Building Resilience in Children Affected by HIV/AIDS

Sr Silke-Andrea Mallmann CPS

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Catholic AIDS Action, Namibia

Maskew Miller Longman Forest Drive, Pinelands, Cape Town Associated companies, branches and representatives throughout Africa and the world. Maskew Miller Longman and Catholic Aids Action, Namibia All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright holder. First edition by Catholic Aids Action Namibia Second edition by Longman Namibia 2003 ISBN 99916 1 274 2 Materials developed by Sr Silke-Andrea Mallmann Edited by Michelle Saffer Cover design and artwork by Karlie Hadingham Typesetting by DTP Impressions Reproduction by Printed by For further information contact: Maskew Miller Longman PO Box 396 Cape Town 8000 SOUTH AFRICA Phone: +27-21-531-7750 Fax: +27-21-532-2302 email: mmli-info@mml.co.za Catholic AIDS Action PO Box 11525 Windhoek NAMIBIA Phone: +264-61-27-6350 FaxL +264-61-27-6364 email:info@caa.org.na website: www.caa.org.na

Contents
Preface A note from the author Acknowledgements 1. Resilience in Orphans and Vulnerable Children What makes children vulnerable? How does a child become resilient? What do children need to cope with adversity? External resources fostering resilience Inner resources fostering resilience How to develop resilience in children The importance of the family The importance of school Experiential learning The benefits of experiential learning Children affected by HIV/AIDS The sickness of a parent Caring for a sick parent The economic impact of a sick parent The stigma of HIV/AIDS Dealing with the death of a parent Preparation for the death of a parent Being infected themselves Dealing with HIV and school Telling others about an HIV/AIDS status Losing a parent Different aspects of mourning Factors that affect the mourning process The death of the parent The relationship with the deceased parent The availability of a surviving parent or caregiver The structure of the extended family Rituals surrounding the parents death Support from the community Peers and friends The age and developmental stage of the child Preparing children for the death of a parent Normal versus severe reactions What are severe reactions? vii viii ix 1 2 3 3 3 4 5 6 6 7 8 9 9 10 11 11 12 14 15 15 15 17 18 18 18 18 19 19 20 20 21 21 39 39 40

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3.

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Preventing severe reactions in a child The STOP system for parents Make a memory box Pray with your child and pray for your child The STOP system for caregivers The STOP system for teachers The attitudes of caregivers and teachers 5. Ideas for helping children showing specific reactions Clinging Explaining her behaviour What can you do to help? Sleeping difficulties and nightmares Explaining her behaviour What can you do to help? Nightmares Explaining his behaviour What can you do to help? What else can you do to help? Night terrors Explaining her behaviour What can you do to help at home? What can you do to help at school? Bed-wetting Explaining his behaviour What can you do to help? Intrusive memories (flashbacks) Explaining her behaviour What can you do to help? How to deal with flashbacks or nightmares Aggression Explaining his behaviour What can you do to help? How can you deal with aggressive chldren? Auto-aggression What can you do to help? Hyperactivity Explaining her behaviour What can you do to help at home? What can you do to help at school? Negative magical thinking Explaining his behaviour What can you do to help at home? What can you do to help at school?

40 41 42 43 43 44 46 47 47 48 48 50 50 50 51 51 52 52 53 53 53 53 54 54 55 56 57 57 59 66 66 67 68 71 72 72 72 73 74 76 76 77 78

Helplessness Explaining her behaviour What can you do to help? How to help children access their inner resources again Physical complaints and body pains Explaining her behaviour What can you do to help at home? What can you do to help at school? 6. Games Games that foster trust Games for group cohesiveness and social skills Games fostering self-esteem, self-confidence and co-operation Games to recognise and understand feelings Games that help to deal with aggression Games that calm children down Games for help-seeking, autonomy and awareness Games to see how feelings appear physically Games to help autobiographical memory Severe problems requiring a specialist How do you know when a reaction is extreme? Complicated grief Severe depression Disturbing intrusive memories Severe and persistent feelings of anxiety Delinquent or anti-social behaviour Physical complaints What can you do to help? Child abuse and neglect What is neglect? What is physical abuse? What is sexual abuse? What is emotional abuse? Is there a type of child who may suffer abuse or neglect? Who abuses children? What can we do to prevent abuse? Talking to children about abuse What to do when you suspect child abuse Important points to remember Child abuse and HIV/AIDS What should I do if a child has been raped?

78 79 79 80 81 82 82 83 84 84 90 96 98 109 114 115 118 123 131 131 131 132 132 132 132 133 133 133 133 135 135 136 137 137 137 138 139 139 140 140

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Childrens rights Background to international childrens rights Types of childrens rights Have these rights been upheld? Obligations of 191 countries What you can do

141 141 142 142 143 144 145 147

Glossary Bibliography

Preface
Who can say that he or she hasnt ever seen children begging along our city streets, heading towards a life of dislocation and crime? Surely, we have all been moved by news reports of children suffering from severe neglect, physical abuse, or rape. Is there any parent left who can say that he or she is not worried about the legacy we are leaving our children? Under these circumstances, who will be our continents leaders, our conscience, our future? According to the best data we have, in 2001 Namibia, for example, had over 82 000 orphans. Within a generation, that number is expected to triple. The plight of these children will be the single largest impact of the HIV/AIDS pandemic on this nation. The plight is similar in other African countries. One thing we know for sure: Orphans and vulnerable children dont deserve their fate. There is nothing that any of them did to justify their sorrow, their hardship, and their losses. And yet, most of them suffer a lot. And as a nation, we suffer with them. Too often, their personal losses result in lost opportunity, lost hope, and a lost future that affects their entire community, and ultimately, the entire country. Thus, the first message we want to give with this manual on psycho-social supports for orphans and vulnerable children is that THESE CHILDREN ARE OUR CHILDREN. They belong to all of us. And they are our collective responsibility. Secondly, the message is that Love is Not Enough. Caring for our continents orphans and vulnerable children takes time. And effort. And knowledge. That is what this manual is about. Read it. Study it. Refer back to it as often as you can. Attend a training course offered by Catholic AIDS Action or another organisation which supports the contents of this book. Above all, this manual is meant to be applied within our own families and in our communities. The Ministry of Womens Affairs and Child Welfare in Namibia is proud to be associated with the development of this manual by Catholic AIDS Action, and the publication of this revised edition in partnership with Maskew Miller Longman, and recommends it to our fellow Ministries and to all people of goodwill everywhere. May God bless you in your work of caring for others.

(Ms) Netumbo Nandi-Ndaitwah Minister, Ministry of Womens Affairs and Child Welfare Republic of Namibia

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A note from the author

Dear parents, caregivers and teachers, This handbook is aimed at people who live and work with children affected by HIV/AIDS. The dimension of the HIV/AIDS pandemic and its consequences for our children, our families, our communities and our society often make us feel powerless. As caregivers, we are faced with an increasing number of children who have already lost or are going to lose their parents. We teach them in our classrooms, we take them into our homes and we share our lives with them. Often we feel unsure about how to help them deal with the loss of a parent. But the children we care for are our future and it is our task to walk beside them into that future. This handbook is aimed at helping parents, caregivers and teachers to understand children who are nursing a diseased parent or who have lost a parent. It provides practical advice for teachers and caregivers on how to support children who have experienced loss and death in order to help them cope. It offers ideas for discussions that can be held on a one-to-one basis in the childs home or with a group of children in the classroom. It is neither a recipe for success nor a book of rules. Instead, this handbook consists of a collection of ideas, theories, tasks and exercises that should help us to understand the behaviour and feelings of children affected by HIV/AIDS. The impact of the HIV/AIDS pandemic challenges us to approach childcare and education differently, but we have experienced teachers on our side the children themselves! Sometimes children know best what they need. When we listen to them, pay attention to their ideas and learn from their coping strategies, we recognise their resources, their skills, their strengths and their endurance. In order to assist them, we have to work with them. Working with children affected by HIV/AIDS requires courage and creativity. We may need enormous reserves of commitment and compassion. Our compassion can be expressed not only in care, but also in understanding and friendship. We can develop a vision of the possibilities that lie beyond the reality that faces us. We can be committed both to the child and to the rights of that child. Children need strong advocates to make their voices heard and to fight for their future. A book cannot answer all our questions. A book will never contain all the exercises and ideas that we will need but it will hopefully encourage us to have the courage and commitment necessary to develop our own creative methods of helping children to cope. Silke-Andrea Mallmann CPS Mariannhill, June 2002 viii

Acknowledgements
This handbook, originally developed in Namibia, is intended to supplement and reinforce various training programmes on Orphans and Vulnerable Children in Namibia and other African countries. Among the many organisations that were involved and consulted for the development of the original Namibia edition are: Catholic AIDS Action; Philippi Namibia; the Ministry of Basic Education, Sport and Culture; the National OVC (Orphans and Vulnerable Children) Steering Committee; the Ministry of Womens Affairs and Child Welfare; the Ministry of Health and Social Services; NANTU (Namibian National Teachers Union); the Legal Assistance Centre; Family Health International and CAFO (Church Alliance for Orphans). We are very grateful to the representatives from these organisations who shared their ideas and support. Expressions of interest from other partners and countries led to the development of this revised edition with Maskew Miller Longman as our publishing partners. The person who must get the lions share of the credit for this handbook is Sr Silke Mallmann. Sr Silke is based at St Marys Hospital at Mariannhill in South Africa. While writing this handbook she drew on her experiences working with refugee children and children affected by HIV/AIDS. We believe that God sent Sr Silke to us. From the moment she contacted Catholic AIDS Action we knew we were on the right track. We offer her our deepest thanks and our admiration. We offer our sincere thanks to our donors. Initial support for this publication came from a training grant received from NANTU and the Canadian Teachers Federation. But as demand for this handbook increased and the table of contents grew accordingly, we needed additional support. For that we thank the Secure the Future Foundation, Bristol Myers Squibb and the Catholic Medical Mission Board of the United States. Finally, we are deeply indebted to Family Health International, USAID, UNICEF, the Ford Foundation, and the Namibian government for their ongoing work in Namibia with orphans and vulnerable children. Catholic AIDS Action staff received their initial training in psycho-social support for orphans and vulnerable children with the assistance of Family Health International and USAID, in cooperation with Philippi Namibia and Masiye Camps (Regional PsychoSocial Institute) in Bulawayo, Zimbabwe. Thankfully, FHI/USAID continues to assist us in training community leaders and volunteers in psycho-social support, as well as in our provision of direct care to orphans and vulnerable children.

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Some other individuals deserve special mention. Karen Landmann gave us the idea for this handbook when she wrote a chapter on childrens issues for one of our publications called,Caring for ourselves in order to care for others. Rose de Buysscher, Sara Bowsky and Paul Pope (from Family Health International/USAID), and Stefan Germain, Ezekiel Mafusire and Ms Ncazelo Ncube and colleagues (from Masiye camp in Zimbabwe and the Regional Psycho-Social Institute for Orphans and Vulnerable Children) contributed valuable ideas, suggestions and background material. We also drew inspiration and support from Kurt Madrin at Terre des Hommes in Tanzania and Liz Towell at SINOSIZO in South Africa. Francis van Rooi, based at our national office, has been the administrative coordinator for this project, as well as for the field-based workshops. Without her commitment and efficiency, the rest of us would have given up long ago. Marianne Olivier of Philippi Namibia rearranged some of her own training and curriculum-development in order to accommodate us. Sr Dr Raphaela Hndler, Caroline Thomas, Petronella CoetzeeMasabane of the Ministry of Health and Social Services (MoHSS) and I reviewed the manuscript prior to its publication, as did Susanchen Dippenaar, Claudia Tjikuua, Mary Collins and Evy George of the Ministry of Basic Education, Sports and Culture. The games and methods used in this book have partly been taken from already existing games and adapted for this book. Part of the games have been acquired during various workshops and youth camps and part of the material has originally been produced by the Katholischen Jungschar Oesterreich. The picture story exercise on page 60 has been developed by Dr Gisela Perren-Klinger. Finally, we thank the children and their caregivers: they are our teachers, our guidance counsellors and our inspiration. It is to them that this book is dedicated.

Lucy Y Steinitz, PhD National Co-ordinator Catholic AIDS Action Windhoek NAMIBIA July 2002

There is more than one definition of a child. Our ideas of childhood are often based on how old the child is, how grown up the child is, whether the child is able to look after himself or herself or whether the child seems to need looking after. Such indicators differ from one culture or society to another and from one country to another. More and more children in Africa are becoming orphans because their parents have died of AIDS. AIDS is a disease caused by a virus called HIV that is spread by the exchange of body fluids like blood, semen or vaginal secretions. Once a person is infected with HIV, he or she will develop AIDS sooner or later. There is no cure for HIV/AIDS yet. Many children have known someone in their family or community who has died of AIDS. If one parent is infected with HIV it means that his or her partner will probably also be infected by means of unprotected sexual intercourse. This then results in both parents getting sick and eventually dying. This means that, unlike orphans who have lost a parent due to an accident or a non-infectious disease like cancer, AIDS orphans are often confronted with the disease and death of both parents. Children are not little adults. Childrens needs and interests are different from adults needs and interests. Children need a lot of security, love and emotional support. They need guidance as they grow and mature emotionally, spiritually, physically and intellectually. Children need to know where they belong and they need close adults with whom they can form an attachment. These adults may be their parents or a close caregiver. This caregiver may be someone in the family or a teacher. The caregiver may also be a person in the community who protects them and allows them to develop in a safe, nurturing environment.

It is usually parents, families and communities that provide for the well-being and development of children. If children are not able to grow up in a caring environment, they become more vulnerable. Vulnerable children are those children who are easily hurt or harmed.

What makes children vulnerable?

There are many things that can make children more vulnerable. Studies have shown that girls in our society tend to be more vulnerable than boys. Babies and young children are more vulnerable than older children. Children without a family or a home are vulnerable. Children held in detention are vulnerable. Children lacking education and skills are vulnerable. Children living in poverty are vulnerable. Children who are not involved in taking decisions that affect their own lives are vulnerable. Being exploited, abused, discriminated against or exposed to violence makes children vulnerable. Children who are isolated or withdrawn, who have no access to schools or adequate medical care, are vulnerable. Children whose rights are not upheld are vulnerable. Children who have lost their parents to HIV/AIDS are especially vulnerable. Some children are taken in by their extended families but, as HIV/AIDS affects more and more families, children are often found to be either living on their own or looking after younger brothers and sisters and elderly grandparents. Households headed by children have become common in many parts of Africa. It is clear that orphaned children are highly at risk of exploitation and increasing impoverishment. However, even though children all over the world face illness, domestic violence, war, poverty, famine, droughts or floods, some children seem to cope quite well, whereas others are overwhelmed. A childs ability to cope seems to have much to do with resilience. Researchers have defined resilience as the human capacity to face, overcome and be strengthened by or even transformed by the adversities of life and the ability to bounce back after stressful and potentially traumatising events. Resilient children are generally better able to cope with lifes adversities.

How does a child become resilient?

As caregivers to orphans and vulnerable children, this is a question that we might ask ourselves. Orphans and vulnerable children need to become resilient in order to overcome the many problems they face, such as dealing with the illness and death of their parents, and being responsible for their own lives and the lives of their brothers and sisters. You can imagine how feelings of grief, loneliness and guilt, and the stigma attached to HIV/AIDS could overwhelm a child.

What do children need to cope with adversity?

Children cope better when they have three capabilities: the capability to understand an adverse event (for example, the death of a parent), the capability to believe that they can cope with a crisis because they know that they have some control over what happens, and the capability to give deeper meaning to an adverse event. The development of these three capabilities needs to be encouraged. Most children will develop all three capabilities before reaching the age of 15. The development of these capabilities is greatly influenced by the childs external and inner resources.

External resources fostering resilience

External resources that help build resilience include: a close and secure relationship with a caregiver, a close relationship with the remaining family members, enough food, shelter, clothing and medical services, education, financial stability, and close links to his or her cultural community. Orphaned children need to have access to external resources to strengthen his or her resilience. But inner resources are just as important to the orphaned child. Inner resources refer to the childs inner strength and ability to deal with a crisis. Inner resources help a child to understand, manage and give meaning to a traumatic event.

Inner resources fostering resilience A wide range of emotions

A resilient child is usually comfortable with a wide variety of emotions. Resilient children are able to understand their own emotions and can express them in words or actions. For example, a resilient child can say, I am angry (or sad, or irritated).

A good autobiographical memory

The autobiographical memory is the memory in which we save personal memories about our lives and our life histories. A resilient child can usually recall positive relationships, moments of kindness, role models (for example parents and teachers), as well as personal achievements from the past.

Resilient children draw strength from their inner resources. As caregivers we can promote the development of inner resources.

A sense of belonging
Resilient children know where they belong. Such children are grounded at home, in the community and have a sense of their own culture, whether in the present or in the past. Resilient children understand how they fit into a family, a small group of friends, the school class, the community or the church. Resilient children are able to look for and find emotional support from other people. Resilient children are self-confident and also confident of the support of peers and caregivers. This support may change from time to time; it may not be provided by the same person over an extended period of time but may change, as the childs needs change.

Interest in others
A resilient child feels the need to help others. The child has a feeling for the needs of others and is able to help.

A value and belief system

Resilient children have a vision of moral order and a sense of justice. Resilient children know what is right and what is wrong. They sense what is unacceptable behaviour. Resilient children have a strong spiritual or ideological belief system. This belief system may include faith in any kind of transcendent being, whether one God, several Gods or faith in the power of the ancestors. This is usually influenced by the childs upbringing and culture. Some children (particularly older children) will develop some sort of political or cultural ideology, or may identify with a certain cultural, political or religious leader.

Creativity, innovation and curiosity

Resilient children are curious and eager to learn. Resilient children are creative and use their imagination. They are able to use materials in their environment to ensure their

survival. Resilient children are able to imagine a future and this gives them something to live for and a goal to work towards.

Self-confidence
Resilient children have a sense of humour and are confident of their own abilities, resourcefulness and identity. A resilient child will say, I can!, I have!and I am.

How to develop resilience in children

Resilience should be encouraged and developed in all children. All children are born with the potential to be resilient, but resilience has to be developed, just like other skills and capacities. We need to promote resilience in the children we care for. Resilience prepares children for hardships and suffering that they may face in the future not only when they are young, but also when they are adults. There are various ways in which we can help the children in our care to develop resilience: Provide a safe, nurturing environment in which the childs needs are met. This includes access to health care, education and welfare services. It is important for children to feel secure at home and to feel that they belong at home. Spend time with the children, listen to them instead of talking about them, and show an interest in them and in what they do, think and feel. It is important to play with them. Play is very important for childrens development. By answering questions and showing them new and interesting things, we encourage children to discover their own initiative, creativity and interests. Teach the children how to communicate with other people. By showing children how to express feelings and ideas and how to solve problems and conflicts, we encourage them to become increasingly responsible for what they do and say. We also help them to understand other peoples feelings and to respect the needs of others. Allow the children to make mistakes. We all make mistakes. We learn by our mistakes! Help children to recognise and understand their mistakes. Encourage them to correct what they did wrong. Support them as they deal with negative thoughts, feelings and behaviour. Involve the children in day-to-day activities as well as family rituals, cultural rituals, religious rituals and festivals. Teach the children family routines. It helps a child if the caregiver provides clear routines for the day and expects the child to stick to the routine.

Acknowledge the children for what they are, not only for what they do. Trust the children. Pray with the children.

The importance of the family

The family is the first environment in which a child experiences love and affection and makes discoveries. Families provide the basic framework for a childs development and have an enormous impact on a childs resilience. The family provides the child with a sense of belonging and an identity. Families have common roots and ancestors. They have shared life experiences. Family members can say to each other, Do you remember when? Families have a similar system of values, rules and norms. Families usually share cultures and religions. Most families are bound together by trust, solidarity and support for one another. Most children make their first social contacts and experience unconditional love in the family. Healthy family relationships are the best environment for a child to develop resilience.

The importance of school

After the family, school is the most important factor in a childs life. As a child grows up, more and more time is spent at school in the company of friends and teachers. Schools do not only teach children about reading, writing and arithmetic. They also look at the whole child and focus on cognitive development (that is, the acquiring of knowledge and skills) while at the same time emphasising the social and emotional development of the child. Research has shown that mature children with good social skills find it easier to learn than children whose social skills and emotional maturity are less developed. It is very important to develop the social and emotional development of students: many children come from single-parent homes, or homes in which there is no parent. Elderly relatives or siblings may raise children. In homes like these there is often not enough emphasis (if any) on the social and emotional development of the child. In this situation, the development of resilience takes place primarily in the classroom and in the community. For some teachers, this development is threatening. Others see it as a challenge.

Children growing up without parents look for extra things in their teachers. They need a lot of instruction, but they also need someone they can trust, someone who is interested in their lives. They need a teacher who will help in times of crisis. They need a teacher who will help them to develop self-esteem and self-confidence. They need a teacher who will help them to set realistic goals, but one who will also make learning fun. For many children, school is an oasis of normality in a harsh world. The teachers job may change so that the teacher is encouraging the childs resilience and not just to pass the exams. The teachers role changes from being simply an instructor to being an instructor, a counsellor, an adviser and a first-aid person all rolled into one. Other people in the community can also assist with this process. A neighbour, a home-care volunteer, a church representative or a member of the extended family may also play a critical role.

Experiential learning
A teaching method that can be used in the classroom (and elsewhere) to teach resilience is the method of experiential learning. Experiential learning combines intellectual learning (thinking skills), emotional learning (feelings) and social learning (learning about relationships).

A student-centred approach
Experiential learning is based on a student-centred approach. Student-centred education means that the interests of each child are the main point of focus. It looks at the childs personality as well as the childs needs and skills. Each child explores questions that are relevant and meaningful to him or her. Children are encouraged to find answers to their own questions and problems. Discovering answers for themselves makes the children feel more competent. Working individually or in small groups, they set their own learning pace, learning as quickly or as slowly as they wish. They are encouraged to find different ways to solve problems this teaches initiative and creativity. Their discoveries are discussed in groups this draws group members closer together and promotes trust, communication and respect for one another.

The benefits of experiential learning

As children discover that they control their own learning process, they get to know their strengths and weaknesses. They also discover what interests them. They learn to solve problems independently and they realise that they can solve problems on their own. Experiential learning is a teaching method that encourages resilience because it teaches the students knowledge and skills at the same time. Being very resilient or having a strong sense of identity does not mean that a child is invulnerable. Children can still be very vulnerable to stressful events in their lives, but being resilient makes them more able to cope with these events. Resilient children are better equipped to bounce back, to adjust to change and then to move on. They have the ability to understand, to gain control and to give meaning to the events that take place in their lives. In the next section we will identify events that are especially stressful to children and discuss how we, as caregivers and teachers, can support children during these times.

Children dont need to be ill or to have HIV/AIDS themselves to be affected by it. It is also very worrying for a child if a member of the family is ill or has HIV/AIDS. One problem leads to another and this creates an enormous burden that is difficult for a child to understand. It makes the child feel overwhelmed and hopeless. Problems that seem to pile up one on top of another are known as cumulative stressors. The effect of cumulative stressors on an orphan can be devastating if the child cant access his or her inner resources and doesnt receive support from the outside. This chapter deals with the most common experiences that orphans affected by HIV/AIDS face. Much of this chapter also applies to children who are faced with other severe or life-threatening illnesses in their immediate families. It deals with the negative effect that such experiences may have on a childs development.

The sickness of a parent

In a family affected by HIV/AIDS, children will be faced with problems long before death occurs. When a parent realises (or thinks) that he or she has HIV/AIDS, the parent may show less interest in the child. People with HIV/AIDS may undergo dramatic mood swings because they are under a lot of pressure. They worry about having the disease and they worry about what will happen to them and to their families. One of the big decisions to be made is whether or not to tell other people that they have HIV/AIDS.

