff team prioritised training on bereavement both before and during the lockdown.

‘The pandemic has been the cause of many losses for the children and their carers,’ says deputy head teacher Nawal Filali. ‘When children face a loss of any kind, they may only be able to express their emotions through regressive behaviour. We found a lot of interesting material. The one that struck us was “A Recovery Curriculum: Loss and life for our children and schools post pandemic”.’

Produced by the Schools, Students and Teachers network (SSAT), this document explores the five main losses: routine, structure, friendship, opportunity and freedom (see More information). ‘We used this as a guide to adapting a curriculum that would incorporate these five losses,’ explains Ms Filali.

Bubble charter

College Green prides itself on having been awarded UNICEF’s Rights Respecting Schools Gold Award (RRSA). Wendy Yianni, the head teacher, says, ‘RRSA is completely embedded in our school ethos. Creating “charters” is one strategy we use. They help children to resolve any difficulties they may face.’

A charter is an agreement between the staff, the children and their families. It is based on the principles of promoting well-being, encouraging participation, cultivating positive relationships and nurturing self-esteem. Ms Yianni explains, ‘For the return to nursery, we jointly decided upon a Bubble Charter. We wanted to reassure children on their return and support them through any regression.’

This charter explains the nature of bubbles. It says that staff and children have bubble friends and waving friends (friends in another bubble). The charter was sent out to all families before they returned. That way, they could all get used to it, as well as contribute their ideas.

‘Because of the nature of the bubble system, the groups the children were used to had slightly changed. So, we asked the children to come up with some ideas for their new group’s name,’ Ms Yianni explains.

This enabled the children to be part of creating the ‘new normal’ at nursery – bubbles wouldn’t be entirely alien to them. Importantly, there would be some predictability about nursery, despite the huge changes from the previous norm.

Home-School Agreement

‘Knowing that parental anxiety can hugely affect children, we wanted to support and reassure them as much as possible. We sent out a Home-School Agreement. It detailed extracts from our risk assessment and how we needed to review it continuously,’ explains Ms Filali. ‘It seems that the parents felt prepared and reassured. They knew that robust safety measures were in place, and that they were in keeping with our ethos.’

Sense of loss

Most of the children at College Green returned with excitement and seemed happy to be back. Some have exhibited an emotional response, saying such things as, ‘When the virus goes away, can we go back to our normal groups?’ Ms Filali says, ‘We respond as we would to a bereaved child – because they have experienced loss of routine, structure, friendship and freedom.’

A USEFUL WAY TO ADAPT

Regression, then, is not usually a relapse or deterioration. It is a useful way for the child to take some time and space to adapt to something they are not quite ready for. Regression is certainly not something to be rebuked, mocked, discouraged or avoided. Due to its very nature, regression can trigger uncomfortable feelings in the adults. As a result, adults may need support so they can bear the child’s regressive states.

Regression is an important part of a child’s emotional and psychic development. It will help to prepare them for future encounters with change and distressing situations.

Professional work with regression

Dean Reddick, an art therapist in the early years, frequently works with traumatised children. In his work, Dean recognises that repeated or compulsive, messy regressive painting might, for example, be an indicator of previous trauma. ‘Children who have experienced trauma in their early life often manifest this reaction in art therapy,’ he says.

He considers it important to give such children an opportunity to regress safely, as part of the therapeutic process. ‘Regressive use of art materials could be seen as a defensive move by the child to avoid having to think about difficult things,’ he says. ‘But it can also allow the child to return to an earlier developmental state. They can find something that might have been missing. The use of liquid and plastic materials (paint, clay, water, wet sand) can facilitate regression since these materials are by their nature more sensory and less structured than the drier, more rigid materials (scissors, pencils, pipe cleaners).’

Anthea Hendry, also an art therapist, talks about how she used regression in her work with an adoptive family. A four-year-old was sick with chicken pox and in a regressed, dependant state. During telephone conversations, while the child was sick at home, her adoptive parents were encouraged to carry out some parenting that the child had missed out on. Anthea describes how they were able to ‘carry her, cuddle her, feed her, wash her and allow her to be as dependant as possible for as long as possible’.

MORE INFORMATION

• Early Years in Mind network at the Anna Freud Centre: a free network for early years practitioners providing guidance on supporting the mental health of babies, young children and their families, www.annafreud.org/eyim
• The Emotional Life of the Toddlerby Alicia Liebermann, www.zerotothree.org
• Hendry A (2017) ‘The imprint of another life: assessment and dyadic parent-child art psychotherapy with an adoptive family’ in Meyerowitz-Katz J and Reddick D (2017) Art Therapy in the Early years: Therapeuticinterventions with infants, toddlers and their families. Routledge
• ‘A Recovery Curriculum: Loss and life for our children and schools post pandemic’, www.ssatuk.co.uk