CASE STUDY: SARAH
Sarah, aged four, was always following the nursery staff around saying she had hurt her finger, had a tummy ache or felt sick. If another child knocked into her or touched her accidentally, she reacted in a very dramatic way and would tell staff, ‘He pushed me, that hurt!’ She was frequently showing them her finger or knee, trying to find a mark or scratch.
The staff were concerned about her friendships with the other children, who increasingly avoided her because she often accused them of hurting her, even though they hadn’t.
Sarah was also very adult-focused, noticing any small changes in their appearance, and found it hard to stay at a task.
If another child was unwell or hurt, Sarah’s ailments increased and she would find a selection of places that hurt, ranging from her arm to her head and toe.
Her parents both worked long hours and Sarah was often the first to arrive at nursery and the last to leave.
Children of Sarah’s age can find it hard to identify why or where they are feeling unwell, or hurt – they just know that they don’t feel right. For example, a child who is very anxious may say they feel sick, or a child who is worried may say they have a headache. When children tell us about their physical symptoms on a regular basis, they may actually be telling us they are not feeling well emotionally.
As adults, we are able to distinguish between physical and emotional discomfort and pain and may have an understanding of why we are experiencing physical symptoms – for example, we may feel sick with fear or be anxious because we have a job interview. Children, however, are unable to do this, and for a child who doesn’t feel right on a regular basis, it can be overwhelming and frightening.
COMMON CAUSES
When an adult feels upset, scared or anxious, they will probably be able to identify this for themselves and can talk to other people and seek support if they choose to. They are also able to understand on a cognitive level what is going on and are likely to be able to reassure themselves.
When young children are feeling upset, anxious or scared, it can be hard for them to even know this is how they are feeling, let alone be able to put it into words and tell an adult. They just know that they don’t feel fine and try to communicate this to the adult through their behaviour.
The child may be feeling emotionally fragile and scared and adopt behaviour patterns like Sarah’s to ensure the adult notices and responds to them. However, the adult could be dismissive of and irritated by such ‘needy’ behaviour, particularly if it is constant. So, there is chance that the adult response is not the extra attention and support that the child seeks but quite the opposite.
HOW TO RESPOND
First, it is crucial not to be dismissive of a child who behaves like Sarah as they could be genuinely unwell or even being hurt, so this needs to be explored and ruled out. In Sarah’s case, staff could talk to her parents about their concerns and check if there is anyone in the family who is ill. They should also discuss how the family respond to illness at home, as this may be affecting Sarah’s behaviour. For example, is an illness largely ignored or do family members make a big fuss if anyone is poorly? Is there a lot of anxiety in the family about people being hurt or becoming unwell? Has the family experienced any recent bereavements?
Strategies in the nursery
I would encourage all staff to:
- keep a record of Sarah’s behaviour to identify any patterns – for example, does the behaviour increase depending on which parent drops her off in the morning? Or is it worse at certain times of the day, such as lunchtime or home time?
- respond in a similar way to her behaviour, so there is a consistent approach that validates and acknowledges her feelings. This is crucial so Sarah feels safe and knows she can trust the staff. If children who behave like this are dismissed or ignored, it not only invalidates their feelings but also gives the message that adults are not interested if children are hurt. This is essential in order to create an environment where children feel they can approach adults if they are genuinely being hurt.
- provide Sarah with a commentary of her behaviour to enable her to feel understood, and use reflective language to explore with her what is happening – saying, for example, ‘Sometimes when we feel a bit sad, our tummy can hurt, I wonder if you feel sad because Nisha won’t play with you.’
- find stories with characters who feel scared or worried to enable Sarah to understand that her feelings are normal and to help her to articulate them.
- provide plenty of positive attention for her to develop her confidence. This is important so Sarah learns she can have attention and be noticed without having to say she feels hurt or unwell. For example, give her a special job such as tidying the book corner with another child to shift the focus and build resilience and reduce her anxiety, along with helping her to develop her peer relationships.
Strategies in the home
At home, her parents could also monitor her behaviour and look for any patterns, along with being aware of their own reactions to being hurt or unwell as these will provide subtle but powerful messages to Sarah. It would also help if both parents tried to spend extra individual time with her as this would help her to feel less anxious and more secure.
HELP AND ADVICE
If Sarah’s behaviour becomes more pronounced or frequent and starts affecting her ability to settle and engage at nursery, it would be appropriate for her parents to talk to their health visitor or doctor, initially without Sarah present, to gain reassurance and check that she isn’t actually unwell. However, if it is purely emotional rather than physical, the strategies outlined above should help and the staff could start to see some initial changes quite quickly.
Cath Hunter is a therapeutic consultant, trainer, play therapist and author of a three-part series of books, Understanding and Managing Children’s Behaviour through Group Work, covering ages three to five, five to seven, and seven to 11 (http://therapeuticfamilyinterventions.co.uk).
NW SHOW 2018
Adult expectations of children’s behaviour and learning is a theme running through some of our seminars and masterclasses at the NW Show in London on 2-3 February 2018.
Inclusion specialist Kay Mathieson will be assessing typical and atypical patterns of behaviour in young children, while early years consultant Anne O’Connor will be looking at what neuroscience is revealing about the infant brain and how these findings should inform nurseries’ behaviour strategies.
Consultant Tamsin Grimmer will be asking what ‘school readiness’ means for four-year-olds, and past winners of the NW Nursery of the Year award will explain how they create challenging and stimulating environments that never underestimate children’s creativity and capacity to learn.
Our masterclass ‘Boys’ learning: rethinking gender and early years practice’, with Gary Wilson, challenges current expectations about boys’ learning and development; while ‘How children learn: inspiring, supporting, teaching’ focuses on the unique child and the kind of curriculum and adult support that will meet their emotional and learning needs. Keynote speaker at this masterclass is scientist and broadcaster Dr Maggie Aderin-Pocock, referred to as the BBC’s ‘face of space’. From a modest background and diagnosed with dyslexia, Ms Aderin-Pocock overcame the naysayers to study at Imperial College London, where she obtained her degree in physics and a PhD in mechanical engineering.
The full programme is available at: www.nurseryworldshow.com