Although the child may not know what is wrong with the parent or why the parent seems so moody, the child will definitely notice that something is different and may react to this with fear and anxiety. The real pressure begins for a child when he or she realises that the parent is often sick. Most children are unhappy when one of their parents is ill, no matter what is wrong with them. When a mother or a father gets sick, life changes for a child that lives with his or her parents. The normal rhythm and structure of family life changes (even for a little while) because the sick parent cant do the jobs around the house that he or she normally does. Other family members have to help. Older children understand that these changes are because the parent is sick, but younger children may be very upset by the changes in routine. Older children will have to accept more responsibility. Children of all ages may begin to feel neglected and angry. Children who already understand the relationship between disease and death might start to worry that the parent may die. They begin to worry about their own future as well. Children of parents infected with HIV/AIDS have reported that they worry about their sick parents, they worry about going to school and they are afraid of finding their parent dead when they come home. Often children are afraid that there will be no one to take care of them. These are very realistic fears and they should be taken seriously. As caregivers, we need to discuss these fears either at home as parents, or at school as teachers. It is not surprising that children who are preoccupied with such fears cant concentrate in the classroom.

Caring for a sick parent

In many families, older children help to care for their sick parents and to raise their siblings. The older the child is, the more aware he or she will be about what lies ahead. Besides taking over household chores like fetching water and herding animals, children have to prepare food, take care of other children in the family, do the washing and, most importantly, nurse the sick parent. This is very demanding. With the extra responsibilities, there is little time left for schoolwork or play. Many children fall behind in their work, start missing school and eventually drop out of school completely. Boys can be caring and responsible caregivers but studies have shown that girls seem to feel more comfortable with this role. Often it is culturally and traditionally more 10

acceptable for girls to accept this responsibility. Boys sometimes feel ashamed and become confused about their role and gender identity. Many children feel overwhelmed by the huge responsibility. They nurse their parents without having been taught what to do. They risk being infected themselves because they dont know what precautions to take when nursing people with HIV/AIDS. In addition to the daily housework, nursing a patient also includes getting up during the night. Nursing a bedridden patient is heavy work even for an adult. It can be exhausting for a child. Is it surprising that these children have problems concentrating or are hyperactive (overactive) in the classroom to prevent themselves from falling asleep? Many children complain about aches and pains that are caused by exhaustion.

The economic impact of a sick parent

When parents become too weak to fulfil their daily tasks, the familys income may decrease drastically. Being too sick to work in the fields will reduce the income of a family. Losing a job means losing an income as well. This is a crisis especially in singleincome homes. It is often left to older children to earn money and to provide food. Many children suffer from malnutrition, which affects their own health. Children are hungry at school and they cant concentrate properly. Some schools wont accept children who cant pay the school fees or buy the right uniforms and books. Poor housing, poor health, lack of access to health services and a lack of education are common in families affected by HIV/AIDS. Many children turn to prostitution to earn money and child labour is not uncommon. The need to earn money is another major reason for children dropping out of school.

The stigma of HIV/AIDS

Children are severely affected by the stigma of this disease. Research in Africa by the British organisation Save the Children showed the seriousness of the effects. Orphans were discriminated against by members of their extended families after the death of their parents. They were expected to work harder than other children in the family. They were often the last to receive food and/or to have their school fees paid. Some orphans were isolated from the other family members because it was believed that they were infectious and would transmit HIV/AIDS. Orphans of school-going age and children with infected parents reported that other children teased them and called them names. Sometimes the teasing led to physical bullying. They werent allowed to play with other 11

children. Many children said that they would rather stay at home than go to school. The children wanted teachers to protect them from the teasing and to respect their privacy. Older children and adolescents said that gossip about peoples HIV/AIDS status by members of the community was common. Many adolescents felt hurt by the gossip and felt that their sense of self-worth was affected. Infected parents felt the same way. They said that it was hard to support their children who were being teased when they were being gossiped about as well. Some families keep the HIV-status of a family member secret. In order to protect the secret, children and adults draw back from their friends and other social contacts. Some children make up stories about their parents and family. Children may start living in this fantasy world in order to cope with what is actually happening at home. Children between the ages of five and eight may not be able to distinguish between their fantasy world and the real world. Older children make up stories about their parents because they feel ashamed and because they dont want to be different from their friends. Some children worry that teachers or other authorities will find out that something is not normalat home and they are afraid of having to answer questions. Forced secrecy can be a great burden on children because they have to control what they say, what they do and how they express what they feel. The secrecy and stigma still attached to HIV/AIDS makes it even more difficult for children to deal with the disease and death of their parents. It is a sad fact that people still think of AIDS orphansdifferently from children who have been orphaned because their parents died of other diseases or were killed in car accidents. The children themselves cannot change this. They need committed adults, religious groups and organisations, and institutions that are willing to stand up to support these children and fight for their rights. This will eventually erase the stigma that is attached to HIV/AIDS.

Dealing with the death of a parent

Most children see dead birds or dead animals at the side of the road. In households with televisions they probably see death daily on television and they also hear about it on the radio. They hear adults talking about death and see them going to funerals. It is quite normal for children to refer to people or animals dying as they play. Nevertheless, a parents death is always shocking and traumatising for a child and it leaves a child feeling extremely vulnerable. How the death of a parent is understood is strongly influenced by the childs age, level of understanding and his or her view of the parent.

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A child who was raised by grandparents may react more calmly to news of the parents death than a child who grew up with the parent. Adults move through clear stages when dealing with death, but children grieve differently. Children dont grieve constantly: instead their grief is periodic and seems to come and go. We will concentrate on the emotional and psychological impact of death on children and their understanding of death in Chapter 3 of this book. A child may have phases of severe sadness and depression. During these times the child may become clinging and cry, while at the same time wanting to be left alone. After a while, the grief seems to fade away and may even be forgotten until something triggers the memory of their deceased parent again. Because of the social and financial effect of the death of a parent, many children dont get a chance to mourn the death of their mother or father because they are under so much pressure to organise other things like telling relatives about the death, making funeral arrangements and organising transport to bring the corpse home from the hospital. Often the familys last money is used to pay for the costs of the funeral and food for the guests. In many cases, the deceased parent dies without a will and without making plans for the children. Older children feel vulnerable and resentful when extended family members suddenly take control of their family life and their brothers and sisters without talking to the child who managed the familys affairs up to the time of the parents death. Family savings are often divided among family members without taking the needs of the children into consideration. Children of an orphaned family are often divided between several family members. The children are thus forced to deal with separation from brothers and sisters as well. A child may be caught between resenting the substitute caregiver while at the same time being dependent on him or her. The caregiver may expect the child to be grateful. Confused by these conflicting feelings, children sometimes act angrily or aggressively towards the substitute caregiver. Ideally, older children should be asked which relative they would like to stay with. If children have to be separated for financial or practical reasons, it is very important that these reasons be discussed with older children.

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Preparation for the death of a parent

Children who have been prepared for the death of their parent (either by the parent or by other caregivers) generally cope better with the death because they understand what is happening. Parents who prepare for their own deaths by arranging with relatives to take care of their children, by drawing up a will to provide for their children and by talking to their children about death, go a long way towards helping their children accept their deaths and preparing for the future of their children. Without such preparation, the death of a parent can be extremely traumatic for a child. The child may be overwhelmed by the sudden loss and may react with shock and confusion. It will take longer for the child to understand what has happened. This makes the grieving process more complicated and may cause severe nightmares, hyperactivity or outbursts of anger. Some children try to avoid dealing with the death of their parents. They dont want to think or talk about their parents and prefer to live in their own fantasy world. It sometimes seems that children feel nothing about the death of their parent; it is almost as if they are numb. Other children tell of sudden pictures of the deceased parent flashing through their minds. They have problems concentrating. They feel helpless, afraid and sometimes have outbursts of anger, aggression or severe depression. Preparing a child for the death of a parent is very painful for everyone concerned. But this preparation is very important. It helps the child and the parent to accept what is going to happen. The death of the parent will still be traumatic, but it softens the blow a little. It also gives the child and the parent quality time to say all the things that they need to share. Looking back one day, this will have been a precious time for the child and this quality time may be the basis for healing after the death of the parent. This preparation for the death of a parent strengthens the childs ability to cope.

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Being infected themselves

Some children have to deal with another crisis: their own infection with HIV/AIDS. Children who have been infected via mother-to-child transmission (through birth or breastfeeding) often dont know that they are infected. They may realise that they are sick more often than other children. They may suffer from the aches and pains of opportunistic infections. (Opportunistic infections are diseases you get when you have HIV, for example TB, diarrhoea and vomiting, oral and genital thrush, shingles and herpes infections.) Children infected with HIV as a result of abuse have to cope with the trauma of the abuse, the disease or death of a parent and their own infection. Children who are infected with HIV and are suffering from AIDS will start thinking about their own death, although many of them will not express it verbally.

Dealing with HIV and school

Infected children may miss a lot of school and will eventually fall behind their classmates. Even when they are at school, they will have less strength and energy than their friends and may not always be able to take part in games and activities. Even though their friends may not know that they have HIV, they may be teased because they get tired quickly. Infected children need special support. They should not be discriminated against at school and they should go to school for as long as their health and strength permits. In order to assist a child without being overprotective, policies and plans should be drawn up so that infected children can fit in at school. Schools need to provide for their special needs (like medication that needs to be given in class, longer rest periods and catching up with work that has been missed when they were absent). It is important for the child to keep up with the rest of the class. Experiential learning (see the brief description in Chapter 1) or other forms of studentcentred education methods could be used to ensure the integration of chronically ill children while maintaining the standard of education. Teaching methods should be adapted to the learners needs.

Telling others about an HIV/AIDS status

Many parents and caregivers decide not to reveal the HIV-status of their children. They want to prevent their children from being teased or shunned by other children but this also prevents the child from receiving the best possible care and support. Either way, this is a difficult decision to make. It takes a lot of courage to tell someone you have HIV because society as a whole has not yet learned how to deal with the

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HIV/AIDS pandemic. Some people take a head-in-the-sand attitude and prefer not to know, which does not help children affected by HIV/AIDS either. Working against discrimination needs to become part of school activities. It is important for children and adults to learn to respect one another, to get along with one another and to work as a team. People need to be friends regardless of whether a person has HIV, a different skin colour or speaks a different language. The HIV/AIDS pandemic challenges children and adults alike to learn respect and tolerance. These values have to be taught both at home and at school. In order to develop resilience in children, we need to understand how children react in difficult situations. We will study this in Chapter 3. We will also consider methods of crisis prevention and crisis intervention techniques that can be used to stabilise a childs response to the death of a parent.

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It is important to understand how children view death and how the death of a loved one affects a child in order to help children who have been orphaned. In this chapter we will refer to the emotional impact of the death of a parent because in many families the parent is still the main caregiver. Please note, however, that grandmother, aunt or any other primary caregiver who basically fulfilled the childs needs and is close to the child could replace the term parent. In Chapter 4 we will study how children react to the loss of a parent. Their reactions are all normal reactions. While some reactions are healthy responses that show that the child is adapting, others are less appropriate. All are normal, coping responses. As parents, caregivers and teachers we have to help the child find a response that is best for him or her. When a parent dies, it is natural for a child to experience feelings of bereavement like sadness, depression or anger. Grievingis the word used to describe the thoughts and feelings that we have when someone has died. Mourninginvolves accepting the death, making the death part of our memories and moving on to a new life. We know that adults mourn the death of a loved one but some people who work closely with children believe the mourning process is too complicated for a small child to go through in the same way as an older child or an adult. Even a baby will feel the absence of a primary caregiver or the change in faces or routines. In this situation, the young child needs a lot of reassurance and patience, but generally we say that a child can truly mourn the loss of a loved one by the age of three or four. At this stage, the child is able to memorise a person or an object even though that person or object is not nearby and cannot be seen or heard. By this stage, the child can recall the image of the deceased person from memory; the child can think about or imagine the person even though they cannot be seen. Being able to think about or imagine the person means that the child is able to mourn.

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Different aspects of mourning

There are different aspects of mourning that a child needs to work though. 1. The child accepts that the person has really died and will never come back. The child feels the pain of loss. It is important for the child to work through these difficult emotions if the child doesnt feel the emotion, the tension may come out later in the form of sickness or behavioural problems. The death of a parent causes many changes in the childs world. This was discussed in Chapter 2. The child needs to be able to adapt to these changes and to adjust to an environment in which the deceased parent is missing. This may take a long time and there will probably be problems along the way. The child has to find a new place for the deceased person in his or her emotional life and in his or her memory. This is important because it keeps the connection with the deceased person. It may be that the child thinks of his mother or father in a certain place (like heaven). The child can imagine the parent watching over them, speaking to them and protecting them. Dreaming and thinking about the deceased parent or keeping an object that belonged to the parent are important ways of remembering positive things about them and feeling close to them.

2.

3.

Factors that affect the mourning process

Various factors influence the childs mourning process and how the child eventually copes with the death.

The death of the parent

Death always comes as a shock. An unexpected death is even more shocking and is more difficult for the child to accept. Death due to a terminal illness often allows the parent and the child to spend some quality time together. The parent can plan for the childs future by drawing up a will and arranging a substitute caregiver for the child. Unfortunately, the stigma attached to HIV/AIDS means that a parents death due to the disease is often shrouded in secrecy and disapproval.

The relationship with the deceased parent

The mourning process is definitely influenced by the closeness of the relationship between the child and the parent before the parents death.

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The death of a parent has more emotional impact on a child when the parent raised the child (and when the child was close to the parent) than when the child was raised mainly by other family members (like the grandmother). The emotional impact of the death of a grandmother will probably be greater when the grandmother raised the child.

The availability of a surviving parent or caregiver

It is important for the child to have either a surviving parent or a substitute caregiver who will remain consistent as the child goes through the mourning process, as well as later on. This person should console and comfort the child as well as give a normal structure to the childs life after the death of the parent. If the child is supported by the rhythm of a normal routine, it is easier for the child to find meaning and to regain control. Very often the surviving parent is dealing with his or her own grief, which prevents him or her from providing the support that the children need. The help of other family members, neighbours, teachers and spiritual leaders is very important. They can support both the child and the mourning parent this reduces the stress for the child. It has been found that children with a resilient surviving parent (or a consistent substitute caregiver) cope better and are more resilient after traumatic events than children lacking support.

The structure of the extended family

A loving extended family that provides security and care can offer an orphaned child a sense of identity and a sense of belonging. Members of a family share the same roots, the same history and generally have similar values and beliefs. This familiarity provides warmth and protection. A family divided by conflict or with problems like alcohol dependency, domestic violence, severe poverty and an absence of strong values and beliefs can be an additional stressor for the mourning child. A dysfunctional family structure may thus have a negative effect on the coping process and encourage poorly adapted behaviour.

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Rituals surrounding the parents death

Family beliefs and rituals are very important when a person dies. The familys religious and traditional belief system provides meaning for the death. This sense of meaning promotes understanding, control and resilience. Although some adults think that they are protecting children from sadness by excluding them (keeping them away) from funerals and other family rituals, in fact the opposite is true. Even though some children will not understand everything that happens at a funeral (or another ritual), it is important for children to take part, even in a limited way, and not to feel excluded from the rest of the family. Taking part in these rituals has a healing and consoling effect on both children and adults. Rituals acknowledge that something terrible has happened, that someone has died. At the same time, rituals can include an awareness of a future life both for the deceased and also for those people who mourn. Rituals provide an opportunity to honour and remember the life of the person who has died. The people who attend the ritual comfort the people who are mourning. The mourners understand that they are not alone in their grief.

Support from the community

The importance of community support is easy to overlook. In many societies, the impact of disasters is shared rather than experienced alone. This applies to the HIV/AIDS pandemic as well. Communities have their own resources and traditional ways of coping with adversity. For this reason, it is important for communities to become actively involved in the care and support of the diseased patient and also in the care and support of the orphans. Communities play a special role in providing supportive structures like schools, health services, womens groups, home-based care groups and religious groups. Each of these groups provides valuable support. Only if there is a strong sense of community will no one point fingers at or isolate people affected by HIV/AIDS. Instead, communities like these gather their resources and try to support those who are affected or infected by the disease. A community with a strong sense of unity and sound, democratic leadership is an ideal environment in which to nurture resilience in children affected by HIV/AIDS.

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Peers and friends

Peers (children of the same age) and friends provide children with vital support in times of grief and mourning. Peers have an intuitive understanding of each other. They understand without having to think. It is often easier for children to share their grief with peers than with adults. In addition, peers often maintain a sense of playfulness and they may help the child temporarily to forget what has happened and help them to rest and relax.

The age and developmental stage of the child

Children understand death differently at different ages and stages of their development. The developmental stage affects how a child sees death, gives meaning to death and is able to access inner and external resources while mourning. Before deciding how to help a child as he or she mourns, we need to understand how the child understands death at that particular stage of development. Remember that each child will react differently according to his or her personality and access to external support.

Children from birth to two years old

Infants and toddlers are very dependent on their mothers and fathers for love and affection, food, protection, bodily contact, a sense of security, comfort and identity. Usually, mother and child have an especially strong bond. The mother can understand and anticipate her childs needs even before the child can speak. The child learns to communicate with his or her parents, how to interact in social relationships and how to express feelings of comfort and discomfort.

The childs understanding of death

When a parent dies, children up to the age of two cannot understand what has happened. They have no concept of death. This makes death impossible to explain to the child. Although infants cant understand what has happened, they still miss the parent. They miss the way the parent touched them, they miss the parents voice and smell and they miss the comfort and security the parent provided. For this reason they may display changes in sleeping and eating patterns. They may cry more and be difficult to pacify. Toddlers may show signs of irritability or anger. Toddlers may also seem to forget skills they have learnt and go back to behaving like a younger child. This is called regression.

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How you can help the child

Infants and toddlers need a close and consistent substitute caregiver to take over the care of the child so that the child can deal with the loss of a parent. It is important that this caregiver should stay the same. Ideally the caregiver should be an adult and not an older sibling who still is a child herself. The infant or toddler will adapt more quickly when there are no major changes in routine. The infant or toddler preferably should be kept in the same home environment, with his or her brothers and sisters. A child who develops a close, affectionate relationship with the substitute caregiver will cope more easily with the changes in his or her life.

What can be done to support an infant or toddler after the death of a parent? The substitute caregiver should be close and consistent. The substitute caregiver should provide lots of bodily contact. The childs routine should stay the same. The childs environment should stay the same. The child should not be separated from his or her brothers and sisters.

Children from two to four years of age

Children at this stage of development are mainly concerned with themselves and their own needs. They are learning about objects and people but they still cant understand concepts like life, death or friendship.

The childs understanding of death

Children at this stage of development do not understand that death means that someone is dead forever; they understand that the person is no longer there but they think the person will return. At this age, a child may say that his mother has died, but in the same breath he will say that she might come back. Some children experience death as abandonment they think that the deceased person didnt want them any more. Children grieve very intensely at this age. They may cry, throw tantrums, cling to other relatives or refuse to be touched at all. As they are primarily concerned with their own needs the grief response at this developmental stage is usually brief, but repeats itself frequently. Between periods of grieving the child seems to forget about what happened.

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Children in this age group are more aware of changes in the way they are cared for. Eating habits may change. Signs of distress and regression are common. Some children display sleeping disorders, either refusing to go to sleep or waking in the night and being unable to go back to sleep. Some children may start wetting their beds. Seeing surviving adults sad and crying may be confusing and upsetting for children of this age because they dont understand what is happening. They sense that their safety and security are threatened and they are frightened by the absence of the parent.

How you can help the child

Once again, a consistent substitute caregiver is very important. The child needs to be talked to in language that he or she can understand. The child needs to be comforted and encouraged over and over again and physical reassurance (in the form of hugs and hand-holding) is also important. Ideally the child should stay with his brothers and sisters and other close family members. If the child is separated from the remaining family members, he or she is very likely to see this as abandonment. The consistency of daily routine and a familiar environment give the child a feeling of structure and security.

What can be done to support a child aged two to four after the death of a parent? The substitute caregiver should be close and consistent. The substitute caregiver should provide lots of affection and bodily contact. The childs routine should stay the same. The childs environment should stay the same. The child should not be separated from his or her brothers and sisters. The substitute caregiver should spend time with the child, showing an interest in the child, playing with the child and having fun together. When talking to the child, people should use honest language that the child can understand. Repeat things and answer questions. Use the same words each time you explain. Listen to what the child says and try to understand what the child is feeling. Share positive memories and stories about the deceased with the child. Look at pictures of the deceased parent together. Encourage the child to play with other children and to explore his or her own world. Pray with the child.

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Children from four to seven years old

During this phase children start to explore the world outside their immediate environment. They gain a sense of autonomy. Being able to speak means that they can talk about their thoughts and feelings. They develop a feeling for who they are (they know their own name, surname and where they live), and they understand about belonging to a family and having friends. Children this age know whether they are girls or boys. They start to see a difference between the things that girls do and the things that boys do. They see that family members also have different jobs to do. Children love being told stories at this age. They love rhymes and songs. Their imaginations develop and they believe in things that older children and adults know are not real, like fairies, ghosts or Father Christmas. The fantasy world and the real world are sometimes blurred around the edges and a little confused. Some children may start to think that they can do magic things or change things that happen in real life. This is sometimes called the phase of magical thinking. Children believe that they have control over what happens in their lives and it helps them to cope with new fears and worries. Children become very creative and explorative at this age. They develop a peer group. They play games with other children and experience conflict with siblings and friends. A child develops a strong sense of right and wrong during this phase of development. The child develops a conscience and the concepts of morals and values become more sophisticated. The childs emotional range now includes feelings of guilt, shame, sorrow and concern for others. God is very real to children during this phase of development. With the help of adults, children learn how to pray. Adults have a very influential role in childrens spiritual development because depending on how God is described to a child by the caregiver, the child will either get a positive image of God (and develop feelings of trust and confidence in God) or a negative image (and develop feelings of powerlessness, punishment, fear and guilt).

The childs understanding of death

The concept that death is for ever is still difficult for children during this developmental phase. An orphaned child longs for the parent, shows signs of sadness and grief and may cling to substitute caregivers. Some children react aggressively, showing anger towards the dead person as well as towards the surviving adults. The resulting changes in family relationships may bewilder a pre-school child. However, with support, children are able to work through their grief.

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In order to come to terms with the concept of death, children may ask the same questions many times. They may also show great interest in the process of dying. They will want to know how and why a person died. These may be difficult questions for the surviving parent (or the caregiver), but it is important to answer them as honestly as possible. Death should be openly discussed and not described with words like, your mommy has gone to sleep, shes restingor weve lost Mommybecause at this stage of development the child will take you literally. Saying, Mommy has gone to sleepwill cause the child to expect Mommy to wake up again. Children are also interested in what will happen to the parent after he or she has been buried. This will be the cause of some concern. It is the caregivers task to explain concepts of heaven, ancestors or reincarnation according to the familys culture and religion. During this phase, the child starts to understand abstract concepts like moving from one form of existence to another (becoming an angel, going to be with Jesus). Before explaining to a child where the parent has gone, it is important for the adult to be sure of what he or she himself believes. Spiritual, religious and cultural beliefs are critically important for the well-being of the child. As explained in Chapter 1, children with a spiritual and cultural belief system are more resilient. They find it easier to give a deeper meaning to the loss. It is up to the caregiver to strengthen the childs belief system. Allowing children to take part in religious and traditional rituals after death (like attending the funeral, for example) helps the child to understand what has happened. Understanding what has happened increases the childs ability to cope. The repetitive questioning about the parents death may be because the child is afraid that the substitute caregiver may die too. It is important to reassure the child that the substitute caregiver wont die.You may need to reassure the child over and over again, each time anxiety or fear is triggered. For adults, these fears seem irrational. But remember that the child is in a developmental phase during which the imagination is very vivid and reality and fantasy overlap. The childs idea that his or her own actions affect things taking place in their lives can make them feel responsible for the death of the parent. Children at this age are looking for the howand the why. Because they cant think logically yet, they may think that their parent fell sick and died because of something that they themselves did. It is not unusual to hear, Its my fault my mother died. I was cross with her and I hoped she would die.Or, Its my fault. She told me to stop fighting with my sister, but I carried on. Thats when she died. This is complicated by the belief that if they are goodenough, then perhaps the deceased parent will return. It is crucially important for the caregiver to explain why the parent died in a way that the child can understand. The child needs to understand that it was not his or

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her actions that made the parent die. This may take a long time to understand because it is not easy for the child to grasp the concept of death and disease. But such understanding and meaning are critical for the coping and grieving process. Caregivers may notice that the child starts playing sickness and death games with other children. Re-enactingplay is a normal and natural process by which the child tries to understand and come to terms with the death and it encourages healing and coping. The child may still show signs of regression, start wetting the bed at night or having nightmares and sleeping problems. This is often caused by a sense of abandonment and the (realistic) fear that there is no one to look after him or her. Children in this age group feel very vulnerable and helpless. Some children may imagine death as a person or a ghost. This is very frightening. They may refuse to sleep alone in a bed or insist that the lights are kept on during the night. Some children may refuse to go outside or use a toilet in the dark. Other children seem to react less than you would expect but this is a way of protecting themselves from a hurt that is too deep and painful. Sometimes children giggle, joke and show off after the loss of a parent. This can be very upsetting for the surviving family members who will then scold or punish the children. Try to understand that these reactions are the childs attempt to distance himself or herself from the pain of loss.

How you can help the child

In addition to providing a daily routine, a close substitute caregiver needs to be patient and sensitive to the childs needs and to provide brief but honest answers that are at a level the child can understand. At this developmental stage it becomes very important for the child to understand what has happened. The more the child is able to understand and the more the child can maintain contactwith the deceased parent, the better the child will be able to cope. Help the child to have positive memories of the deceased parent. Talking about the parent who died helps to keep the childs memory alive. Children generally like to hear stories about the deceased parent, to see pictures of the deceased parent, and to have some of the belongings of the deceased parent to keep. This helps children to maintain their sense of identity and their sense of belonging.

What can be done to support a child aged four to seven after the death of a parent? The substitute caregiver should be close and consistent. Provide the child with lots of physical affection. Offer comfort and encouragement.

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 The caregiver should maintain the childs normal routine. Where this includes attending a playgroup or pre-primary school, this should continue. Try to keep the childs environment the same or similar. If possible, the child should not be separated from his or her brothers and sisters. Encourage the child to play with other children and to explore his or her environment. As the caregiver, you should spend time with the child, showing an interest in the child, playing with the child and having fun together. Share positive memories and stories about the deceased with the child. Look at pictures of the deceased parent together, visit the grave and have moments of remembrance. If you are a member of the family, tell the child stories about things that the deceased parent did when he or she was the childs own age. Talk to the child. Dont avoid talking about disease and death. Explain to the child how disease can affect our bodies. Explain how people feel when they are sick. Use honest language that the child can understand. Use the same words each time you explain. Listen to what the child says and try to understand what the child is feeling. Explain religious rituals (like the funeral) to the child and encourage the child to take part. Pray with the child.

Children from seven to nine years old

Childrens cognitive skills their ability to understand things clearly and conceptually increase dramatically during this phase of development. Children start to think logically, looking for meaning in the events in their lives but their thought patterns are still very concrete and operational (directed at solving immediate problems). Children start attending school during this phase and they are eager to learn. Learning new skills boosts their self-esteem, but children who do not manage the new challenges of school start to feel disappointed and inferior. They need a lot of acknowledgement, constructive criticism and praise from their parents and teachers. Teachers are very important to children during this phase of their lives. The teacher may spend more time with a child each day than the parent. The teacher is the one to guide the child through the learning process. A teacher who is supportive, encouraging

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and who responds to the natural curiosity of the child will be able to build a good relationship with the child. The child may see an alternative role model in the teacher, trust the teacher and feel able to confide in the teacher when a problem arises. School is also where the child learns to socialise with a wider social circle. Break time and after-school activities are as important as classroom activities because social learning is one of the most important developmental tasks for children in this age group. Although friends may change more often than in later stages of development, friendships and group activities are important opportunities for children to learn how to deal with conflict and to contribute as team members.

The childs understanding of death

At this stage of development, the immediate reaction of a child to the death of a parent is similar to the reaction of a child of pre-school age. Typical grief will include sadness, depression, anger, helplessness, deep emotional pain and longing for their parent. Sadness and a sense of powerlessness seem to be the strongest feelings. The child will see that even adults are distressed by death and the child has a basic understanding that death is beyond our control. This makes the child feel vulnerable. In response to this sense of vulnerability and helplessness, the child may either try to suppress all feelings or may go to the opposite extreme and have outbursts of anger or sadness. It should be understood that both responses are attempts by the child to come to terms with what has happened. Children in this age group have more specific questions about death and require more detailed information than younger children. The child now has the ability to mourn and to recognise mourning in other people. Some children may nonetheless feel unsure about what behaviour is expected from them, even though they can relate to their own grief and to the grief of other family members. Some children may copy adults behaviour. Children are now able to understand the physical separation from the parent who has died. They may develop a fantasy relationship with the deceased parent in an attempt to keep him/her alive. They may talk to the deceased parent or claim to have had mysterious encounters with the parent. Some children may still feel responsible for the parents death, believing that their bad behaviour or unkind thoughts caused the death or disease. But unlike younger children, children in this age group are able to understand logical explanations for the death of the parent. Some children may submerge themselves in household activities or in looking after their siblings in order to compensate for guilty feelings. If it seems that this behaviour is becoming compulsive, it will be necessary to discuss the behaviour with the child. Ask whether the child only wants to help or whether there is another reason for working so hard. It is important that the child does not burden

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himself or herself with feelings of guilt and self-blame. The child must be made to understand that disease and death are not in any way related to the childs behaviour. Sometimes children will start to behave like the deceased parent. This seems to be an attempt to keep the parent alive and may reach such extremes that they complain of the same aches and pains as the parent did before his or her death. All physical ailments should ideally be medically investigated. In some cases no physical reason will be found for the complaints the aches and pains may then be an expression of mourning resulting from a close identification with the deceased parent. If the pains dont subside after a few weeks, it is advisable that the child be reassessed by a medical professional and perhaps referred for professional psychological treatment. Children in this age group are fascinated by what happens to the body after death. This interest is confused and has a strong element of fear. Children also want to know where the deceased parent has gone. This is because children need to fit the deceased parent into a mental and emotional world. They need to find ways to relate to the parent after the parent has died. Children maintain the connection with the parent by visualising the parent in a certain place (for example in heaven) and by feeling as though the parent is watching and protecting them. They keep the connection with the parent by dreaming about him or her, by keeping an object that belonged to the parent or by speaking to the parent. Regularly visiting the grave or holding special memorial services are other ways of maintaining the connection. Children worry about how the parents death will affect their own lives. They are also anxious about how other people may react when they hear that their parent has died. Some children fear that another close relative or caregiver (or even they themselves) may die too. They will worry what will happen to them if they should die. This causes some children to become increasingly concerned about their own health and well-being. Since the child has learned that death can be caused by disease, even non life-threatening diseases like flu and the common cold may frighten the child.

How you can help the child

Schoolteachers may notice a change in the child after the death of a parent. The child might re-enact scenes of death and dying during play, draw pictures of the deceased parent, become hyperactive and attentionseeking or withdraw completely. The death may affect the childs general conduct: there may be concentration problems as the child is distracted by the situation at home and the new responsibilities that he or she has to shoulder. The sadness alone may be overwhelming.

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School provides an important daily routine and structure in the childs life. This structure helps the child to regain control, at least over parts of his or her life. The responses of the teacher and the school are critical to the childs well-being. The child knows what is expected at school and this provides security. The teacher needs to help the child to express his or her feelings (through talking, writing or even drawing pictures) and to answer questions that the child does not dare to ask at home. This is crucially important. Providing clear and honest answers helps the child to gain understanding and control. Acknowledge the childs abilities and skills boost his or her self-esteem and selfconfidence. Encourage the child to take part in sport and to play games so as to release tension and feel himself or herself to be part of a group. At a time when there is a crisis at home, the child needs the stability of a secure place in the peer group. Knowing that there is somewhere where he or she belongs that has nothing to do with the pressure at home gives a child a sense of security. Taking part in religious (or traditional) rituals also encourages the grieving and healing process. Try not to exclude children from rituals, but do prepare the child for what he or she is going to see. If the child is unprepared and does not understand what is happening, some rituals may be as upsetting as the death itself, increasing the childs fear and confusion. It is good to have a supportive adult with the child during the ritual, giving support and explanations when needed. Rituals are healing and consoling for children and adults. Rituals acknowledge that something terrible has happened, in this case that someone has died, but they also reinforce that there is a future for the person who has died and for those who mourn. Performing a ritual gives those who mourn a chance to remember the person who has died and to honour him or her. It gives the mourners a sense of comfort and support as they see that they are not alone in their grief. Excluding the child from the ritual means that you deny the child an opportunity to begin the long walk to hope and healing. Rituals emphasise moving towards the future and so they are crucial in promoting resilience and coping.

What can be done to support a child aged seven to nine after the death of a parent? Explain religious rituals (like the funeral) to the child and encourage the child to take part. Provide the child with lots of affection. Offer comfort and encouragement. Teach the child basic life skills. Make sure that the child goes to school. Encourage the child to be part of a group (for example at religious institutions or community level, like a choir or a sports team).

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 Keep the childs environment the same or similar. If possible, the child should not be separated from his or her brothers and sisters. Encourage the child to play with other children. The substitute caregiver should spend time with the child, showing an interest in the child, playing with the child and having fun together. Talk to the child. Dont avoid talking about disease and death. Explain to the child how disease can affect our bodies. Explain how people feel when they are sick. Talk honestly about how people feel when they die be honest and use language that the child can understand. Use the same words each time. Listen to the childs replies. Teach the child how to keep in contact with the deceased parent by relocating the memory of the parent to a place where the child can easily bring the parent to mind. Look at pictures of the parent with the child and visit the grave. Share happy memories and stories about the deceased parent. If you are a member of the family, tell the child stories about things that the deceased parent did when he or she was the childs own age. Try to find stories about death. Tell the stories or read the books and then talk about them with the child. Death and disease are subjects that should be discussed at school. Teachers can use the concepts for creative writing. Children could make a memory corner in the classroom. Pray with the child and teach the child how to pray.

Children from nine to 12 years old

The biggest developmental difference between these children and children in the younger school-going group is that the older children fully understand that death is irreversible (cannot be changed).

The childs understanding of death

Children at this developmental stage can understand what causes death and they can understand the consequences (results) of death. Abstract concepts like heaven are clear. Although the child may still occasionally use magical thinking (as explained in the section dealing with children aged four to seven), the child generally knows the difference between fantasy and reality. However, understanding the finality of death often leaves the child feeling powerless and helpless. It is important that children are helped to regain control over their lives.

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Children in this age group go through a similar mourning process to the mourning process of an adult. Some children may, however, try to deny the parents death and will simply refuse to accept it. Others may look for a reason why the parent died, feeling betrayed by fate, God or their ancestors. Such children need meaning to be given to the death of their parent.

How you can help the child

It is very important that children at this developmental phase attend rituals like funerals and prayer services, as well as visit the grave after the funeral. Knowing where the body was buried gives them a sense of control. The ritual gives deeper meaning to what has happened and in this way encourages resilience. In the same way that a child in the previous developmental stage tries to regain control over his or her life, these children need religious or cultural rituals to help them cope. Even when a child has come to terms with the parents death, it is normal for the child to miss the parent for a long time. It is important that the child be given time to grieve grieving is a natural process and it should not be rushed or prevented. The caregivers role is to support the child during the grieving process and to help him or her to function and grow while they grieve. It is important to allow the grief to come and go. As a caregiver (or a teacher) it is important to focus on the reason for any changes in behaviour (like increased sadness, anger, fear, guilt, feelings of abandonment, loneliness or helplessness), rather than on the details of the behaviour. It is more helpful for the child to talk about why they behaved in such a way rather than for you to forbid certain behaviour and reactions. You will need patience and compassion. Set rules that allow feelings to surface, but prevent destructive actions. Offer alternatives.You could say for example, It is OK for you to be angry and I understand that. It is not OK for you to break things in the classroom. What could you do instead to let off steam and get rid of your bad feelings without breaking things? Being nine years old and understanding death means that a child has to face his or her own mortality (the fact that everyone eventually dies) and the mortality of other loved ones. This may lead to anxiety that shows itself through sleep disturbance, poor school performance and disrupted social relationships. From time to time there may be outbreaks of distress, anxiety, anger or regression. By now the child can understand the concept of time and can think about the future. These thoughts may include happy plans, but for some children, fear of mortality may be a realistic worry. Knowing that death is often related to physical pain and that it is also unpredictable causes more anxiety or worry. Externalising the anxiety. Some children may be able to show these fears by drawing pictures of what scares them most about death and disease. This helps the child to gain control. By putting thoughts on paper, the child is able to look at them from a distance

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 like an observer or a bystander. If they are on paper, the child can also change things or rub out the parts that are too frightening. Externalising fear (or feelings of anger or sadness) gives the child a chance to look at the fear face-to-face, but because the fear is now outside the child (on the paper), the child has control and can confront it without being overwhelmed. Sharing thoughts with an outsider. Children at this developmental stage need to express their feelings whether in speech, play, drawing or writing. But they may find it difficult to discuss the topic with the remaining parent or a substitute caregiver. Some children prefer to discuss their feelings with their friends or with an outsider like a teacher or a community volunteer. Teachers, community members and peers are valuable resources for a child during this time. Although the private conversations between the teacher (or another community member) and child are helpful and important, disease and death should be included in the school curriculum and discussed in the group situation in class. Sharing thoughts in the classroom situation. Many children may have lost relatives to HIV/AIDS. Disease and death are topics that concern most people. Even if a child has not lost a relative, they may know of other people who have died. Talking in class about death, feelings related to death and ways to cope with death and loss allows children to share their different experiences and learn from each other. Those who dont want to contribute to the discussion will learn by observing and listening. Protecting themselves against HIV/AIDS. Due to the tremendous spread of the disease, children must understand how it is transmitted. Children of this age are able to understand that HIV/AIDS is transmitted by the exchange of bodily fluids like blood, faeces and genital excretions, especially through sexual intercourse. Children need to be taught how to care for diseased people without infecting themselves. Many children in this age group know about condoms because they are constantly exposed to advertisements for condoms. Some people believe that distributing condoms amongst nine to 12-year-old children prevents the transmission of HIV/AIDS in teenagers. Other people argue that this is an invitation to experiment with sexual intercourse. Although some children in this age group may be physically able to experiment with sexual intercourse, they are definitely not emotionally ready to have sexual relationships. Sexuality is more than just a physical act. For this reason, campaigns that promote distributing condoms to children do not in fact focus on the childs best interests but instead open the door to child abuse and exploitation. Sexuality is a topic that should be addressed, but addressing sexuality in class should not be limited to the biological or physical aspect of sexual intercourse. Discussions should include feelings, traditional and personal values, aspects of human rights and human responsibilities.

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Discussing HIV/AIDS and sexuality in a superficial way (and giving a step-by-step discussion of what it is rather than what the consequences are) may be more comfortable for the teacher, but it is woefully inadequate and does not cover the topic in a suitable way.

What can be done to support a child aged nine to 12 after the death of a parent? Encourage the child to take part in religious or cultural rituals. The substitute caregiver should be close and consistent. Offer comfort and encouragement. Teach the child basic life skills. Make sure that the child goes to school. If possible, the child should not be separated from his or her brothers and sisters. Encourage the child to spend time with other children. Encourage the child to be part of a group (for example at religious organisations or community level, like a choir or a sports team). Spend time with the child, showing an interest in the child and having fun together. When talking to the child, use honest language that the child can understand. Listen to what the child says and try to understand what the child is feeling. Encourage the child to express his or her feelings and concerns. Share positive memories and stories about the deceased with the child. Look at pictures of the deceased parent together. If you are a member of the family, tell the child stories about things that the deceased parent did when he or she was the childs own age. Have moments of remembrance. Teach the child how to keep in contact with the deceased parent by moving the memory of the parent to a place where the child can easily bring the parent to mind. Death and disease are subjects that should be discussed at school. Discuss HIV/AIDS transmission and prevention. Discuss caring for HIV/AIDS patients. Hand over small responsibilities and tasks to the child.

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Adolescents: children from 13 to 18 years old

The developmental task of an adolescent is to establish a concept of self. They have to work out who they are, what their purpose in life is and where they belong. Developing an identity involves developing a body image, a gender role and a distinct personality. Adolescents are insecure about themselves. They are preoccupied with changes in their body and afraid that their bodies may be harmed. Disease and death are very threatening to them. They are preparing themselves to get involved in life and the idea of their lives being limited or ended by disease is threatening to their partlydeveloped concepts of self and of life.

The adolescents understanding of death

Adolescents recognise death as final and irreversible. They are fully aware of the consequences of death. Adolescents tend to be very egocentric (focused on themselves and their own problems) and they may pity themselves when a parent dies. They apply the consequences of the parents death to their own lives and think, I have to leave school or, I have to be responsible for my siblings this may be threatening to them. Adolescents have ambivalent attitudes towards their bodies. Although they are scared that their own bodies may be hurt, adolescents take risks because they seem to be convinced that they cant be harmed.Yet when confronted with vulnerability, pain and death, deep fears and insecurities are evoked. To imagine that their own life could also end causes confusion and disbelief and so the thought is quickly rejected. It wont happen to me,is the adolescents reaction. There are various forms of risk-taking behaviour. Some adolescents start to experiment with alcohol, with drugs, start to smoke, or sniff glue. Another form of risk-taking behaviour is demonstrated by the adolescents attitude towards HIV/AIDS. Most adolescents know the facts about HIV/AIDS. They know it is transmitted by unprotected sexual intercourse. They know that it leads to a terminal disease. Still, many adolescents (partly due to peer pressure) engage in very early sexual relationships. Very often they do not protect themselves. In their imaginary cocoon of security, adolescents take risks that can be life threatening. Many adolescents tragically believe that it wont happen to them or that they wont be infected because, Its the first time. The transition from childhood to adulthood. A teenagers struggle from childhood to adulthood can be seen in his or her reaction to death. Their cognitive (intellectual) understanding of death is that of an adult. But while some adolescents cope on the emotional level by expressing appropriate emotions, talking about death and loss and actively mourning, others may appear undisturbed, extremely angry or totally withdrawn. It is common for teenagers to react with denial, delayed reactions and the suppression of feelings. 35

Given their preoccupation with their bodies, it is not surprising that this struggle often emerges in the form of physical aches and pains. The influence of a peer group. A peer group is essential for an adolescent. Because adolescents strive for independence, the guidance and direction of adults is often rejected. An adolescent wants to belong to a group of peers and their acceptance is important. Group acceptance is often achieved through group conformity, meaning that teenagers who belong to the same group show that they are part of the group by having the same interests, behaving the same way and wearing similar clothes. It is important not to differ in any way from the group. Adolescents fear isolation from their peer group. They fear discrimination. The loss of a parent due to HIV/AIDS is seen as threatening their conformity and so many teenagers try to keep the cause of death a secret in order to avoid any stigma. Loneliness. The reality of the HIV/AIDS pandemic is that many adolescents have to become caregivers at home, parenting their younger siblings. Although many teenagers do this with great commitment and compassion, it takes a lot of their time and isolates them from their peer group. Since the peer group provides most of the support during this developmental stage, this means that the adolescent is cut off from his or her support group. In addition to accepting enormous responsibility, the adolescent also feels alone, betrayed by relatives (which sometimes includes the deceased parent) and lonely. Loneliness at a time when support is needed weighs heavily on many teenagers. It makes them vulnerable to abuse, especially girls. It is difficult for many teenagers to find a role in their society. Not yet adult men and women, they are not part of the school-going teenage group either because of the burden of responsibility that they bear. Not fitting into either group can have a great impact on the adolescents sense of self-worth, self-confidence and developing identity. Because many adolescents have to leave school in order to look after their siblings and to earn a living, their future hopes and dreams are often shattered. For this reason many adolescents feel hopeless and see no opportunities in the future.

How you can help the adolescent

It is evident from public statements and publications that adolescents receive less recognition than younger orphans. Adolescent orphans, especially when they are heads of households or caregivers, are rapidly becoming an invisible group. While much has been done for younger children, adolescents are often left out. As adults we sometimes assume that younger children need more support and help

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than their older brothers and sisters. We think that adolescent orphans will manage to get along on their own. It is true that adolescents have more life experience and cognitive (thinking) skills than younger children, but in most cases (especially in child-headed households) the adolescent orphan is left with lot of responsibility. This means that the adolescent orphan has to cope with the loss of a parent, as well as with the responsibility of providing for a family, while at the same time working through a very difficult developmental stage. We need to pay attention to the questions, comments and behaviour of the adolescent, and to respond by offering emotional understanding and support. At the same time, adolescents need to be told clearly what the acceptable limits of behaviour are. They also need to understand what is expected from them in terms of responsibilities. Together, this can be very stressful. For example, having to leave school affects the adolescents self-confidence and his or her orientation towards the future. The adolescent needs help to see that things will improve in the long run, that he or she still has a future, and that there is still hope. Thus, the situation of the adolescent orphan calls for as much attention as the situation of the younger child. Focusing on the needs of the younger child should not prevent us as caregivers from keeping the adolescent in mind as well.

What can be done to support an adolescent after the death of a parent? Ensure that the adolescent continues to attend school. Provide substitute caregivers (for example, your community might have home-based carers) to assist the adolescent with family responsibilities and to free the adolescent to continue studying or training. Adolescents strive for independence, but at the same time they need support. Often adolescents will refuse to take advice from parents or caregivers but will look for their own role models. It is important that there should be other positive role models (like teachers, community members or community leaders) with whom the adolescent can identify. When trying to assist adolescents, ask them what they think they need in order to cope better. Dont impose what you think they need. Acknowledge that adolescents face a difficult situation. Offer help, be there as a safety net, but let the adolescent be involved in decision-making processes.

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 Adolescents have to understand the concepts of rights and responsibilities. Although an adolescent has more independence and freedom, he or she also has more responsibilities, especially when a parent has died and the adolescent has been left in charge of siblings. As a caregiver, be clear about what is expected of the adolescent. Set a framework in which the adolescent makes decisions, but be clear about the limits. When an adolescent engages in risk-taking behaviour, discuss the consequences of such behaviour. If their behaviour becomes selfdestructive, set clear rules. If possible, do not separate siblings. Make sure that the adolescent has time to be with his or her peers. Encourage the adolescent to be part of a peer group (at religious organisation or community level) like a choir or a sports team. The transmission and prevention of HIV/AIDS and caring for people with the disease should be discussed in class and in community settings.

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4
The reactions to the loss of a parent described in Chapter 3 are normal reactions and are part of a childs normal mourning process. When we talk about childrens reactions we need to remember that children generally know how to cope and they are able to adapt to crises and changes in their lives. Even strong reactions of sadness or anger (like those described in Chapter 3) are normal as long as they subside after a period of time and dont lead to changes in overall behaviour. Children who experience death may continue to grieve and mourn periodically (that is, some of the time, but not all of the time) until they are well into adulthood. Nevertheless, as caregivers we need to identify when normal reactions turn into severe changes in behaviour that need professional attention.

Normal versus severe reactions

Many children have lost their parents due to HIV/AIDS. The events that lead to a child becoming an orphan are very traumatic. Severe illness and the death of a parent are not normal events in a childs life. The situation is even more difficult if more than one parent (or other close relative) dies, which is often the case. Reactions of distress, helplessness, grief or anger from a child are normal reactions to an abnormal event. As caregivers we can help a child deal with these normal reactions and feelings. Remember that even though children may show signs of stress and grief, they are able to cope as long as they can understand what is happening. They must also believe that they can manage and they must be able to give deeper meaning to the event. When they receive support from the other parent, the substitute caregiver and the members of the community, orphaned children cope even better. It is the children who cant understand what is happening, who feel helpless and out of control and who cant give deeper meaning to what is happening, who feel increasingly 39

overwhelmed and unable to cope as they as they struggle to survive. Without help, their feelings of depression, helplessness, fear and isolation become stronger. If a child lacks resilience, instead of slowly fading away, their feelings of stress and grief may become more extreme or severe. The childs behaviour may change and his or her reactions to new situations may be inappropriate (the childs reaction may seem wrong). Inappropriate reactions are a sign that the child is not coping with what has happened and is not adapting to the changes in his or her life. Being unable to cope with the sickness and death of the parent may lead to severe reactions instead of normal reactions.

What are severe reactions?

Very intense reactions. This will be discussed in more detail in Chapter 6. Reactions that last for a long time. Reactions that profoundly alter the general behaviour of the child. Reactions that become self-destructive (causing harm to him or herself) or delinquent (carrying out minor crimes or looking like he or she may do so). When it becomes obvious that a childs reactions are severe, the child may require more specialised help than ordinary caregivers and teachers can give. This is discussed in more detail in Chapter 7 of this book. Many severe reactions in children can be prevented if the necessary help and support is given before an upsetting event or if the necessary precautions are taken immediately after the upsetting event has happened.

Preventing severe reactions in a child

Ask yourself these questions. How can I help the child to deal with problems ? How can I help the child to understand what happened? How can I encourage the child so that he or she feels able to manage? How can I help the child to find a deeper meaning in the event that has taken place? How can I prevent the death of a parent from harming the childs development? What can I do to break the spiral of disease, death, stigmatisation, inappropriate reactions and emotional suffering? We must break this spiral so that the childs inner resources and resilience can be given a chance to grow. As caregivers, each of us has an important role to play. As caregivers, it is our job to STOP problems from developing and to help the child to cope.

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The STOP system for parents

As a parent, you can STOP and: Share your thoughts and ideas with your child and listen to your childs ideas, thoughts and values. Talk to each other. Teach your child to be independent. Trust your child. Organise arrangements to provide for your childs financial and emotional stability. Draw up a will. Choose a substitute caregiver for your child. Collect some of your special belongings to be given to your child as a token of remembrance after you have died. Make sure that all your official documents (your ID card, your birth certificate and the birth certificates of your children) are kept together in a safe place where they can be found easily. Offer your child Opportunities to help you. Helping you with small jobs will make your child feel less helpless and enhance the feeling that he or she can cope. Prepare your child. Plan things for your child and share them with him or her.You can pray with your child and pray for your child. Talking to your child about your disease and your death is very difficult. Many parents are afraid of raising this topic. They want to protect their children. But children watch adults constantly and they notice when something is wrong. If children dont know the truth, they worry. Children often imagine the worst. Although it may be very painful, children should be told about the likely death of a parent. Learning the truth causes terrible pain, but at the same time it makes the death easier to understand when it happens. This is better than the death coming as a complete shock because the child was not prepared for it. It is easier for a child to adapt to change when the change was expected. Many parents want to give their children something to keep. Having items that keep the memory of the deceased parent alive is critical. Making a memory box is discussed on the next page.

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Make a memory box

The aim of a memory box is for a parent to put together special items to leave behind for the children after his or her death. When parents and children work on memory boxes together, it creates opportunities to express feelings and to talk about death and dying in a caring environment. Creating a memory box is an ideal opportunity to prepare children for the death of a parent. Helping to put the memory box together strengthens a childs resilience, even if the child is too young to do much more than decorate the box. The box can be just a shoe box or a cereal box what is important is what goes inside it. These items may be special messages for each child, photographs, recorded tapes with messages, important documents that the children will need (like birth certificates, a will and the parents ID card), a diary, letters or a special passage from a spiritual text. Sometimes the parent will tell stories about the family history to someone so that they can be written down and put in the memory box. Creating a memory box can be an important step for the adult on the way to accepting his or her death. A memory box (or a memory book, if you prefer) helps children come to terms with the loss of a loved one. They can go back to the box and read a letter over and over again. They can look at the photographs and think about the message that was left behind. It shows the children that their parent loved them very much and cared enough to leave something precious and valuable for the child. Knowing about the family history helps a child to identify with his or her roots. In some families, the children write messages to the sick parent and put them into the box for the parent to read later. These letters are also kept in the box. In this way, the memory box becomes a precious tool for communication. Sealed envelopes, which contain letters to be read after the parents death, are kept unopened until after the death. Making a memory box is a wonderful idea for all parents and children, even if no one in the family is sick. Important documents or tokens of sentimental value could be kept in it, but it could be updated with precious items as time goes by. A memory box project would be worthwhile integrating into the normal school curriculum. Memory boxes promote resourcefulness in all children, not just children affected by HIV/AIDS.

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Pray with your child and pray for your child

You may want to pray with your child. Teach your child about the divine being (God or Allah, or what may be appropriate to your beliefs). Teach your child that God is a loving God, that every person comes from God and returns to God when they die. Teach your child to pray. Children who are able to pray and who have strong religious faith, generally cope better with lifes adversities. Teach your child that God is always with us and that God will always hear a prayer. Tell your child that we can ask for anything in a prayer. We can tell God when we are happy and when we are angry. We can tell God about things that worry us. We can tell God in prayer about what happened during the day. God always listens. He is always there and He will always take care of us.

Prayer cannot be taught in one lesson

Children learn how to pray like they learn how to walk. Children who see their parent praying will start to pray. Faith in a transcendent being is not difficult for most children until they become adolescents. They learn to trust in God in the same way that they learned to trust their parents. Children who have faith, have hope. Older children may blame God for the death of a parent, but faith will make them feel less helpless, knowing that they can depend on God He will help them to cope. Children who have faith feel less lonely after the death of a parent because they talk to their parent in the same way that they can talk to God in prayer. Being able to talk about their feelings makes it easier to come to terms with them. In Chapter 7 we will discuss complicated grief children with religious faith do not suffer the agony of complicated grief as often as children that have no faith.

Prayer time is quality time

Praying with your child is a good way to be close to your child. Prayer time is quality time, both for the diseased parent as well as for the child.

The STOP system for caregivers

As a caregiver taking over the responsibility after the death of a parent, you can apply the STOP system as well. Structure (a normal day-to-day routine), Safety, Security and Solidarity (mutual understanding). Structure and normality are very important for a childs well-being after an upsetting event. The structure and rhythm of normal day-today life gives a child security. A feeling of safety and security comes 43

when a child knows what tomorrow will bring. Even though something terrible has happened, the child knows what is expected of him or her and can see that life goes on. Talk, Teach, Tenderness, Truth. Children need to express how they feel. This may be by talking, by drawing pictures or by writing in a diary. Smaller children may feel more comfortable re-enacting what happened in play. Remember that children need information to understand what has happened. The information that you give must be honest, true and shared in a way that the child is able to understand. Children need tenderness care and understanding but at the same time they need directions, especially when their lives seem to be falling apart. Openness, Opportunities for growth and development. Be open and honest with the child. Dont try to hide your own feelings. Seeing adults hiding their feelings worries children even more. Provide opportunities for growth and development; make sure the child attends school and teach him or her life-skills at home. Teach them things that you are interested in yourself, things that fascinated you as child and games that you used to play. Doing things together will bring you and the child closer together. Parenting and Participation. Treat the child like your own child. Show the same affection, care, concern and interest as you would show to your own child. Let children (especially the older children) help make decisions that affect their own lives. Involve the children in the preparations for the funeral. Involve older children in the choices you make for the funeral (for example, which coffin to choose, or how to decorate the graveside). Involve the children when you discuss their future. Ask them where they would like to live.

The STOP system for teachers

Schooling, Security, Structure. Even if the child cant afford school fees, uniforms or books, it is important that the child still goes to school and is treated the same way as all the other children. School does not only provide knowledge and education. School is where children mix with their peers. School is also a place of special belonging children talk about my school, my

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classand my teacher. School allows a child to fulfil another role. At home the child has the role of a son or a daughter but at school the child is a student. It emphasises another part of his or her identity. When a child is orphaned, the home-world is in crisis and turmoil. His or her identity as a son or a daughter is confused because his or her parent has died. This is when the school world becomes a safe haven. At least at school the child knows where he or she belongs and what is expected of him or her. Going to school after the death of a parent is very important because it gives the child a sense of security. It feels normal and in making the child feel normal, the child feels in control. It is also perhaps the only place where the child is allowed to behave like a child. This is particularly true of child-headed households. Talk, Teaching and Training. The role of the teacher will change as the number of children coming from families disrupted by the AIDS pandemic increases. Classroom activities will also change. The teacher will need to play an important role in helping the children to cope with lifes challenges not only teaching information that will help the child to pass exams but also providing emotional support and teaching the child life-skills. This is a great responsibility, but it offers a very rewarding challenge. Children who have lost a parent or have experienced other major life crises need to say how they feel and what they think. Expressing ones feelings is the first step to healing. As teachers, we will have to be good listeners so that we encourage children to express their feelings. Organised play as an Opportunity for children to express themselves. Children express their thoughts and feelings through play and personal expression (like art, music, writing and acting). When children are orphaned or a parent is sick, they often have to accept new responsibilities at home and there is little time to play. Play is an important part of a childs development. Schools need to be sensitive to this and perhaps offer substitute play opportunities. There are games and activities that specifically encourage childrens inner resources and coping skills. Using these games as teaching aids would be a low-key way of encouraging the development of resilience in children. Chapter 6 looks at different games that can be played. Participation in Peer group activities, Peer group support. Although circumstances may force children to take on adult responsibilities, children are still children. Spending time with peers allows a child to be a child. Together they can share their feelings and discuss life. 45

Children of a similar age see life differently from how adults see life. Children often feel that they relate better to their peers than they relate to adults. Many children prefer to share their problems with a friend rather than with an adult. Peers support each other and help each other to grow. Peer groups provide a sense of belonging and identity.

The attitudes of caregivers and teachers

The attitudes of caregivers and teachers play a role in encouraging normal responses in children. There is a danger in labelling children affected by HIV/AIDS as orphans and vulnerable childrenbecause the term vulnerablesometimes makes us see them as victims. Seeing them only as victims suggests that they are dependant, helpless and unable to survive. This is wrong. They need our support and assistance, but these children are in fact survivors! Think for a moment about how much they achieve. They carry an enormous workload, help and support their families, do their schoolwork and at the same time grow as individuals. It is easy for us to overlook the fact that they are actually coping. We often overlook their initiative and creativity, the effort they make and the strength they display. The way we look at the children in our care, whether in our homes or in our classrooms, and the manner in which we see these children, will affect the way we treat them. If, for example, you label children victims of waror a lost generation of youth, then that is how you will react to them. If they are treated as though they have a psychological disease then they are more likely to need psychological help, and not everyone has access to this or can afford it. We need to bear this in mind with regard to the situation of orphans and other so-called vulnerable(but resilient) children. As parents, caregivers and teachers, we need to prepare our children so that one day they will reap the harvest of resilience even if we are not there to share it with them. We must never forget the strength, resilience and ability to cope of children affected by HIV/AIDS. If we look at them as victims, we feel pity and compassion and so we distribute goods, offer support and pat their heads. But if we look at them as survivors who have managed to cope, then we acknowledge their strengths, their skills and their expertise. If we look at them as survivors, we must ask them what we can do to assist them. Our assistance will then build on their coping skills, their creativity and their needs. Then will we be providing the best possible assistance and we will be encouraging them to cope better and to become more resilient.

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There are several specific reactions that caregivers come across when caring for orphaned children. These include clinging behaviour, sleeping difficulties, nightmares, night terrors, bed-wetting, intrusive memories (sometimes called flashbacks), aggression, auto-aggression (hurting themselves), hyperactivity, magic thinking, feelings of helplessness and body pains. In this chapter we will use a case study to explain each of these reactions and we will look at ways of dealing with them while at the same time increasing the childs resilience. There are several suggestions to deal with the different kinds of reactions. You will need to decide which one works best for you and for the child.

Clinging
Nangula is four years old. Her mother died two months ago. Nangula has never met her father. Nangula and her siblings are living with their 70-year-old grandmother. Each time Nangula is separated from her grandmother she starts to cry and scream. Nangula does not play with other children but tries to stay near her grandmother all the time. At night she sleeps in her grandmothers bed. Nangula is very anxious and she cries easily. When other people come to the house, Nangula clings to her grandmother, very frightened.

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Explaining her behaviour

Nangula clings to her grandmother because she fears that her grandmother will leave her, like her mother lefther. Nangula does not understand that separation can be temporary (for a short time). Nangula thinks that if she is separated from her grandmother, her grandmother will never return.

What can you do to help?

1. Try to find out why Nangula does not want the grandmother (or you) to leave. Is it possible that something or someone else upset or hurt her? Find out when she started to show clinging behaviour before or after her mothers death? Is there anyone else with whom Nangula likes to stay? Are there certain people with whom Nangula does not want to stay? If so, dont force her to stay with them, and do not leave them alone with Nangula. 2. Let Nangula be clinging for a while. Try not to be away from her for a long time and keep telling her that you will not leave her for ever. Tell her that you will always come back. When you have to leave her alone, prepare her for this, although she may cry and scream. Tell her where you are going and when you will be back. Nangula is too young to understand the concept of time, so you should link the time with something that she can relate to. You could say, I will be back after you have eaten your lunchor, I will be back after you have had your afternoon sleep.Leave her with someone that she knows and likes (such as an older sister) and explain to Nangula that this person will look after her and care for her while you are gone. Make sure you are back when you promised dont let her wait for you because this will make her more clinging and afraid. When you get back, praise her for being so strong and brave. 3. If there is enough space, Nangula should sleep in her own bed or on her own mattress. Explain to her that she is big enough to sleep in her own bed. Make her bed next to your own bed. Allow her to sleep with a favourite toy (or something else that gives her comfort). In the beginning you may let Nangula fall asleep in your bed and then carry her to her own bed. If she wakes up during the night, you can reassure her and tell her that you are there, right next to her. After Nangula gets used to waking up in her own bed, start putting her to sleep in her own bed as well. Praise her for her independence every time she sleeps in her own bed. 48

If there is no space for Nangula to sleep in her own bed, let her sleep with an older sister. Dont put her to sleep in the same bed as her brothers. When putting Nangula to sleep, have a ritual (a routine) that is followed every evening. This may involve praying together, telling her a short story or talking about the best moment of her day. If she is afraid of going to sleep in the dark, leave a light on. If the source of light is a candle or an open fire, make sure its far away from Nangulas bed. 4. Try playing games with Nangula. She needs to learn that objects and people can disappear and return again. She has to learn to internalise objects and people so that she will feel secure even when they are not around. These games may be of help to her. (All of these games are much more fun if brothers and sisters or friends play too.)

Here are some examples:

Hide-and-seek with an object

Play hide-and-seek with Nangula, using an object. There are two ways of doing this. Either you can hide the object (like a handkerchief or a spoon) and let Nangula look for it while you help her by saying, Look far away, even further,or Youre close, very close!or you let Nangula hide the object and you must look for it. Make Nangula give you directions while you search for the object. This teaches her that although something cant be seen, it still exists.

Ordinary hide-and-seek
Teach Nangula how to play ordinary hide-and-seek. Tell her to hide while you close your eyes and count to ten. Then go and look for her. When you find her, give her a big hug. Then swop over: while Nangula closes her eyes you must hide, but let yourself be found by Nangula! Make sure the area in which you play is safe so that Nangula cant hurt herself. Agree that some places are not good hiding places, like fridges and cars. Agree on these before you start playing.

Memory games
Which things can you remember? This game teaches Nangula to internalise objects and improves her memory. 1. Put some objects that Nangula knows (like a spoon, a stone, a piece of wool, a paper-clip) in front of her. Ask her to look at all the things and to memorise them. Cover the things with a cloth. Ask Nangula to tell you what is hidden under the cloth. Remove the cloth and look at all the objects again. Count how many objects she remembered correctly. 49

2.

Now do the same again, but while Nangulas eyes are closed, remove one object and put it behind your back. Tell Nangula to open her eyes, remove the cloth and ask her which object is missing. Give Nangula old magazines and help her to cut out pictures of different people. Place the pictures in front of her. Ask her to look at all the pictures and memorise them. Cover all the pictures with a piece of cloth. Ask her to close her eyes. Remove one picture and hide it behind your back. Tell Nangula to open her eyes, remove the cloth and ask Nangula which picture is missing.

3.

When Nangula has played this game a few times it will get boring.You will need to find new objects.You could also increase the number of objects you show her.

Sleeping difficulties and nightmares

Rebekkah is five years old. She and her other siblings live together. Her eldest sister, who is 17 years old, looks after them all. Both her parents have died. At night, Rebekkah refuses to go to bed. She makes excuses to stay awake and finally falls asleep anywhere in the house.

Explaining her behaviour

There could be different reasons for Rebekkah refusing to go to bed, for example: she may not be tired enough to go to sleep, she may be hungry, there may be too much noise in the house, she may not want to be separated from close family members, she may be afraid of having bad dreams, she may be afraid of the dark, she may be afraid that her sister (her caregiver) will disappear or die as her parents did, or something might have upset her during the night.

What can you do to help?

1. Find out the real reason why Rebekkah does not want to go to sleep. If she is hungry and you have food in the house, give her something small to eat or a drink of warm milk or water. Dont give her cooldrinks or fizzy drinks (like Coke) to drink.

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2.

Make sure that she has a quiet corner to sleep in. Turn the radio and television down. Dont let her watch television before going to bed. Wash her with warm water or give her a warm bath before tucking her in. Try to make her comfortable in her bed and promise her that you will be there when she wakes up. Tell her that her older sisters will soon be coming to bed as well. Tell her that you will make sure that she is safe while she is asleep. When putting Rebekkah to sleep, have a ritual (a routine) that is followed every evening. This may involve praying together, telling her a short story or talking about the best moment of her day. If she is afraid of going to sleep in the dark, leave a light on. If the source of light is a candle or an open fire, make sure its far away from Rebekkahs bed.

3.

Having a child in your family that refuses to go to sleep every night can be stressful for the caregiver. But it is important to be patient and calm. Dont shout at Rebekkah or threaten her, but do be firm and insist that she goes to sleep. A child needs more sleep than an adolescent or an adult and should go to bed at the same time every day. This routine provides security and comfort to the child. Dont give in when Rebekkah begs you to let her stay up. If she starts crying, comfort her briefly, but then leave her alone in her bed. She may cry until she falls asleep but dont let her get up. Although this may sound mean (and although her crying may upset the other people in the house), stay firm. She will soon learn to calm down and fall asleep when it is her bedtime.

Nightmares
Manuel is 6 years old. Since his mother died he has been living with the neighbours. Often Manuel wakes up in the middle of the night and cries. He dreams that someone has died. Sometimes he dreams that the house is on fire.

Explaining his behaviour

Many children have nightmares. In Manuels case, the nightmares are probably worse because his mother died and he had to move in with the neighbours. Childrens nightmares are usually related to something the child is afraid of or to something frightening that the child has experienced. Sometimes the frightening event in a nightmare is symbolic the frightening event in the dream may take a different form from what happened in real life. Sometimes the frightening thing in the dream is based on an imagined fear rather than something that has actually happened.

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What can you do to help?

1. When Manuel wakes up during the night, comfort him and calm him down. Tell him that it was only a bad dream. Tell him that you are with him and that he is safe. If he is fully awake, make him look at his bed, the room and an object that he likes reassure him that he is at home in his bed. Only then ask him what he dreamt about and let him describe the dream in detail. Take his dream seriously. Although much of what he dreamt may be symbolic, the underlying fear is real. Some children dream the same nightmare over and over again. In older children this can be a sign that there is something serious upsetting the child. For example, Manuel may have seen a big fire and heard adults talking about the danger of fires burning settlements down. After the death of his mother and losing his own home, dreaming about the house being on fire may actually be symbolic of Manuels fear of losing all his belongings, including his security, warmth and shelter.

2.

3.

Nightmares that occur after upsetting events in a childs life normally show that the event doesnt fit into the childs understanding of life. While we sleep, our brains work through memories and incorporate them into our understanding of life. In Manuels case, he might be trying unconsciously to understand the death of his mother and to work through his own fears.

What else can you do to help?

1. During the day, remind Manuel of the dream and talk to him about it. Find out what scares him in the dream and ask him what scares him when he is awake. Talk to him about the things that he finds frightening. Ask him to draw you pictures about these frightening events. By talking about them, or putting them down on paper during the day, Manuel will be facing the fears. This will slowly reduce the frequency of the nightmares and after a while they will stop. Dont allow Manuel to watch a lot of television especially at night. Watching television increases the likelihood that violent or frightening pictures will be triggered while Manuel is sleeping.

2.

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Night terrors
Ndapewa is 5 years old. During the night she wakes up screaming with her body shaking. When her grandmother tries to hold her and comfort her, Ndapewa pushes the grandmother away. She does not recognise anybody.

Explaining her behaviour

Night terrors are very common in children. When a child has a night terror, the child doesnt wake up completely. When the child does wake up, he or she remembers nothing of the event and is not afraid. The child falls asleep again quickly.

What can you do to help at home?

During a night terror, sit next to the child and watch dont wake the child up. When the child does wake up, help her to relax, make her comfortable again and let her fall asleep again immediately.

What can you do to help at school?

There is not much that a teacher can do to assist sleeping problems in children, but the teacher may realise a child is having sleeping problems before the parent or the caregiver does. The teacher may see that the child falls asleep in class, is constantly yawning, has problems concentrating or is hyperactive in order to stay awake. The teacher could ask the child questions about his or her sleeping habits like: Where do you sleep? Do you have a bed of your own? Does someone share your bed? What do you do before you go to sleep? Does someone tuck you in at night? Do you sleep well at night? Why dont you sleep well? Do you need to get up during the night? Is it noisy where you sleep? Do you have enough blankets?

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In some households, especially those headed by children, children do not have a place of their own but sleep in different places every night. It is important for a child to have his or her own place to sleep (even if it is shared with a sibling). It is also important for the child to go to sleep at the same time every night. If a teacher realises that a child has a sleeping problem he or she may contact the caregiver and explain how important it is for a child to get enough regular sleep. The teacher may need to advise the caregiver (especially if the caregiver is a child as well) about possible ways to deal with the younger childs sleeping problems.

Bed-wetting
Moosa is seven years old. After the death of his father, Moosas mother had to go to work in town and she only comes home to the farm four times a year. Moosa, his brothers and sisters have been living with his grandmother and seven other cousins since his father died. Moosa has started wetting his bed for the first time since he was two and a half years old. He wakes up in the night and finds his bed wet. He is embarrassed and he cries. His cousins and his brothers laugh at him so he tries to hide the sheets behind the house. The bigger boys call him baby and wont allow him to play with them. At school the children also laugh at him. Moosa doesnt want to go to school anymore. He misses his mother and wishes his father would come back.

Explaining his behaviour

Bed-wetting is a very serious problem for many children. It causes a lot of additional emotional suffering. Many children who have experienced stressful events start to wet their beds again during the night, mostly due to emotional reasons like fear, insecurity and feeling unwanted or abandoned. For some children, bed-wetting is caused by a medical problem. If it continues for a few days, the child should be taken to a clinic to see whether the child has a bladder problem. If there is no medical reason, the bed-wetting could be a reaction to frightening events that the child has witnessed or experienced, like a father beating up (or screaming at) the mother, a friend being run down by a car or a schoolteacher hitting a child (or Moosa himself). Bed-wetting can also result from changes in the family, like the death of a parent, a parent moving away from the home, a divorce or the unexpected birth of a baby. In each case, the bed-wetting is related to fear, insecurity and helplessness. Moosa feels threatened that something has upset his normal family structure. He feels insecure. Bed-wetting always shows that a child is under a lot of emotional pressure.

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What can you do to help?

1. Do not scold, blame or punish Moosa. He doesnt wet his bed on purpose. Give him clean sheets and clean clothes and make sure that he doesnt smell of urine when he goes to school. Talk to Moosa in private. Try to find out what is upsetting him. Has there been a special occasion when he felt very threatened or afraid? Find out how he feels about wetting his bed does he feel ashamed or inferior (less than) to other children? Tell him there are many children with the same problem and promise to help him to solve the problem. Tell him that you know that he does not wet the bed deliberately. If Moosa decides to tell you about things that scare him, listen carefully and encourage him. Say things like, Yes, I can understand that this is very upsetting/scary/worrying for youAt the same time, tell him how well he is doing despite his problems. Make a point of noticing his skills and give him positive feedback as often as possible. Encourage him by addressing his strengths and say things like, You are such a big help to me!or, You are so good at maths/soccer. Moosa needs a lot of encouragement and positive assurance to build up his self-image and self-confidence. When Moosa wakes up during the night, comfort him calmly and change his linen. (You might need to cut down the side of a plastic bin bag and place it beneath his sheet to protect the mattress.) If possible, have extra linen nearby. It would be best for Moosa to sleep in his own bed or on his own mattress so that he doesnt wet other children. Make sure Moosa isnt exposed to a lot of upsetting events. Dont let him watch a lot of television. When adults in your home talk about violent events in the community, make sure that you explain the conversation to Moosa later on. Explain that he is safe and that you will take care of him. Dont let Moosa drink too much in the evening. Make sure that he goes to the toilet before he goes to bed at night. Have a quiet time with him before he falls asleep and chat about the good things that happened during the day. Bedtime routines always help children and adults to relax and prepare for sleep. Before you go to bed yourself, wake Moosa up and send him to the toilet. Make sure that he is wide awake. If he is afraid to go to the outhouse in the dark, have a bucket nearby for him to use. Teach him to get up during the night and use the bucket when he feels he needs to go to the toilet. If possible, leave a light burning so that he can see.

2.

3.

4.

5.

6.

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7. 8.

Dont allow the other children to laugh at Moosa. After a night when Moosa did not wet his bed, praise him and acknowledge that his bed is dry.

Example of a bed-wetting chart

9.

Have Moosa help you to draw up a calendar to monitor the dry and wet nights. In the beginning reward Moosa after he has one dry night in a week. After he manages one dry night in a week, increase the number of nights that he must stay dry during the week in order to get a reward. Increase the number of nights until Moosa is dry every night.

Intrusive memories (flashbacks)

Aletta is 8 years old. Two months ago her mother suddenly became sick. She was taken to hospital with acute encephalitis and she died three days later. Aletta and her two brothers are now living with their aunt, who is looking after them very well. Aletta still goes to school, but for a few weeks she has been very absent-minded in class. She finds it difficult to concentrate. She seems restless. She is falling behind her classmates. One day, after an ambulance passed the school building, she started crying and shaking. She told her teacher that she suddenly remembered her mother being taken away to the hospital. She wont walk past her old house when she walks home from school.

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Explaining her behaviour

Aletta is suffering from intrusive memories, also known as flashbacks. Intrusive memories are memories of a painful, upsetting or traumatic event that suddenly pop up in your mind and cant be controlled. Intrusive memories are like nightmares that happen during the day. They are not recalled willingly, but instead the memories intrude into our brains. This means that they flood our minds. They are uncontrollable and they expose us to the stressful event that took place in the past. Intrusive memories are usually triggered by something that resembles the original event in Alettas case the ambulance. A sight, a sound, or even a smell that was present at the time of the original event can trigger the intrusive memory. Intrusive memories are overwhelming and very vivid. The memory feels so real that it is just like reliving the original event and so a person reacts with the same feelings that he or she felt at the time of the original event. Having a flashback about her mother being taking into hospital left Aletta feeling as helpless, afraid and sad as she felt when it really happened. The intensity of intrusive images varies from very mild to very strong. When Aletta experiences a very strong flashback her teacher may notice changes in her body: Aletta will breathe more quickly than usual, her eyes will look blank and glassy, her face might get flushed or she might start to shiver, tremble and get goosebumps. Flashbacks are overwhelming and may be very frightening. Some children try to prevent intrusive memories by refusing to think or talk about the traumatic event that took place. They may also try to avoid situations, objects or even people that they associate with the original event.

What can you do to help?

Aletta needs to express what is worrying her and it would help her to tell her story. Telling her story would give her control over her memories and help her to come to terms with her strong feelings. However, describing the traumatic event may overwhelm Aletta and trigger another flashback. We need to find a way to help Aletta describe the event without becoming overwhelmed. 1. When Aletta is experiencing an acute flashback, take the following steps immediately: Go to her, speak her name in a firm voice and tell her that you are going to touch her. Hold her firmly by the shoulders. Make eye contact, say, Look at me!and dont allow her to lose eye contact with you. Maintaining eye contact is reassuring for her and helps her to keep control.

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Use short sentences when you talk to her. Say things like, Everything is OK.You are in the classroom.Or, I am with you. Nothing is going to happen to you! You are safe! If Aletta is breathing heavily, try to slow her breathing down.You can do this by asking her to hold her breath after breathing in and then breathe out gently as though she was blowing out through a straw or a whistle. Direct her breathing all the time, saying things like this: In. (As she breathes in.) Stop. Hold your breath. (This is to slow down her breathing.) OK, now breathe out slowly as if youre blowing through a straw. Good. (Wait a moment before saying In again.) Good! Try to develop a steady rhythm in her breathing. Repeat your directions, gradually slowing down as she breathes out. Keep eye contact! 2. When Aletta has calmed down, let her have something to drink or send her to wash her face. Let her rejoin the classroom activities, but talk to her after school. Ask her what was so scary and upsetting. Dont ask for too much detail at this stage. Dont ask her why she reacted like that. Dont ask how she feels about the event. Asking Aletta to explore her feelings may trigger another flashback. Reassure Aletta that having flashbacks after a very upsetting event is normal. It happens because she is trying to come to terms with what happened.

3.

Flashbacks consist of fragmented pieces of memory that suddenly come up. The pieces of memory dont seem to fit together and they dont fit into the childs memory. This makes them chaotic and uncontrolled. When someone describes something that happened to them, they have to arrange the memory pieces in the order that they really happened for the story to make sense. In this way, telling a story helps to put pieces of memory into a meaningful structure. This structure makes the memory less chaotic and uncontrollable. By having more control, the child is in charge of the situation and of the memories that surface.

It is important to talk about the upsetting event, but the child may be flooded with painful, unwanted feelings. We have to be careful not to trigger a new flashback when we ask a child to tell his or her story. It is important to find a way for the child to confront the upsetting event in a controlled way. When a child can look at what is upsetting him or her, the traumatic event becomes easier to integrate in the memory and in the life context. Once integrated, the child can give the event meaning and work out how to control it.

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4.

Drawing pictures is an ideal way of looking objectively at an upsetting event in a controlled way without becoming overwhelmed. As Aletta puts the upsetting event on paper she can control what goes into the picture and what is still too painful to show. It is important for Aletta to create her own picture story and to talk about her picture when she has finished drawing. Dont tell Aletta what to do let her come up with a solution that will suit her own needs.

5.

Look at the picture again and ask Aletta what else the child in the picture could do herself to feel better. What does the child usually do to make herself feel better when she is sad, upset or angry? Ask Aletta which of those activities she would like to try herself. She may suggest playing with friends, talking to someone or playing with a baby cousin. Say, Yes! You should do those things as often as you can! Encourage activities involving sport and outdoor games. Also encourage activities to do with religion or culture. Passive activities (activities that do not involve interacting with other people) like watching television or sitting under a tree are less helpful. Teach her a breathing exercise. Breathing exercises are very helpful when helping children suffering from intrusive images and nightmares.

6.

Tell Aletta that the activities she has chosen are great. Tell her you look forward to hearing how they are helping her. Agree that you will ask her to tell you how she is doing from time to time. Encourage her self-esteem praise her for doing so well in such a difficult situation. Thank her for sharing her story with you. Invite her to come and visit you whenever she has a problem. Talk to Aletta again after two or three weeks. Find out how she is doing. If she is still suffering from flashbacks you may need to contact her caregiver and ask for Aletta to receive professional help.

7.

How to deal with flashbacks or nightmares

There are ways to encourage children to look at the content and structure of flashbacks or nightmares. These activities can be used for an entire youth group or the whole class, not just with children whose parents or caregivers have died. While you will need to be very sensitive to orphans and vulnerable children in the group, it is best not to single them out because they may experience this as stigmatising.

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The picture story exercise

This exercise is suitable for children aged seven to ten. (It is easier if the child likes to draw.) It is used to assist a child suffering from flashbacks by focusing on the content of the flashback and giving structure to the memories. Set aside some time to work through the following exercise with Aletta after school. It will take some time and it is imperative that you are not disturbed. This exercise could be critical to Aletta and she needs your undivided attention. 1. Ask Aletta if she can draw a picture story or a comic about what happened to her. Divide a sheet of paper into nine equal squares. Have a few coloured pens so that Aletta can choose which colours she wants to use. The blocks in the diagram have been numbered to help you dont write the block numbers on Alettas paper! Ask her to start in block one. a. Block 1: Ask Aletta to remember the last time that she felt happy and safe before the upsetting event took place. What was she doing then? When Aletta is able to remember it clearly, ask her to draw a picture of the good moment in block 1. Jump to the opposite corner (block 9). Ask Aletta to draw the first good moment she remembers after the upsetting event was over. Point to block five and ask Aletta to draw the worst part of her story (for example, the death of her mother). This is a critical moment because Aletta will be confronted with painful memories but because she is talking and drawing the event, she will be able to stay in control. Drawing a picture prevents her from having another flashback. The picture should be as accurate as possible. Stay with Aletta as she draws. If she talks, listen closely to what she says.

2.

b. c.

d. Ask Aletta to draw pictures in blocks two, three and four to show what happened before the worst part (for example, when her mother fell sick and had to go to hospital). e. Ask Aletta to draw pictures in blocks six, seven and eight to show what the people in the pictures did after the worst part was over (for example, the neighbours coming to visit and going to the funeral).

3.

When she has finished all the pictures, ask Aletta to tell you the story of the people in the pictures. Move from picture to picture so that the parts of the story are told in order. Talk about the girl in the picture this allows Aletta to distance herself from her story. Guide the story to 60

end at the point at which the girl in the picture felt safe and calm again. To show Aletta that you paid attention to her story, repeat her story to her. Hearing her own story told by someone else also helps Aletta to distance herself from what happened. It also helps her to memorise the story in a meaningful form. 4. Ask Aletta how the people in the picture felt especially the girl in the picture. If Aletta replies,good, help her to find a more precise word like happy, satisfied, joyful or content. If Aletta says, bad, help her to find a more precise word like sad, angry, guilty, ashamed or helpless. Ask Aletta where she feels angry, sad or happy feelings in her body. Describing the feelings in her body helps her to look at those feelings in a controlled way. This prevents the feelings from becoming overwhelming. Talk about what people do when they feel angry, sad or disappointed. When you have finished discussing everyones feelings, tell Aletta these feelings are quite normal when something like this has happened. Tell her that it is normal for children to feel afraid when their mother is taken to hospital. Tell her that it is normal for children to cry and to feel lonely and helpless. Tell her that it is normal for children to worry about their parents. Point out all the good things that Aletta did during this difficult time, like looking after her brothers, packing the things they needed to take to their new homes, helping her aunt and attending school. Praise her for this achievement. 5. Ask Aletta what she thinks the child in the picture needs to make her feel better. (Remember to refer to the child in the picture.) Dont be surprised if Aletta replies that the child needs her mother back. It is a normal response for younger children. Tell her that you can understand this because every child wants a mother but say that there are some things that are impossible. Discuss how the child in the picture can still have contact with her mother, for example by talking to her, by having a special memorial place or ritual, by looking at her picture and by praying.

Guided drawing with the whole class

This method helps children to take a step back and reflect on things that have happened in their lives. Because it is a group method, it can be used in the classroom.

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The teacher gives the class a specific topic and asks the children to draw a picture related to this topic. Guided drawing can be done as a regular classroom activity in the class twenty minutes every day or every second day would be time well spent. It is important not to start immediately with problem topics. Start off with topics that foster resilience and inner resources in children. In a class with several orphans your topics could start like this: Day 1: Draw a picture of yourself doing something that made you feel very happy. Draw a picture of yourself after you achieved something that you feel very good about. Draw a picture of yourself doing something that you enjoyed very much. Draw a picture of a day something good happened. Draw a picture of a day something bad happened. (Pictures of funerals or death may appear.) Draw anything you like. (Observe what the children draw.) Draw a time when you felt very strong. Draw someone you love very much. Draw a day when you were very sad. Draw anything you like. (Observe what the children draw.) Be flexible. If you observed that death featured prominently in the pictures drawn on days nine and ten, allow the children to draw whatever they like. If not, give a new topic like a great day at schoolor, a day you were terribly scaredor,something that makes you very angry.

Day 2:

Day 3:

Day 4: Day 5:

Day 6: Day 7: Day 8: Day 9: Day 10: Day 11:

Be creative in the topics you give the class. If your problem topic keeps the children busy for a few days, follow up with a resilience-based or resource-based topic. After a few sessions the children may start to volunteer topics make use of their proposals because they reveal what the children are concerned about. Take a few minutes after each drawing session to look at all the pictures with the children. Put the chairs in a circle and spread the pictures on the floor in the middle of the circle. Ask if anyone would like to talk about his or her picture. Dont force any of the children to discuss their picture.

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Before the pictures are shown to the class, suggest the rule that no one may laugh at a picture or tease another child about what he or she has drawn. Once the children understand how the circle works, they will probably not need reminding about this. Have a file (or a large envelope) for each child to keep his or her pictures in.

Memory or communication books

Older children and adolescents may not want to draw. Writing stories down on paper is another way of structuring memories and feelings. The memory book is a tool that is suitable for the classroom situation. Give each child an exercise book and a pen that may only be used for the communication book. The child may decorate the exercise book to make it special. Encourage the child to write about events that have taken place in his or her life. Tell the children that these books are their personal property and that no one may read the book except the children themselves. There is only one exception to this rule: if a child feels that he or she wants to share his or her story with you (the teacher), you will read the story the child has written and you will write a comment in the book. This book then becomes part of a dialogue. It is up to the child to decide whether or not to agree to this. Never force a child to let you read his or her thoughts. Children are usually hesitant to share their feelings with you as an authority figure in the beginning. Once the first child is brave enough to risk it and your response is warm and encouraging, other children will usually come forward as well. Tell the child that what you both write is absolutely confidential promise that you will not tell anybody. Tell them that spelling mistakes and bad handwriting dont matter either! Communication books can be developed into diaries. Adolescents normally find it difficult to relate to a person who is not one of their peers, but adolescents who head households have little time to socialise with their friends and so this is an opportunity to express their thoughts and feelings. There is probably not much time after school to write in a diary. It would be helpful to reserve twenty minutes during the school day for children to write in their diaries. Most children like to take a few minutes once a day to think about themselves and to write their thoughts down on paper. Putting thoughts and feelings down on paper promotes creative writing skills and encourages self-control, self-knowledge and problem-solving skills.

Play and re-enactment (suitable for children aged 4 to 10)

Children who have experienced traumatic events and major life changes tend to replay these experiences over and over in their heads. This is normal and part of the healing process. It has been said that play is a means by which children handle and work on experiences and tackle difficult problems.

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Through play, children express their feelings and work through difficult negative experiences. Often the child repeats a scene over and over again until a solution is reached. This is known as repetitive play. The child may also involve his or her peers. Together they role-play the event over and over again. Role-playing allows the child to take on different roles and to view the upsetting event from various angles. Roleplaying also allows the child to fantasize about miracles and about superhero strength. Imagining that he or she can control the event helps the child to cope and to gain control. Children may also role-play their intrusive images as they try to understand them and to integrate them into their life concept. Children should be encouraged to play. This means that they must have enough time at school and at home for free play. Children who play, learn better. A child that regularly chooses not to play with his peers or siblings should be encouraged to join in. Find out why the child is not taking part in the activities. Role-playing can be encouraged in the classroom. 1. Ask the children to get into groups and to think up a story that they will present to the class later on. Before they start, explain to the children that a role is something you play. Talk about the kind of roles that people play (for example, a woman may be a mother, a doctor, a caregiver, a netball coach and a Sunday School teacher she has different roles to fulfil at different times). Give them enough time to work on their story. Provide some props that they might need for their story (like an apron, a broom or a hat). Let them present their play to you and the rest of the class. Before the plays start, agree that no one may be laughed at unless the story is funny. If a story is serious, talk to the children about what happened in the play. Explain again that each learner in the play was playing a role. Take the children out of their roles by saying, Sanette, who was the bad girl, is the real Sanette again!and, Rachel, who was the mother that was crying, isnt the mother anymore shes Rachel again!

2.

3.

Older children, who are used to role-playing, may be given themes to work with. Role-playing promotes creativity, imagination, problem solving, team spirit, group cohesion and self-confidence as well as verbal fluency in children.You could ask older children to put their role-plays into writing. This encourages their creative writing. And last but not least, role-playing is fun!

Breathing exercises
Breathing exercises are helpful not only when a child has flashbacks but also when a child is very agitated, has problems concentrating, has problems falling asleep or demonstrates aggressive behaviour. 64

Breathing exercises can be done at home or in the classroom. It is worth doing breathing exercises with the whole class on a regular basis not just with vulnerable children. Breathing exercises help people to calm down and collect themselves. Children who have been trained to breathe calmly and deeply are able to study better. Children and adolescents with exam feverlearn to control their anxiety through regular, deep breathing. Teach the children the steps to follow. (You might want to change the way you explain things!) Step 1. You say: Sit up straight with both feet touching the ground. Rest your hands on your legs. Your back is straight. Imagine that there is a fine thread tied to the top of your head. There is a little man sitting on the ceiling and he is pulling the thread. Try to sit very straight so that the thread doesnt snap. (The story of the little man is important because it makes the children straighten their backs so that the head rests on the spine and the shoulders are pulled back.) Step 2. You say: Now when I give you a sign, we will all start to breathe in as if we are sucking air in through a small straw. We are going to let the air flow deep down into our bodies. Imagine the air filling our bodies. Step 3. You say: When the air has filled our bodies, we hold our breaths for a second or two. Then we blow the air out slowly through the straw. When you stop breathing out, pause for a second or two before breathing in again. And repeat. (You need to direct the children like you would conduct a choir, praising and encouraging them from time to time. After breathing in and out a few times, slow down the speed of the breathing as the children breathe out.) Practise this exercise twice daily for about five minutes. This exercise is very helpful when the class is very noisy or when you want the class to concentrate before you introduce a new topic.

More breathing exercises

Exercise 1. Ask the children to stand in a circle and hold hands. Tell them to breathe in slowly through their mouths while everybody raises their hands until they are above their heads. Everyone holds their breath and then slowly lowers their hands while breathing out through the mouth and bending their knees until their hands nearly touch the ground. Pause, and then breathe in again. As everyone breathes out, they can make a sound like puhhhso that they can hear the sound of their

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breathing. It is a good idea for you to join the circle while the children are doing this breathing exercise because you can direct the speed with which the arms are raised. Gradually slow down the breathing speed. Let the class breathe like this for five minutes. Repeat the exercise twice a day. Exercise 2. Each child will need a heavy book. Ask the children to lie down on blankets or outside on the grass (if it is dry). Ask them to place the books on their stomachs. The children must breathe so deeply that the books move up and down. (The book will only move when the child uses his or her abdominal muscles correctly.) Let them repeat this exercise for five minutes twice a day. This exercise relaxes the children and enhances their breathing skills. Once the children understand how to do the exercise properly, you could give it as homework. It is good for children who find it difficult to fall asleep to do it while they lie in bed at night.

Aggression
Ebrahim is eight years old. He lives with his grandmother. His mother died two years ago. His father left the family when Ebrahim was three years old. Sometimes Ebrahims father sends Ebrahims grandmother some money. The grandmother works as a domestic worker. Ebrahims aunt and her four children also live with Ebrahims grandmother. Ebrahims aunt says that he doesnt obey any rules at home. His teacher reports that he hits smaller children at school. Ebrahims grandmother reports that she is too tired to run after him when she comes home in the evening. Sometimes he stays away from his grandmothers house till late in the evening and he has been seen hanging around with the taxi drivers at the taxi rank. On the rare occasions that Ebrahim is at home, his aunt observed that he and his cousin were playing violent games that included throwing stones at the girls next door and deliberately hurting the cat. Ebrahim doesnt have real friends at school. Some children still hang around with him, but others are scared of him. Ebrahim gets very lonely.

Explaining his behaviour

Aggression is not an emotion or a feeling, but is actually an expression of feelings like anger, rage, disappointment, fear or sadness. Aggression is a state of increased energy resulting from underlying feelings. For this reason, aggression can be channelled into constructive (positive) behaviour or 66

destructive (negative) behaviour. Destructive behaviour means that the energy is used to harm or hurt someone or something and often to hurt oneself. When we talk about aggressive behaviour, we normally mean destructive energy. Aggression can have various causes. A child like Ebrahim may act aggressively because he grew up in an aggressive environment. He may have been exposed to aggressive behaviour and so he learnt that aggression is an acceptable way to reach his goals. He may have been exposed to violent attacks and he may have learnt that aggression is the only way to survive. If this is how Ebrahim learnt to be aggressive, we would say that his aggression is the result of his social learning process because he learnt by observing people in his environment. These persons become his role models and he imitated their behaviour. If a child sees aggressive behaviour being rewarded, the child learns that aggressive behaviour is acceptable and desirable in order to reach goals. Many children become aggressive when they are not allowed to do what they want or get what they want. This aggression is the result of disappointment and frustration. Other children may react aggressively because they dont have the necessary social skills to make friends or to gain other childrens respect, for example by sharing, communicating effectively or by having a good sense of humour. Instead, they use aggression to gain respect and status from their peers. Aggression releases tension that has been built up by unwanted feelings. Aggressive behaviour in children often becomes an upward spiral, becoming more intense as it feeds on itself. Aggressive behaviour may be deeply rooted in the childs insecurity. In Ebrahims case, the loss of a parent, the displacement into his grandmothers home, the change in his environment and having to get used to a new group of family members was very threatening for him. This increased his feelings of inadequacy and insecurity. Ebrahim may feel deeply threatened and inadequate (not good enough). He probably craves acknowledgment and recognition. Hanging around with older boys and men at the taxi rank probably gives Ebrahim a sense of strength and imagined respect.

What can you do to help?

Because aggression often stems from insecurity, frustration and a lack of self-worth, it is important to encourage Ebrahims self-confidence. At the same time he needs to learn that aggressive behaviour does not always bring the right results. He needs to learn how to express his feelings in an appropriate way. He needs to learn self-control. Naturally this wont happen overnight. Dealing with aggressive children can be difficult and it takes a long time for such children to unlearn their aggression and replace it with new ways of self-expression. When dealing with aggressive children it is especially 67

important that we do not become aggressive ourselves, but instead stay calm, firm and give clear instructions. This is sometimes difficult. When dealing with aggressive children it is important to have confidence in our own skills and our ability to deal effectively with such children. We need be self-assured and know that we are in control. Authority, honesty, calmness and self-confidence are critical when dealing with aggressive children.

How can you deal with aggressive children?

Aggressive adults who are role models for children promote aggressive behaviour in those children. Instead of becoming aggressive, parents, caregivers and teachers need to be very clear about what they expect from the child. The child needs clear guidelines about what is acceptable behaviour and what is not. Aggressive children need rules. Although they may find it difficult to obey the rules, rules give them the feeling of security and control. Sit with the child to draw up the rules. The child needs to realise that disobeying the rules will have consequences. As with all children, do not hit or beat an aggressive child. Hitting or beating the child sends the message that violence is acceptable.

The aims of punishment

Punishing a child should (ideally) lead to a process in which the child reflects (thinks) about what went wrong and comes up with ideas about solving the problems. Punishments that are more effective than beating a child could include not allowing the child to play with his or her friends for an afternoon or two (not longer), helping at home, or helping repair the damage caused by the aggression (if material objects were involved). If other people were involved, make sure the child understands the effect of the aggressive behaviour on the other person. Make the child apologise to the person who was hurt so that the old relationship can be re-established. It may be appropriate for the child to do something for this person so that they can see that the child is genuinely sorry.

Distinguish between the child and the behaviour

The better the punishment is suited to the aggressive deed of the child, the better the chance that it will lead to a change in the childs behaviour. Never threaten punishment without fulfilling your threat. It is important for the child to understand that you are not punishing him because you dont like him or because you are angry with him, but you are punishing him for his wrong behaviour. The child needs to understand that punishment is not an act of revenge on the side of the caregiver, but is a consequence of inadequate behaviour. As a caregiver or a teacher you should clearly distinguish between the behaviour that you disapprove of and the child whom you still love and respect.

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Talk to the child about what he did. Explain why you are punishing him. Punishment should not be aimed at degrading the child or increasing his insecurity and frustration. Punishment should happen in private and not in public.

Choose the way you speak to an angry child

If a child is in a rage use short, precise sentences. Because he is emotionally tense, these are easier to understand. Be clear and firm about what you want. Say,Sit down here. We will sort it out.Keep your voice calm, but firm. Ask the child to stop the unwanted behaviour. Say, for example,Stop screaming now. It is important for the child to understand that you are in charge and that you are in control. At this stage of emotional upset it is your responsibility to provide the necessary control. When the child has calmed down you can hand control back to the child.

Discuss feelings with the child

Aggressive children find it difficult to deal with negative emotions like anger, frustration and helplessness because these feelings usually arise at times of crisis or conflict. The tension or emotional excitement produced by these feelings is not necessarily negative in itself, but unfortunately the tension expresses itself in a negative, destructive way. Aggressive children have to learn how to show their feelings in a positive, constructive way. In order to promote this learning process, teachers and caregivers should discuss the aggressive behaviour as well as the underlying feelings with the child. It is important for the child to understand why he or she feels angry or frustrated. Often children find it difficult to identify emotions and they lack words to describe their feelings. A child first learns about feelings, and expressing feelings, in the context of a family by relating to his or her parents and siblings and by observing the interaction between parents and other children. Emotions and feelings need to be discussed in the classroom situation as well in order to support children in their learning process. You will find some exercises on teaching children to identify emotions and their responses at the end of this section on aggression. Being able to identify feelings is important for all children. Orphaned children need this skill even more because there is often no adult to provide emotional security and protection. Understanding your own feelings helps you to find suitable behaviour. Understanding our feelings improves our coping skills.

Identify causes of the aggressive behaviour

Aggressive or disruptive behaviour is often a reaction to frustration, fear or feeling threatened. Talk to the child about why he or she reacts aggressively. What made him or her angry, frustrated or scared? Try to understand the reason for the behaviour.

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(Remember that it may seem like a trivial thing to you.) Support the child as he or she describes his or her feelings and frustrations. Sometimes a small event might trigger an aggressive response. Often the triggering event is related to another situation that the child was not able to solve adequately and the triggering event serves as an opportunity to relieve tension that has been building up. In Ebrahims case, the death of his mother, the move to his grandmothers home and the lack of attention are all causes of tension. In addition to feelings like sadness and frustration, more complicated feelings like betrayal, abandonment, neglect and loneliness may be hidden underneath. Ebrahims aggressive acts can thus be attributed to attention-seeking behaviour and to a need for acceptance, attention and acknowledgement. Identifying the real cause for the aggressive behaviour can be difficult because there may be many. Finding the cause for the aggressive behaviour can only happen if you talk to the child.

Look at the behavioural response

Ask Ebrahim to look at his behaviour with you. Ask him what he did and how he felt. Talk about how other people would see and judge his behaviour. Make it clear to the child that although you understand the childs anger or frustration and you acknowledge the reason for his feelings, you do not agree with the way the child expressed his feelings. Ebrahim needs to understand that you do not approve of his behaviour, but you still approve of the child as a person.

Teach positive ways to express emotions

1. Discuss actions Ebrahim could take when he is very angry, excited or frustrated. Say to Ebrahim,Now think of the next time David takes something away from you without asking. What could you do instead of breaking his pencils?Or,Now imagine the same situation again. The others are shouting names at you.You feel hurt. What else could you do instead of throwing stones at them? Write a list of all the ideas that Ebrahim comes up with. These ideas may include walking way from the source of the frustration, getting rid of the tension by talking to someone, asking someone for help, getting physical exercise, or doing something that he is good at. Discuss the best ideas with Ebrahim. Ask him to choose one or two ideas. Agree with him that the next time he gets angry he will try one of these ideas first.

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Ask Ebrahim to draw you a picture of (or write down) what he is going to do the next time he gets angry. The picture helps him to memorise the decision he has taken.

Ask Ebrahim to come and tell you when he manages to control his anger or frustration. Praise him for his achievement.

Teach the child to take time out

Another aspect of learning to control feelings of rage is for the child to realise when he or she needs time out. Children can learn to identify when they are getting really upset. Teaching the child to move away from the tense situation and do something that calms him or her down (for example, deep breathing exercises) gives the child a way of preventing aggressive outbursts. You will need to agree with all the children living in the house (or all the learners in the class) that when any child feels that he or she is becoming very upset, the child may quietly leave the house (or the classroom) and go and sit at a pre-arranged place until he or she calms down. No one may disturb the child there, and when the child has calmed down, then he or she will return to the house (or the classroom). When the child returns, no one may make funny remarks or laugh. This is a very effective way of allowing the child to take control.

Games to help aggressive children

Wild games and sports activities (soccer, netball and hockey) are wonderful ways to relieve tension in children and to boost childrens self-esteem. There are many games and exercises to help children relieve tension and cope with frustration and conflict. Look at the games in Chapter 6 for some ideas. There are games to relieve tension, to calm children down, to lessen frustration, to foster group co-operation, to foster selfesteem, to solve conflict and to identify emotions, all of which will help with aggressive behaviour.

Auto-aggression
Instead of turning tension into aggressive behaviour directed at other people or objects, some children turn the aggressive behaviour against themselves. Auto-aggression means that the aggressive behaviour is directed against ones own body. It reveals itself in self-destructive behaviour: some children start to bite their fingernails down to the nail bed or pull their own hair out. If auto-aggressive behaviour continues, children may hurt themselves deliberately. Small children may bump their heads against walls repeatedly; older children may cut themselves deliberately. Severe auto-aggression with self-hurting is a sign that a child has serious problems.

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A child or an adolescent who shows increased signs of auto-aggression urgently needs the attention of a specialist. Minor signs of auto-aggression like nail biting need the attention of the caregiver and the teacher. These are signs that the child is tense and under emotional pressure.

What can you do to help?

1. Find out when the child bites his or her nails (or hurts himself or herself). Is it when he or she feels uncomfortable? Is it when they are scared or nervous? Is it before exams? Talk to the child about the behaviour and try to find out what is causing it. Find alternative ways to relieve stress like breathing exercises, playing sport, doing creative writing, singing or dancing.

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Hyperactivity
Sara is nine years old. She is the middle child in the family. Sara does not know her father. Her older sister is 13 years old and her younger brother is one and a half years old. The baby has been sickly since birth. When her mother fell ill six months ago, Sara was sent to stay with her aunt who lives about an hours walk from home. Sara sees her mother and the baby occasionally over weekends when her aunt has the time to take her to visit. Saras sister is taking care of her mother and the baby. Sara does not know what has made her mother sick. Sara still attends the same school. The teacher has noticed that Sara (who always was a good student) is becoming restless and finds it difficult to concentrate in class. She gets easily distracted and seems to have a shorter attention span. Her work is becoming increasingly untidy. Sometimes it is full of mistakes and at other times there are incomplete sentences or whole parts missing. Sara acts without thinking more often than before and in recent months has had some major conflicts with classmates. She seems to be very impatient, both with herself and with her friends. She is easily frustrated. Her aunt realises that Sara is finding it difficult to complete tasks. She wanders around restlessly. She is not capable of sitting quietly with the family or sitting still in class without getting up and walking around.

Explaining her behaviour

Sara shows the signs of hyperactive behaviour. Hyperactivity can have different causes. It is often caused by an Attention Deficit Disorder (known as ADD for short) that may be the result of a lack of oxygen 72

during birth, but hyperactive behaviour can also be caused by an extremely shocking event or traumatic living conditions. Saras hyperactive behaviour is the result of her separation from her mother and her siblings. Her life situation was changed drastically without Sara being involved in the decisions. She is probably afraid of what is happening to her mother. Because she was the only child sent away, she may feel that she has been abandoned. On the other hand she might blame herself for having been sent away, and be feeling guilty and inadequate. Her hyperactive behaviour reveals a high level of stress and emotional excitement.

What can you do to help at home?

Sara needs a person she can trust and talk to. She needs time to come to terms with her situation. It would help Sara if she knew why she had been sent away. Then she could come to terms with her new situation and begin to cope. It is important for you, the caregiver to: 1. Explain to Sara that she has not been sent away because her mother does not love her. She has not been sent away because she misbehaved. Explain what is wrong with her mother. Even if finding out is upsetting, the knowledge will give Sara control because she will be able to understand. It may be better for Sara to return to her mother. Sara may be jealous of her sister and her brother who, unlike her, were allowed to stay at home. Sara needs time with her mother; she needs to be prepared for the likely death of her mother. It may be possible to arrange for someone else in the community to help care for the mother and her three children. If this is not possible, frequent visiting times should be arranged. During these visits Sara should spend as much quality time with her mother as possible, without other adults being present. 3. Encourage Sara to prepare for the visits. She could take little presents or food that she has prepared. This will reduce Saras feeling of helplessness, because she will also be doing something for her mother. It will also make her feel that she is still involved with her family. Ensure that Sara is not exposed to too much noise or too many visual images. A radio playing all the time or a television on all the time will increase her hyperactivity. Sara needs quiet time. Give Sara her own place to sleep and regular bed times.

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Encourage Sara to keep a diary in which to record her thoughts and feelings in words or pictures. Make sure that Sara has plenty of opportunities to take part in sport or other after-school (or community) activities. Reward Saras good behaviour by acknowledging her efforts. Later on, when she has a whole day of good behaviour, you could introduce a chart on which you mark her good days to encourage her to keep up the effort. This also boosts her self-esteem.

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What can you do to help at school?

Sara will also need a lot of understanding and reassurance in the classroom. 1. As her teacher, try to make some time for her. Explain that you understand this is a very difficult situation for her. Sara is a good example of a child that would benefit from the breathing exercise before she starts to work. Encourage her to practise the breathing exercise at least three times after she gets home from school and once in the morning before she comes to school. She will realise that it helps her to concentrate. Praise her for trying to work so hard under such difficult circumstances. As far as her schoolwork is concerned, give Sara small tasks that do not need a long concentration span. Sit down with her before she starts and ask her to remember a time when she did very well. How did that make her feel? Let her think about that for a few moments and then ask her to describe her feelings. She may say that she felt strong, happy, or successful. Encourage her to feel the same again now; tell her that she will feel strong, happy or successful again. Tell her that you believe she can do it again. Explain the new task to her and ask her to explain to you what she is supposed to do. If she has not understood, explain it again and make sure she understands. Let her begin. In the beginning (if time allows) you may need to stay close to Sara. After she has completed a task successfully, praise her and allow her to take a short break (of three to five minutes) during which she may wander around and helpyou. Find a task for her to do, like taking a note to the principals office. Do not allow her to disturb the other children. Then give her some more work to do, and if possible, go through the same process again. While she is doing her work, do not allow Sara to

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get up. To make it easier for her to concentrate, remove objects that may distract her you may even consider pushing her desk to face a wall during working time so that other children cant distract her either. Discuss this with Sara so that she doesnt see it as a punishment, but understands that it is to help her. Expect her to turn around and be distracted even to walk around. Dont scold her, but insist firmly that she sits down and carries on with her work. 4. After Sara completes her work, turn her desk back again so that she is part of the group. Keeping her at the front of the classroom will reduce the distractions for her, and prevent her from distracting the other learners in the class. It will also make it easier for you to keep an eye on her. During group activities make frequent eye contact with her, showing her that you know she is there. Dont allow her to disturb the teaching process or the group activities. Praise her when you realise she has managed to control herself. During the breaks, encourage her to join in the games and exercises. As with aggressive children, hyperactive children have a great need for physical activity. Make sure she uses up a lot of energy running around in the playground. Boost Saras self-esteem and self-confidence. Find out which are her favourite activities and talents (like running or singing). Encourage her to spend time developing her skills. Give her an opportunity to demonstrate her skills.

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Medication. There is medical treatment available that reduces the activity of hyperactive children. An example of this is Ritalin (methylphenidate). The medication is a stimulant that is meant to reduce the hyperactivity and impulsiveness in school-age children so as to improve their performance. The drug suppresses all spontaneous behaviour and makes the child quiet and often a bit drowsy. This makes it easier for the caregiver and the teacher to deal with the hyperactive child, but from an educational point of view these drugs may have a bad effect on the childs coping capacity. The child finds it even more difficult to integrate the traumatic incidents that they have survived into their life concept. In addition it has been shown that Ritalin can have severe side effects and may have a bad effect on the childs development. In Saras case, the prescription of a stimulant like this would reduce her hyperactive behaviour but it would be an obstacle to the coping process.

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Stimulants should be given to children as a last resort, after intense consultation with an experienced medical practitioner. They are not generally recommended.

Negative magical thinking

Three months ago, six-year-old Petrus came home from school to be told by his mother that his father had died suddenly. He was sick only for a few days. Petrus did not show signs of excessive grieving at the time. He was sad and withdrawn, he didnt talk much and he didnt ask many questions. He attended the funeral and he visits the grave occasionally with his mother. He has been withdrawn and quiet since the death of his father. He doesnt like leaving the house to go to school. When he gets to school he is very shy. He concentrates on his work, which he does neatly and accurately. When he makes a mistake he seems frightened, compulsively erasing the mistake so that his exercise books are full of holes. When his teacher confronted him about the holes in his books, he started to cry. When his mother asked him why he had rubbed holes in his books, he said that if he didnt rub his mistakes out properly, his mother would die too. When his mother asked him why he thought that, Petrus said that his father had died on the day that he got into trouble for not listening at school and he had been told to repeat a whole exercise.

Explaining his behaviour

The example of Petrus is a typical example of a child who engages in magical thinking. As described in Chapter 3, magical thinking originates from the childs imagination. Children Petruss age think that their own actions have a direct impact on the events that take place in their lives. In Petruss case, he believes that making a mistake and being scolded in school had a direct impact on his fathers death. Magical thinking (or omen) can help a child to cope with adverse events. Magical thinking helps children to gain control and meaning. Without magical thinking this would be impossible. Positive magical thinking even if it is unrealistic can help a child to survive. Negative magical thinking (as in Petruss case) can lead to feelings of guilt and failure and have a negative impact on the childs coping capability. It is clear that magical thinking can have a positive or a negative impact. It is important for caregivers and teachers to identify how the child gives meaning to an adverse event.

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What can you do to help at home?

Let Petrus tell you the whole story in great detail. Ask him why he thinks that he could have caused his fathers death. While he is telling you, if he wants bodily contact hold him close to you. He needs reassurance and clarity about his fathers death. 1. Tell Petrus that you understand that he is still worried about his fathers death. Tell him that it shows how much he loved his father. Explain that it is normal for a boy to miss his father after he has died. But emphasise strongly that he had nothing to do with his fathers death. Tell him that his father died because he was very sick. Tell Petrus that his father loved him very much, that he was proud of everything Petrus did. Tell him that he will always love Petrus, even when he makes mistakes. Reassure Petrus that you also love him very much and that you will always love him. Tell him that you are very proud that he is doing well in school. Explain to him that it is normal to make mistakes when we learn and that you love him even when he makes mistakes. Give Petrus an opportunity to ask questions about his fathers death and try to answer them honestly. Tell him that he must come and talk to you when something worries him say that even if he thinks you are busy he should still come and talk to you. Try to find some books about children dealing with death and dying. Read them to Petrus and discuss them with him. Ask Petrus if he wants to draw a picture for his father. He could take it to his fathers grave and together you could make up other rituals that will help him mourn and grieve the loss of his father. If you are Petruss mother, you can mourn the loss of your partner with Petrus. Play Real and unreal games with Petrus. Invent a story consisting of events that can really happen and events that can only happen in your imagination. Tell the story to Petrus and ask him to tell you what is real and what is unreal. After he has understood the concept of the game, ask him to invent a story so that you can take a turn identifying the real and the unreal parts of the story. You can teach Petrus how to pray. Prayer can be like talking to a person. When we talk to someone, our thoughts become more structured as we express them. The same happens when we pray. Chaotic thoughts structure themselves and we feel calmed and comforted.

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You might decide to visit Petruss teacher to explain what has happened and to ask the teacher to acknowledge Petruss efforts a little more than usual to boost Petruss selfesteem and make him feel more confident and less guilty.

What can you do to help at school?

It is more effective to concentrate on childrens strengths and abilities rather than their mistakes. Explain to the class that mistakes are part of the learning process. Explain that everyone has to practise before we can do things without making mistakes. Mistakes are nothing to be afraid of a mistake is nothing more than a challenge to improve and do better.

Helplessness
Tutula is 14 years old. When she was 11 years old, her mother was diagnosed with HIV/AIDS. Because Tutula is the eldest of four children, her mother told her about her HIV/AIDS status. Tutula reports that she is glad her mother told her. When Tutula was 13 years old, her mother fell ill and slowly grew worse. Tutula took over the responsibility of looking after her mother and her three siblings. She stopped going to school because she couldnt combine her education with all the work at home but she made sure that the other children attended school regularly. Her brothers and her sister were always clean and well cared for. In her spare time she worked in the garden to provide food. She managed to generate some income by producing beadwork that her brothers sold on the streets when they walked home from school. Tutula accompanied her mother to the clinic regularly. They often had to wait for a long time because other patients with adult relatives pushed in front of the queue. Tutula felt that she was being treated unfairly, but no one listened to her complaints. When her mother died six months ago, Tutula arranged a simple funeral. Not many relatives attended the funeral. Tutulas neighbours informed the social worker that Tutulas mother had died and the social worker came to visit Tutula and her siblings. The social worker arranged for the children to be sent to different members of the extended family, but she did not consult Tutula. Tutula now lives with her uncle who pays for her education. She is glad that she can go to school and she is grateful to her uncle, but she would rather stay with her brothers and her sister. She feels that she is neglecting the responsibilities her mother entrusted to her. Tutula feels confused. She feels helpless again just the way she felt at the clinic, when she nursed her mother and when she arranged the

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funeral. Once again adults are taking decisions in her life without consulting her. It makes her angry, yet at the same time she knows that she should feel grateful because she is getting an education.

Explaining her behaviour

The experience of total helplessness is a central experience for people going through trauma and loss. The sense of helplessness makes people feel extremely vulnerable. Helplessness is closely related to traumatic events such events make people feel that they have lost control over their lives and that they cant manage. This sense of helplessness often makes people lose faith in themselves and makes them distrust their own skills and abilities. Helplessness makes people feel overwhelmed by what is happening, and it triggers feelings like rage, guilt, inadequacy and shame. Tutula coped. By coping she demonstrated strong organisational skills as well as a warm and nurturing personality. She has a strong bond with her family. It is likely that she often felt helpless when she had to care for her mother and parent her siblings, yet she somehow managed. She maintained control and the helplessness never made her feel inadequate. In contrast, her experiences at the clinic and with the social worker made her feel vulnerable because she was not treated as an adult. Suddenly all responsibility and control was taken away from her and she was left to face the disruption of her family, despite all her efforts to maintain normality. The separation of the siblings may well have been in the best interests of the family in the long run, but Tutulas involvement in the decision and her consent would have left her feeling less inadequate and guilty. Because her contribution to the family was ignored, Tutula feels desperate and very confused about her situation.

What can you do to help?

1. Ask Tutula what would help her now. Tutula may have some concrete suggestions to make. Discuss which suggestions may be possible and which are impossible. Treat Tutula like an adult, but remember that because she is not yet an adult she needs more attention and guidance than an adult. Tutula needs someone to boost her self-esteem and her selfconfidence. She has to be reassured that everything she did to care for her siblings, she did well and that she did everything she could. She has to learn to trust herself again and to trust other people too. Tutula needs a trusting relationship with an adult, based on mutual

2.

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understanding and acceptance. In the new relationship, Tutula has to recognise her own strength and her ability to cope. 3. Hand over some responsible tasks to Tutula that she will be able to manage and control. This will boost her self-esteem. Encourage her to have frequent contact with her siblings. Reassure her that they are doing well. In future, include Tutula in decisions that affect her life.

4.

5.

How to help children access their inner resources again

Traumatic and upsetting events can overwhelm children so much that they find it difficult to access inner resources and qualities. Like Tutula, they have to rediscover their strengths and abilities. The following exercise can help children who feel insecure and inadequate to recognise their inner resources again. It builds coping skills and selfesteem and is suitable for children aged nine and older. It can be done on a one-to-one basis, or with a group of children together. Each child needs wax crayons, a piece of paper and a pin (or anything that can be used to scratch with). 1. Start off with an imagination exercise. Ask Tutula to sit straight, feet on the ground and eyes closed. Ask the child to imagine a situation where she is in charge. She feels self-confident, she is successful and she is managing difficult situations. Ask her to look around the scene that she is imagining. Does she see the scene she is imagining in black and white, or colour? Is she indoors or outside? Does she feel warm or cold? Is it light or dark? Who else is there? What is she doing? Can she hear anything? Is the sound loud or soft? Can she feel anything? Can she smell anything? Note: Tutula does not need to answer the questions. The questions are to help her get in deeper contact with her feelings. 3. Ask Tutula how it feels when she is strong, successful and in control. When she can really feel that feeling, ask her to open her eyes, choose some wax crayons in the colours that symbolise this feeling and start colouring the piece of paper. Tutula should cover the whole sheet of paper with those colours. When she has finished, ask what memories she had. Listen to what she tells you. Ask her to remember times when she felt helpless. Remind her about

2.

4.

5.

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the way she feels at the moment: angry, inadequate or exposed. Note: Dont do an imagination exercise for the negative feelings! 6. Once again, ask her to choose colours that express her negative feelings. Ask her to colour vigorously over the first layer of colours with the colours of her negative feelings. She must cover them all up! (Usually the child will use darker colours for the negative feelings.) After she has finished, talk about how she felt while she coloured with the negative colours. Look at her paper together and ask her if this is the way she feels at the moment. Once again, let her describe the way she feels. Help her give names to her feelings. Ask her if she can remember her strengths and successes that are hidden beneath her negative feelings. Ask her if she thinks they will come to the surface again. If she says yes, ask her when she will let them come up again. If she says no, ask her what prevents them from coming up again. Ask her what needs to change to allow her good qualities to come to the surface again. 9. Ask Tutula to list the things she is able to do. Prompt her to say, I can Ask Tutula to list the things she likes about herself. Prompt her to say, I am Ask her to list the external resources that can help her. Prompt her to say,I have 10. Take a sharp object (a pin or a sharp stick) and scratch these positive words onto the surface of her paper so that the positive colours beneath shine through. After Tutula has finished, look at her picture together and talk about her hidden qualities and resources. Explore what it means to have hidden resources. Sometimes we cant see them because our problems seem to overshadow (or cover) everything.

7.

8.

Physical complaints and body pains

Ingrid is 11 years old. Since her mother died of TB six months ago she has been living with her grandmother. The house is crowded with other cousins who also live with the grandmother. Ingrid is very quiet and shy. She doesnt talk much, but she likes to watch the other children. She is very sensitive and is afraid of leaving the house. Often

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she cant go to school because of a sharp pain in her chest. She says that all her bones ache. Her grandmother took her to the doctor. The doctor could find nothing wrong.

Explaining her behaviour

When a child is sick but the doctor cant find anything wrong, it usually suggests that the childs body is reacting to emotional stress. This type of sickness is called psychosomatic. To be on the safe side it may be a good idea to get a second opinion from another doctor but if the second doctor also finds nothing wrong, it is likely that the child is reacting to stress. In Ingrids case, the pain in her chest could be related to her mothers death. It is quite common for children to report the similar complaints to those reported by their sick parent Ingrids mother would have complained about pains in her chest. In order to stay connected to their parents, some children identify with the illness suffered by the deceased parent. They may behave like the deceased parent or they might have similar complaints. Insecurity and anxiety are also often expressed through body pains.

What can you do to help at home?

1. Create a warm and nurturing environment. Try to keep some space in the house just for Ingrid to which she can quietly withdraw when she feels that there is too much noise and activity in the house. But dont allow Ingrid to stay in this corner constantly encourage her to join in the games of the other children and give her some jobs to do about the house. Ingrid must attend school. Although she may complain about the pain in her chest, send her to school just the same. Tell her that many children get aches and pains when they feel scared, sad or insecure, but the pain will go away. Talk to Ingrid about her pain. Find out when the pain is stronger and when it fades away. Children often get pains in their stomachs or chests when something is bothering them. Suggest that if she talks about it, draws a picture about it or writes it down, she may find out what is bothering her and this will help her pain to go away. Make sure that Ingrid participates in physical games or sport. Once you have thoroughly investigated the cause of the pain and discussed it with her, dont dwell on it. Pay more attention to her on the days that she feels well. This will also reduced the occurrence of the pain. 82

2.

3.

4. 5.

6.

Take Ingrid for regular check-ups at the clinic, just to make sure that you are still dealing with a psychosomatic complaint. Teach Ingrid the breathing exercise and encourage her to practise it regularly. Ingrid could use the breathing exercise any time that the pain is very strong.

7.

What can you do to help at school?

1. 2. Contact the caregiver to make sure that a doctor has examined Ingrid. If the doctor diagnoses that the pain is stress-related, reassure Ingrid when she complaints about pain, but dont give her too much sympathy or attention. Allow her to take a short break, drink a glass of water and then carry on with her work. When she starts working again, praise her for handling the pain so well.

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6
Games
Children learn as they play. These games have been developed to assist teachers, group leaders and home-based carers as they encourage children to explore their worlds while learning skills that foster resilience and help them to deal with other people and the challenges that life brings. The games are designed to foster social and emotional learning and intelligence in children. PLEASE NOTE: The ages indicated below show the minimum ages that activities should be used for. Most activities can be used, however, for any ages above the minimum age, The falling game and even for adults.

Games that foster trust

The aim of this game is to enhance trust and group cohesiveness and to encourage children to take responsibility for one another.

All children except one stand close together in a circle, holding their hands in front of them so that the palms of their hands face towards the middle of the circle. The remaining child stands in the middle of the circle and makes him or herself as stiff as a rod. When everyone is ready, the group leader gives a signal and the child in the middle lets him or herself fall in any direction. The other children in the circle must catch the child and push him or her gently in a different direction so that someone else in the circle catches him or her.

Age group: 7 years and older Number of players: 7 to 9 Materials required: None Duration: Short

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Let the game go on for a few minutes and then discuss the questions below with the children. How did you (the child in the middle) feel when you had to let yourself fall? How did it feel when someone fell towards you and you caught that person and gently pushed him or her in a new direction? What must we remember to make the game to work properly? What risks are involved? What would happen if someone in the circle was not paying attention?

Variation The child in the middle closes his or her eyes while falling and being pushed gently to and fro. Ask the child how the experience changes. Does this require more trust? Is this more frightening?

It is important that the children trust one another. While the children in the circle learn to take responsibility for the one in the middle, the child in the middle experiences what it means to be dependent on others but also looked after and protected. The child in the middle experiences how much trust it requires to rely on others. Be prepared some children might find it difficult to let themselves fall towards the circle.

The human cradle

The aim of this game is to enhance trust and group cohesiveness, and to encourage children to take responsibility for one another. All children except one divide into two groups. Children in each group stand shoulder-toshoulder in two lines, with the two lines facing one another, close enough so that with arms outstretched, they can touch the hands of the children in the opposite group. One child lies on the floor between the two groups. When the group leader gives the signal, the children in the two opposite lines link hands beneath the child lying on the floor. When all the children are ready, one child gives the command to stand up carefully and to raise the child in the middle on their linked hands. Once everyone is standing, the children start to rock the child slowly to and fro. When the exercise is finished, the children supporting the feet and legs of the child being carried slowly lower their arms so that the child can jump off. 85

Age group: 7 years and older Number of players: 7 to 11 Materials required: None Duration: Short

Discuss these questions with the children How did you (the child being lifted) feel when you were lifted off the ground? Were you scared? Anxious? Nervous? Why did you feel like this? How did it feel to be rocked to and fro? How did it feel to support someone on your hands? What must you be aware of for the game to work? What risks are involved? What would happen if someone didnt pay attention? What would happen if the groups didnt work together? Would you be able to lift a child on your own like this? When is it especially important to work as a group or a team? (As group leader, you want the children to name various things that cannot be done alone but need teamwork to achieve them.)

The ambulance game

The aim of this game is to enhance trust and group cohesiveness, to encourage children to take responsibility for one another. One child pretends to be a sick person who must be taken to hospital urgently. Three or four children form an ambulance by kneeling closely together on their knees and hands. Decide in advance where the hospital is. First, the ambulance fetches the sick person from his or her house. The sick person lies across the backs of the children (who are on their hands and knees) and holds on. The ambulance starts to move slowly, but the children must make sure that the sick person is neither shaken up too much nor falls off. The game ends when the ambulance reaches the hospital. The more often the game is played, the better the ambulance children learn to co-ordinate their movements, to find a common rhythm and to reach their goal quickly. Children should take turns at being the patient.

Age group: 6 years and older Number of players: 5 Materials required: None Duration: Short

Discuss these questions with the children How did it feel to be a patient? How did it feel to be part of the ambulance? What are the difficulties for the patient and for the ambulance? Why is it important to find a common rhythm?

Variation to the game Once the children have become used to this exercise, it can be played as a competition with more ambulances and patients. The group that reaches the hospital first wins the competition.

Walking blindfolded
The aim of this game is to enhance trust, to encourage children to take responsibility for one another and to activate the senses. The children get into pairs. One child in each pair is blindfolded and his or her partner is the guide. 86

Age group: 7 years and older Number of players: Any equal number of children Materials required: Pieces of cloth to blindfold one child in each pair Duration: Short

Ideally, the blindfolded child places one hand on the shoulder of the child who will lead. Together, they explore the environment by walking in different directions, up and down steps, over gravel, across sand, etc. The guide must make sure that the child who is blindfolded doesnt trip over things or bump into things. The blindfolded child can explore objects in the environment using senses other than the sense of sight, i.e. by touching, smelling and listening. Bear in mind that it may be frightening for some children to allow themselves to be led around by someone else. After playing the game once, the children should swop roles: the guide wears the blindfold and the other child leads him or her around.

Discuss these questions with the children How did it feel to be blindfolded and guided by someone else? What did the blindfolded child hear? And smell? And feel? Does walking around feel different from when you are able to see? Other than not being able to see, what else felt different? How did the guide feel? What was the most impressive experience for you? What was the most difficult part of being blindfolded/leading someone around? What did you not like about the exercise? Did you prefer being led or being the guide? Why?

The blind dogs

The aim of this game is to enhance trust, to encourage children to take responsibility for one another and to activate the senses. Sometimes we see blind people who have specially trained dogs to help them. In this game, the dogs are blind. The two pairs of children are 10-20 metres apart from each other. In each pair, one child pretends to be the dog and kneels on his or her hands and knees. The dogs are blindfolded. After the group leader gives a signal, the dogs start to run towards each other with the other child running (or walking) alongside. The second child is the guide, and must help his or her dog by tapping on the left or right shoulder (or pulling gently on the left or right ear) to indicate to the dog when he or she needs to move to the left or the right. A gentle tap on the head indicates that the dog must stop. It is important to use nonverbal signs because many younger children are 87 Age group: 4 years and older Number of players: 4, in two pairs Materials required: 2 pieces of cloth for blindfolds Duration: Short

not yet familiar with the concepts of left and right. After the dogs have found one another, swop over. Each child should have a turn at playing both dog and guide.
Discuss these questions with the children How did it feel to be blindfolded and guided by someone else? What did the blindfolded child hear? Smell? Feel? Other than not being able to see, what else felt different? How did it feel to guide someone? What was the most impressive experience for you?

Variation for older children The dogs must approach each other without the guide running alongside. Instead, the dogs should bark and listen to each other to identify where the sound comes from to find each other.

Blind walk with directions

The aim of this game is to enhance trust and selfconfidence, to encourage children to take responsibility for one another and to activate the senses. Before starting the game, build an obstacle course with various obstacles. Agree on the start and the finish. Blindfold one child in each pair. The children gather at the start and set off together in pairs. The blindfolded child has to cross the obstacle course from the start to the finish. His or her partner calls directions to guide the blindfolded child over or around obstacles so that he or she can reach the finish as quickly as possible.

Age group: 9 years and older Number of players: Any equal number children work in pairs Materials required: Enough pieces of cloth to blindfold one child in each pair, and some items to build an obstacle course: sticks, stones, benches, chairs, boxes, schoolbags, etc Duration: Short

Discuss these questions with the children How did you feel before you started the exercise? How did you feel afterwards? Were your partners instructions helpful? When were they the most helpful? Would you have managed the obstacle course without help? How did it feel when several children crossed the obstacle course at the same time?

Tip: It is easier to start with one child mastering

the obstacle course at a time. Once the children have got used to the game, several children can start at the same time. This makes the game more difficult because each blindfolded child has to focus on the voice of his or her own guide. It is also more difficult for the guides because they have to be very observant in order to prevent the blindfolded children from bumping into each other. Allow each child to take a turn at being blindfolded. 88

When setting up the obstacle course, make sure that the obstacles are manageable for the children. You dont want them getting hurt! Avoid making the children jump: not being able to see has an influence on a persons balance and jumps that can be performed easily with open eyes are more difficult when wearing a blindfold.

Variation To make it more difficult, the obstacle course can be set up after the children have been blindfolded so that it isnt familiar to them when they set off.

Was it more difficult crossing an obstacle course that you had not seen? In real life, other kinds of obstacles make a person feel weak, helpless and frightened can you name any? In real life, how does it feel when you manage something you thought you would never be able to cope with? In real life, do you have someone who helps you to overcome obstacles, like a guide? Who?

Blind snake
The aim of this game is to enhance trust and to encourage children to take responsibility for one another. The children stand one behind each other to form a long line (like a snake) and place their hands on the shoulders of the child in front of them. The child at the front of the line is the snakes head and keeps his or her eyes open. All the other children close their eyes. The snake starts to move forward slowly. The snakes head decides where the snake will go and the others must follow without losing contact with the child immediately in front of him or her. The head must set the pace so that everyone feels safe and is able to follow. The head must be responsible for all the other children in the snake and must move carefully. The other children need courage to be led about with their eyes closed and their hands in a fixed position. Depending on how much time is available for this game, children could take turns at being the head of the snake.

Age group: 6 years and older Number of players: 5 or more children Materials required: None Duration: Short

Discuss these questions with the children How did it feel to be blindfolded and being guided by someone else? As a blindfolded child, what did you hear? Smell? Feel? Other than not being able to see, what else felt different? As the snakes head, how did it feel to lead a group? What was the most impressive experience for you?

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Games for group cohesiveness and social skills

The games in this section are to foster group cohesiveness, encourage social learning skills and responsiveness to the needs of others.

The messenger
The aim of this game is to encourage observation, concentration, flexibility and co-operation. All the children stand in a circle. One child is the main messenger. He or she stretches both arms above the head. The children on either side of the main messenger are helper messengers. These children lift the hand that is closest to the main messenger. The main messenger now sends a message to another child in the circle by nodding his head towards the other child. This child now becomes the main messenger and must lift both arms. The children standing on either side of the next main messenger become helper messengers and must lift the arm closest to the new main messenger. The first messenger and first helper messengers drop their arms to their sides again. And so the game continues. Anyone who raises the wrong arm must leave the circle. The game becomes more difficult as fewer children remain in the circle. The last three children to remain in the circle are the winners.

Age group: 9 years and older Number of players: 7 or more children Materials required: None Duration: Short

Wandering rings
The aim of this game is to encourage co-operation, team spirit, group-cohesion and self-esteem through overcoming obstacles. All of the children stand in a circle holding hands. The rule is that no one may let go of the other childrens hands. This is important. Before the last children hold hands and close the circle, the group leader puts a hula-hoop (or the 90

Age group: 8 years and older Number of players: 5 or more children Materials required: Hulahoops (a length of rope or strips of material approximately 1.5 m long and tied in a circle work as well) Duration: Short

length of rope) over the hands of the last children so that the hula-hoop hangs over their clasped hands. The hula-hoop dangles loosely. The children must make the hula-hoop move around the circle without the circle ever breaking. One child must start by climbing feet-first through the hula-hoop and then squeezing his or her whole body through the ring so that the hula-hoop moves over his or her head and across the other arm. The first childs neighbour must repeat the process. The trick is to step through the hula-hoop feet-first and then with the help of ones neighbours, jiggle the hula-hoop up until the head can be squeezed through. In the beginning this will take some practice. The children will realise that they must assist one another by allowing their hands to be pulled in various directions as each child wriggles through. To make it more interesting, you could add a second hula-hoop at the opposite side of the circle. Since all members of the circle are interconnected and everyone is either helping or climbing, everyone is involved in the activity. The hula-hoops will only move around the circle if the children observe and respond to the needs of their neighbours and work together as a team. For really advanced teams you could have three hoops moving around the circle at the same time.

Discuss these questions with the children In the beginning, how did you feel when you got stuck and didnt know how to get through the hulahoop? What helped you to get through the hula-hoop? Can you think of situations in real life in which you have to adjust to other peoples needs so that everyone can reach a goal? How does it feel when you have to respond to the needs of different people at the same time? How did you feel when there were three hulahoops to move around the circle?

The penguin game

The aim of this game is to encourage group co-operation, recognising one anothers needs, sharing, survivor skills and problem solving. In this game, one child is the sun and the other children are penguins. Each penguin is given a sheet of newspaper. The paper is spread on the floor and each penguin stands on his or her sheet of newspaper. Tell the

Age group: 6 years and older Number of players: 5 or more children Materials required: Sheets of newspaper Duration: Short

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children that the newspaper is the penguins ice brick. Penguins can swim, but they dont have much endurance. A penguin must always be in touch with an ice brick or else it falls into the sea. The sun now walks around and starts tearing pieces of newspaper from the ice bricks on which the penguins are standing. Eventually penguins will have to stand on one leg or even share ice bricks with neighbours.

Discuss these questions with the children How did it feel when the ice bricks became smaller and smaller? What did the penguins have to do in order for everyone to survive? (Answers will include share a brick, move closer together and hold tightly to each other.) Can the children think of situations in their lives when there is not enough of something for everybody? What is scarce? (Answers might include food, space, bed space, clothing, money to pay for school, or attention.) How do they overcome these obstacles? What helps them to survive? Who helps them to survive?

Newspaper run
The aim of this game is to foster group cohesiveness, team spirit, conflict resolution skills, decision-making skills and self-esteem. This is a competitive game. Agree on a distance that both groups have to cover. The children work together in teams of three. Each team receives two big sheets of newspaper. One sheet is placed on the ground and the whole team stands on it, in a row, holding hands. The second sheets of newspaper are placed in front of each team. On your command, the children must cover the distance to the finish line by stepping from one sheet of newspaper to the next, then bending backwards, picking up the sheet of newspaper that they have just stepped off, placing it in front of them and stepping on to it. To make it more difficult, the children may not let go of each others hands and they have to collect the remaining piece of paper with their free hands. The team to reach the finish first wins the game.

Age group: 7 years and older Number of players: 6 or more children, divided into groups of three Materials required: None Duration: Varies

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The fox, the chick and the hens

The aim of this game is to foster group cohesiveness, team spirit and self-esteem. This game can get a little wild! One child plays the fox, one child plays the chick, and the rest of the children are the hens. The hens form a line holding hands and the little chick is the last child at the end of the row. The chick holds hands with the hen beside her. The fox now tries to chase the chick. The hens try to protect the chick by winding themselves in circles around the chick or forming lines between the fox and the chick so that the fox cannot reach the chick. The hens must keep holding hands. If the fox manages to touch the chick, the chick becomes the fox and the fox becomes one of the hens. The hen at the end of the line (the one who was next to the chick) becomes the new chick.

Age group: 7 years and older Number of players: 6 or more children Materials required: None Duration: Varies

Keeping balance
The aim of this game is to encourage observation, awareness of and respect for one another and concentration. Each pair needs two straight sticks, preferably of equal length. The children stand facing each other at about the same distance as the length of the stick. Place one end of the stick against the tip of the index finger of the first childs right hand and the other end at the tip of the index finger of the second childs left hand. To keep the stick balanced, both children have to apply a little pressure. Now place the second stick between the tips of the index fingers of the remaining hands. Age group: 8 years and older Number of players: 2 or more children, divided into pairs Materials required: Each child should have a straight stick (a pen with a lid works as well). Sticks should be of similar length. Duration: Varies

To keep the two sticks balanced, the children must observe closely and react quickly to one another. Both children have to learn to adjust to each others movements. This is not easy! 93

Depending on the number of children, the game can be played with children standing in a triangle, in two lines or in circles. The game becomes more difficult if more children participate.

Towel catch
The aim of this game is to encourage group co-operation and co-ordination. Working in pairs, children hold opposite ends of a towel. A ball is placed on one of the towels. The children holding the towel with the ball try to throw the ball by lowering the towel and then pulling it quickly to make the ball fly into the air. (This may need practice at first.) As soon as the ball is in the air, the other pairs try to catch the ball on their towels. Once the children get better at this, they may start counting how often they can toss the ball without falling on the ground. If you have a large group of children, you could use bigger towels, sheets or blankets and have groups of four children. Bear in mind that if more children take part it becomes more difficult to catch and toss the ball. Much more co-ordination and communication is needed.

Age group: 8 years and older Number of players: 4 or more children, working in pairs Materials required: One towel and one ball per pair of children Duration: Varies

Chase the tail

The aim of this game is to encourage group co-ordination and group cohesiveness. The children stand in a row, one behind the other, holding on to each others shoulders. The child at the front of the row is the head of the snake and the last child is the tail. A piece of cloth is stuck into the belt or the trousers of the child at the end of the row. The aim of the game is for the head of the snake to grab the piece of cloth at the end of the tail. While Age group: 5 years and older Number of players: 6 or more children Materials required: A piece of cloth to be the tail Duration: Varies

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the head of the snake chases the tail, all the other children hold on tightly to the child in front of him or her. This means that the head can only run as fast as the whole snake allows. If the head manages to grab the cloth, the head becomes the tail and the next child in the row takes over as the head. If this game gets too wild, the children will let go of one another and they may stumble or fall. You should interrupt the game the aim of the game is for the children to stay connected to one another. The head and the tail must pay attention to the rest of the group while running and chasing each other.

Discuss these questions with the children When you were the tail, what things did you have to be aware of? When you were the head, what things did you have to be aware of? Which did you find more difficult: being the head or being the tail? Why?

Electric rope
The aim of this game is to foster group cohesiveness and team spirit, to reinforce conflict resolution and decision-making skills, and to encourage self-esteem. This game is an ideal way to observe skills and strengths and leads nicely into the games for self-esteem and self-confidence. Two children take opposites ends of a rope and pull it taut about 30 cm from the ground. All other children stand on one side of the rope. The group leader tells the children standing next to the rope that they must climb over the rope as a group, but they must imagine that the rope has an electric current and no one should touch it. 1st exercise: The children must get over the rope as a group holding one anothers hands. This is quite easy and children usually manage without much difficulty. 2nd exercise: Raising the rope Now the exercise becomes more complicated. The group leader asks the two children holding the rope to lift it so that it is approximately hip height. Now the group must get over (not under) the rope without touching it. 95

Age group: 8 years and older Number of players: 5 or more children Materials required: A piece of rope about 2 m in length and plenty of space Duration: Varies

Some children will still not find this particularly difficult. But they only win the game if everyone gets over the rope including the less agile children! Tell the children to develop a strategy to get everyone over the rope. (Nothing else may be used to help them. For example, they may not use chairs to stand on.) The children will realise that it is only possible to get the whole team over the rope if they discuss the problem and develop a strategy. They will also realise that the stronger children must assist the less agile children. Usually, children climb over the rope by lifting each other over it or climbing onto each others backs. If some children do not manage at all, make it a little easier for them by lowering the rope. The rope should be high enough that the children can just manage without any accidents. It is crucial to discuss the game with the children after they have finished.

Discuss these questions with the children Why did the whole group manage to get over the rope? What was helpful? Who took the decisions? How did the weaker children feel? How did the stronger children feel? Is strength all that is needed to jump over the rope, or does it need other skills like thinking, communicating and decision-making as well? If you are strong, does it mean that you are generally strong or do you have weaker points as well? If you belonged to the less agile group, do you have other skills and strengths that are valuable? What are these skills and strengths?

Games for fostering self-esteem, self-confidence and group co-operation Age group: 4 years and
Ball in the circle
The aim of this game is to enhance group co-operation and self-esteem. Divide the class into equal groups of five to eight (or more) children. Each group will need a ball. The groups play against each other. Each group stands in a circle and the circles must stay the same size. Each child in the circle gets a number (for example, the numbers one to eight if there are eight children in the group). Child number one in each group stands in the middle of the circle. On your command, all the number ones throw the ball to each child in the group, who immediately throws it back to number one in the middle. older Number of players: 5 or more children Materials required: None Duration: Varies

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When number one has thrown the ball to each of the group members, number two runs to the middle of the circle and starts throwing the ball to each group member in turn. The game goes on until each child has had a turn in the middle of the circle. The first group to finish is the winner.

Twin soccer
The aim of this game is to enhance group co-operation and self-esteem. Twin soccer is played like normal soccer except the players are tied together in pairs. (The rules can be simplified if the children are young.) Divide the class into two teams. Ask the children to stand in pairs and to tie the left leg of one child to the right leg of his or her classmate. Twin soccer should be played on soft ground because many pairs will take a tumble! Twin soccer is a competitive game with a strong emphasis on teamwork. The pairs really have to work together to be able to run and kick the ball.

Age group: 5 years and older Number of players: an even number at least 12 Materials required: A ball and a lot of short ropes (cloths will work too) Duration: Varies

Games fostering self-esteem and self-confidence

My five best points
The aim of this game is to enhance self-esteem and self-confidence, to encourage participants to take responsibility for one another, to encourage selfevaluation and public speaking, and to foster tolerance. To start with, discuss the fact that each of us has things we can do well (like running, climbing or reading), good attitudes (like being gentle or honest) and good feelings (like feeling brave, or feeling caring) as well as things that we cant do as well. For this exercise we are going to focus on our strong points. Each child must think about his or her five best points what he or she is good at. When each child has identified five strong points, Age group: 10 years and older Number of players: No limit Materials required: Paper and pens/pencils to write with Duration: 30-45 min, depending on how many children participate

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each child must think of times when they demonstrated these strong points. The children should write down the five strong points and the times that they demonstrated these strong points. For example: I am brave. I was very brave when I had to take the taxi to town on my own for the first time. I am helpful. I was helpful when I prepared and collected more firewood than we needed. I am good at reading. The group leader wrote this in my school report. When everyone is ready, the group leader asks children to read what they have written. Before they start, agree with the group that no one should talk while a child is reading and we do not make any comments about what each child says about him or herself.

Discuss these questions with the children After everyone has had a turn to present his or her five best points, ask: How did you feel about the exercise? Do we need to be shy about our good points?

When the children start to work, move around the group and make sure that all children write down five points. Children with a very low self-esteem may find this difficult.You could help by giving little hints like,I have seen in class that you seem to be a very good listener. Can you remember a time when you listened very well?After a while, the children will become less hesitant and will start to enjoy thinking positively about themselves. Boosting self-esteem and showing that there is more to life than school performance is particularly valuable in a school environment where the emphasis may be put on academic achievement only.

Games to recognise and understand feelings

Feelings are important. They are signals that tell us how we feel at any particular moment. For a child to know how he or she is feeling, the child has to be consciously in touch with his or her feelings. Only feelings that are known to us can be consciously experienced and verbally expressed. Children need to know their feelings in order to understand them and to express them. Part of understanding feelings is knowing how to interpret the signals that our bodies give to us. Children who understand their own feelings can understand how other people feel too. Both adults and children often find it difficult to find words to describe their feelings. It is important to be able to describe feelings in order to learn how to deal with them. Children need to learn to understand and express their feelings from when they are very young. 98

If youre happy and you know it

The aim of this game is to get to know ones own feelings and to be able to express them. This is a famous song in English and is sung to the tune of Shell be coming round the mountain. You may need to adapt it to the childs mother tongue. If you are not familiar with it, be courageous enough to invent a tune of your own! Children love the repetition of the song.Young children are eager to learn new tasks and repeating an already-known task boosts their selfesteem and gives them self-confidence. While singing the song, the child learns about different feelings and various ways of expressing feelings. The song consists of four lines that are easy for children to remember. The activities described in the song are performed by all the children (everyone claps, everyone shouts, everyone stamps their feet). If youre happy and you know it clap your hands (clap, clap), If youre happy and you know it clap your hands (clap, clap), If youre happy and you know it, and you really want to show it, If youre happy and you know it clap your hands (clap, clap). Once the children know the song, you can start to change the words. For example: If youre excited and you know it, start to jump (everyone jumps) Or: If youre angry and you know it, stamp your feet (stamp, stamp) Or: If youre sad and you know it, start to cry (boo hoo) 99

Age group: 4 years and older Number of players: Any number Materials required: None Duration: Short

Soon the children will want to add their own verses and activities. It is important to find several activities for the same feeling, because this teaches the children a variety of responses. Ask the children what else they do when they feel happy and then sing the song and perform all the behaviours named for demonstrating happiness.

Show me how you look when you feel...

The aim of this game is to get to know ones feelings and how feelings can be expressed, to encourage motor co-ordination. This is a very simple game, but it helps children to learn a variety of names for their feelings as well as ways to express their feelings. All the children stand in a circle. One child has a ball (or anything you can throw and catch without getting hurt). The child passes the ball to another child calling,Show me how you look when you feel sad,(or happy, angry, jealous any kind of feeling). The child who catches the ball has to act out the feeling with his or her whole body. If children find this difficult you could change the sentence to, Show me what you do when you are... Some children find it difficult to act out a feeling. The other children will have to explain when they felt sad/happy/jealous. They should say,The last time I felt jealous was when... Sometimes children cannot get in touch with their feelings immediately. It may help to say,Think about the last time you felt jealous. Can you remember how it felt? Try to put yourself back into that situation. Older children will soon realise that there are some feelings that people express more or less in the same way, but different people express other feelings differently. As the group leader you may notice that the more often you play this game, the more the children become accustomed to expressing their feelings and giving their feelings names. With children that have become used to the game, you could introduce a new rule: no feeling may be mentioned more than once. The children could also count how often the ball is passed until none of the children can think of any new feelings. 100 Age group: 6 years and older Number of players: Any number Materials required: A ball Duration: Short

Picture games
The aim of these games is to get to know ones own feelings and to be able to express them. Cut out pictures that show people expressing feelings. Show the pictures to the children and ask them what the people in the pictures are feeling. Make a list of the feelings a person can have. This list may get very long! Display the list in the classroom. Ask each child to choose one feeling and then to draw a big face showing that feeling. Cut the word out of the list and stick it onto the face. Hang the faces around the classroom.

Age group: 4 years and older Number of players: Any number Materials required: Old magazines and newspapers Duration: Varies

Variation Find pictures that show people expressing feelings and which show what caused the feeling, for example a soccer player looking happy after scoring a goal, a woman looking angry after someone bumped her car, a child looking excited on her birthday, or a person looking sad saying goodbye to a friend. Ask the children to describe what they see in each picture. They should make sentences like, The soccer player is happy because he scored a goal. With older children (eight years old and older), you can take this activity a step further by asking the child to write a short story about the event happening in the picture. This enhances their self-expression and writing skills. Discuss the situations that cause certain feelings in the children. Ask them to describe something that made them angry (or scared, satisfied, excited, etc.)

Faces and hands

The aim of this games is to get to know ones own feelings and to be able to express them. Write the names of feelings on little cards. Let each child choose a card and read the feeling silently to himself or herself. (If the child cant read, you should whisper the name of the feeling to them.) Each child must demonstrate the feeling to the class using only facial expressions or body language. The other children in the class must guess what the feeling is. 101

Age group: 4 years and older Number of players: Any number Materials required: paper or card to be cut into cards Duration: Varies

Pictures and bubbles

The aim of this game is to get to know ones feelings and how feelings can be expressed. Exercise for children younger than 9 years old Use a speech bubble as shown on this page. Let the child choose a picture (or show a picture to the child). When working with a group of children, each of the children chooses a picture. 1. Ask the child to describe what he or she can see in the picture. 2. Ask the child what the people in the picture are doing. 3. Ask the child how he or she thinks the people in the picture feel. Is the child in the picture happy, sad, jealous or angry? When working with younger children you may have to suggest some feelings! 4. Hand a bubble to the child and ask him or her to place it on one of the figures in the picture. Ask the child what the figure in the picture is saying. Say to the child, Imagine that the angry child in the picture is a real child. What do you think the child would say now? Write the childs comment into the bubble and glue it to the picture. 5. If there is another figure in the picture, ask the child how he or she thinks this person would respond. Write this on a separate bubble and let the child paste it to the picture. 6. Now ask the child to imagine that the picture could come alive like a movie or a TV programme. What would happen next? Let the child tell the story. 7. After the child has finished telling the story, summarise it, emphasising the feelings in the story and tell it back to the child. 8. Praise the child for making up such an interesting story.

Age group: 6 years and older Number of players: 4-5 Materials required: Pictures showing people interacting in various situations. Collect pictures from newspapers or magazines. Use bubbles as illustrated below and on the next page. Duration: Short

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Picture and bubbles for children 9 years old and older The exercise is similar to the one for younger children, but older children are able to differentiate between feelings, thoughts and deeds and so it is important to give them different shaped bubbles to use. A feeling bubble (how do you think the figures in the pictures are feeling?) could be square, a thinking bubble (what do you think the figures in the picture are thinking?) could be cloud-shaped and a speaking/acting bubble (what do you think the people will say/do next?) could be round. After asking what the children see in the picture, ask them to describe how the people are feeling, what they are thinking and what they are saying or doing. Write the comments in the appropriate bubbles and paste them onto the picture. If a child describes a story that contains negative feelings (or expressions of helplessness, anger, sadness, aggression, hate, revenge, betrayal, guilt, shame or disgust) you could introduce a new symbol: a help bubble or a rescue star. The child could use the rescue star to identify a possible solution to the situation in the picture. For example, the child in the picture could be described as very anxious because she is afraid that other children in school will tease her because she has no shoes. Use the rescue star she could perhaps try to talk to the group leader about her problem. The group leader could discuss teasing in class and establish a class rule.

Feeling dice
To make it more interesting for the children you could make feeling dicewith them. Feeling dice are made out of cardboard or paper. (Of course you could use wooden cubes if they are available.) Make a copy of the illustration and give one to each child in the class. The children should cut out the illustration, fold it along the dotted lines and glue it 103

together in the form of a cube.Younger children may need some help with this. Before gluing the cube together, ask the children to draw a face displaying a different feeling on each panel. After the children have finished making their dice ask them to get into small groups or pairs. Explain that they are going to play games with their dice. The goal of the game is to answer the questions as honestly as possible. Each honest answer will get a point. Questions will refer to feelings what causes feelings and how we express them. For example,Describe what happened when you were last very ______. It may be easier for you as the group leader to prepare written cards containing questions like: Where in your body do you feel it when you are very ______? What do you do when you are very ______? What should you not do when you are very _______? How do other people feel when you are very ______? How do you express that you are feeling very _______? How does your face look? How does your body look? How do you know that another person feels very ______? 104

One child should then throw the die (Note: We use one die, but many diceto play a game.) If it lands on an angry face, a second child should ask the questions which the first child must answer. Each time a child answers a question honestly, he or she gets a point. Answers like I dont know, will not be accepted. After answering the question honestly, it is the next childs turn. This game encourages children to speak about their feelings and the way they express their feelings. With older children who can already reflect more deeply, you could play the game with two dice. Both dice are thrown and two different faces come up (for example, angry and excited). Ask the question,When did you feel angry and excited at the same time?Let the child describe the situation. Ask the other children if they can think of similar situations.

Dressing the doll

Teaching a younger child to identify emotions Preparations 1. Take two thick pieces of card of the same size (approximately 25 cm x 20 cm). On one piece of card draw the outline of a simple figure. 2. Cut along the outline of the figure with a sharp knife without cutting into the figure. When you have finished, the figure should drop out.

Age group: 6 years and older Number of players: 1 and the person who guides the process Materials required: Two thick pieces of card, a sharp knife, sellotape, koki pens or colouring pencils, scraps of wool, scraps of material Duration: Short

3. You now have the cardboard figure, a piece of cardboard with a hole in the shape of a figure and another piece of cardboard. 4. Lay the two pieces of cardboard on top of each other and with a pencil, trace the outline of the figure onto the second piece of cardboard. 5. Cut the head off your cardboard figure. Glue the rest of the (headless) figure onto the outline that you traced on the second piece of cardboard. Take the first piece of cardboard (with the hole in it) and the second sheet of cardboard (with the figure pasted to it) and stick them together with sellotape along one side only, so it flips 105

open and closed like a book. The figure should fit into the hole when the two sides are closed. 6. Use the head to trace some more heads and cut them out. 7. Draw different expressions (or feelings) on each head. 8. Take the card that you have made and glue some wool around the head-hole to look like hair. 9. Take some scraps of material and cut squares approximately 15 cm x 15 cm. These squares will be the clothing. 10. Flip the card open, slide one or two pieces of material inside the card and then close it again. The fabric shows through the cut out shape. 11. Choose a head that represents how the child feels and put it in the head hole. When working with younger children, you could ask the child to dress the figure in the card by flipping it open, slipping the material inside and flipping it closed again. Ask the child to choose a face that shows how the child felt at any particular moment, for example during his fathers funeral or when her mother died. The figure in the card can be changed as often as the child wishes.

My face in the mirror

The aim of this game is to identify feelings and to learn how feelings can be expressed Preparations: how to make a mirror window 1. Glue the mirror onto the A4 cardboard. 2. Place the other two pieces of cardboard on top of the mirror so that they cover the whole mirror and stick the left-hand side of the A5 card onto the left hand side of the A4 card. 3. Do the same with the other piece of card, but stick it along the right-hand side. If the top pieces of card are stuck correctly, they will open from the centre like cupboard doors to show the mirror inside. The child has the mirror window closed in front of him or her. Ask the child to open the window and describe what he or she sees in the mirror. 106

Age group: 6 years and older Number of players: 1 child and the person who guides the process Materials required: Three pieces of strong cardboard (one A4 and two A5), scissors, strong sellotape and a mirror (preferably square) Duration: Varies

The conversation may go like this: Its me! Yes, its you. Have a close look and describe what you see...Yes, ears, nose, mouth, hair, eyebrows, teeth, the collar of your shirt. Try to get the child to give you as detailed a description as possible. After the description, ask the child whether the reflection in the mirror looks happy, sad, angry, content, etc. Then ask the child to change the picture let the child experiment with making funny faces. Ask the child to close the window. Then ask him or her to make a sad (happy/angry/jealous) face. Say that this is easier to do if he or she thinks of a sad (happy/angry/jealous) situation. As soon as the childs face changes, ask the child to open the mirror and check for him/herself. Older children may describe what happens to their faces when their emotions change.

The mirror book

The mirror book is a development of the mirror window. For a mirror book you will need two pieces of cardboard of the same size and two mirrors of the same size. Glue the mirrors onto the cardboard and using sellotape, join them to one another with the join in the middle like a book. If the child puts his or her nose close to the mirrors and moves the two mirrors towards his or her face, the child will see him/herself from different angles.
Discuss these questions with the children

Feeling chart
Feelings are not only experienced in our minds but manifest themselves in the whole body. One way of drawing attention to where a child feels different feelings in his or her body is by giving the child a copy of the illustration over the page.

After completing the exercise, discuss it with the child. Emphasise that it is important to feel the feelings in our bodies and that our bodies give us signs about how we feel.

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Ask the child to colour in (or draw a circle around) the part of the body in which he or she feels anger. Say,Where in your body do you feel it when you are really angry?Or,Where in your body do you feel it when you are sad? Developing the point further You may want to follow up with the following exercise, which makes us think about the way we deal with our feelings. It is also a way to assist a child in finding adequate and helpful ways to deal with negative feelings. Ask the child to complete the sentences below. 1. The last time my body gave me a sign that I was very upset, I_______ (activity the child did) to make me feel better. 2. I _______ (activity the child did) to make me feel better when I felt _______ (feeling). It helped me a lot/helped me a bit/didnt help me at all. 3. When my body gives me signs that I am very angry (impatient/jealous/etc) and I can feel it in _______ (part of the body), I can do _______ (activities) to make me feel better.

Games to deal with aggression and frustration

House of cards
This games examines how children deal with frustration. Let the children work together in groups of three to five. If you only have one pack of playing cards, have one group of children demonstrate the game to the rest of the class.You may want to make notes about how the children react. Ask the group to build a three-storey house by leaning the cards towards each other and building
6

Age group: 8 years and older Number of players: Groups of three to five Materials required: Decks of playing cards Duration:Varies

2 3

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J 9

4 6

one layer on top of another as illustrated in the diagram. Give the children ten minutes to try. Watch the children for signs of frustration. How do the children express frustration? Do conflicts arise among group members? Are all the children in the group involved? If the children get very frustrated, end the exercise and discuss it with the class.

Discuss these questions with the children in the group How did they feel when they were given the task? How did they feel when they first started building the house? How did they feel when they realised they wouldnt be able to finish it? Ask them what other situations make them feel frustrated. Ask the class for ideas about what they can do when they get frustrated.

Get rid of it!

This game is good for letting off steam. Divide the children into two teams and allocate each team to one half of a field with a line down the middle. Each player is given one sheet of newspaper, which must be squashed into a paper ball. Depending on the age of the children, set the alarm clock for four to eight minutes. On your command, all children throw their paper balls into the opposite half of the field. The aim is for both teams to have as few balls as possible on their side of the field at the end of the game. Each team immediately tosses the balls that land on their side of the field back to the other side. The winning team when times up is the team with the fewest balls on their side of the field. Dont forget to ask the children to collect the paper balls and throw them away after you have finished playing. Age group: 4 years and older Number of players: 4 or more children Materials required: Old newspaper, wristwatch, alarm clock or cellphone (mobile phone) with an alarm Duration: Until everyone is exhausted!

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Lion and hunter

This game is good for letting off steam. First mark the boundaries of a field within which the players must stay. Make sure that the ground is soft and that there are no obstacles to trip over or sharp stones to hurt the children. The children choose:

Age group: 7 years and older Number of players: 7 or more children Materials required: A ball and a piece of cloth Duration: Until everyone has been caught

Who is going to be the lion. The lion must try to get the piece of cloth. Who is going to be the hunter. The hunter must try to get the ball. The rest of the children are the impala. The impala try to hide in the field. The hunter and the lion both chase the impala, either trying to hit them with the piece of cloth (the lion) or shootthem with the ball (the hunter). The hunter has the advantage of the ball being faster, but the ball leaves the field more often and he or she has to fetch it. The lion has the advantage that the cloth stays where it falls, but the lion has to get closer to the impala to catch them. Each impala that is hit either by the ball or by the cloth leaves the field and sits on the lions side or the hunters side, depending on who caught him or her. The game ends when all the impala have been caught. Either the lions team or the hunters team will win, depending on the side that has the most impala. Alternatively, the game ends if the hunter hits the lion or the lion hits the hunter, then the side with the most impala already caught is the winning team.

Hit me if you can

This game is a good ice-breaker when children are getting to know one another; it encourages concentration and quick reactions. All the children sit in a circle. One child stands in the middle of the circle holding a rolled-up newspaper. To start the game, the group leader calls out the name of one of the children sitting in the circle. Immediately, the child holding the newspaper tries to hit the knees of the child whose name was called out. The child whose name was called out

Age group: 6 years and older Number of players: 7 or more children the more, the better Materials required: One rolled-up newspaper see Observations below Duration: Short

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may only rescuehim or herself by quickly calling out the name of another child in the circle. The child holding the newspaper immediately tries to hit the second child on the knees. The game continues until one child doesnt react quickly enough and is hit on the knees. This child then stands in the circle with the newspaper and the other child joins the children in the circle. The faster the children react, the faster and more fun the game becomes. Observations Because children may hit very hard with the newspaper, it is important that only a newspaper is used and not a stick. In an environment where hitting or beating children is common (although not allowed) it may be necessary to discuss the game with the children, explaining that their game is the only time that they may hit one another. It may be valuable to use this game as a starting game for a group discussion about aggression, anger and how to express negative emotions.

Discuss these questions with the children How do you feel when someone hits you? Do you think its right to hit someone or to be hit by someone? Why do some children hit others? What feelings make them hit a person? (Helplessness, rage, anger, etc.) What could we do instead of beating or hitting? Why do adults hit children? You think its OK for adults to beat children? What legal rights do children have?

Mock fighting with remote control

This is a useful exercise to deal with conflict in a classroom. It helps aggressive children deal with their aggressive behaviour. If there has been a fight in the classroom or during break, the children who were fighting will be very tense. The rest of the class may also be upset and may have taken sides. The atmosphere could be very unpleasant and it would be useless trying to teach. Ask each of the opponents to describe briefly what happened. Make sure that neither child is interrupted by anybody. Dont take sides.

Age group: 6 years and older Number of players: The whole class Materials required: None Duration: Varies

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Tell them to come to the front and play the fight in the classroom. Establish some rules first. No one may disobey the rules. No one is allowed to touch the other person. Each movement has to stop a few centimetres short of the other child. There is no talking. Everything has to be said by gestures and actions. Tell the children that you are in charge of an imaginary remote control. (Make sure that the children understand what a remote control is. Test it on the whole class: ask them to move their arms around, press your imaginary button and call,Slow!Everyone should slow down. Press your imaginary button and call,Fast! Everyone should speed up. Press your imaginary button and call,Stop!Everyone should freeze.) This imagined control allows you to control what is happening. The whole scene will first be played in slow motion (like an action replay on television, moving very, very slowly). Arrange the starting scene with the two opponents. Press your imaginary button and call,Start.Stay in total control of the scene. It might still be full of anger and rage. Dont allow any real fighting to start. When you see the players speeding up, slow them down with your remote control the movements can be extremely slow.You can even stop the scene, leaving the two opponents standing there frozen. When the two opponents reach the end of the scene,freezethem and ask them how they feel in that situation. Ask if they can think of another way to solve their conflict and avoid a fight. Ask the class for ideas (keep the players frozen). Ask the players if they would like to try another scene in which they try out other ways to solve the conflict. Tell them that you will have to rewind the scene (like you rewind a tape). When you press the rewind button they will have to walk backwards and do all the movements backwards. This will have to happen very quickly because tapes rewind very quickly! This usually looks very funny and makes everyone laugh. When they are back in their starting position, press playand start the two players off again. Start them in slow motion, but allow the scene to unfold at normal speed.

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When they reach the end of the scene, ask them how they feel. If there are still negative feelings, talk about what can be done to solve the problem. What should happen in the scene to make these feelings disappear? You may need to rewind the scene and play it all over again until everyone is happy. After you have finished, let the ex-opponents sit down. Ask the class what happened. Discuss the non-violent problem-solving. This technique is time-consuming and you will probably not have time to return to your lesson plan. Dont see this as wasted time as a homework exercise you could ask each child to write down as many solutions to solving this problem as they can think of.

The screaming game

This is a game that helps to relieve tension. Take your class far away from the school buildings as possible so that you dont disturb the other classes! Divide the class into two groups. Each group stands in a line, about 15 metres apart. One child from each group stands behind the opposite group. Each group creates a five-word sentence (younger children need only think of one word). One person from each group tells the teacher the sentence that the group has chosen. The teacher stands between the two lines, right in the middle. When you give a sign, both groups start shouting their sentence from the child from their group who is standing behind the opposite group. Both groups are shouting at the same time, so it will be difficult for the children behind the lines to understand their sentences. As soon as one of the two children thinks they have understood the sentence, the child must run to the teacher to report the sentence. If the child understood the sentence correctly, his or her group gets a point. If the child misunderstood the sentence, the other group gets a point. The two listeners join their groups again and two other children are chosen to stand behind the lines and listen. 113

Age group: 6 years and older Number of players: The whole class Materials required: None Duration: Varies

Games that calm children down

The fish game
This is a good game to calm a class down and obtain silence after an upsetting event or an exciting break. It helps children to relax. All the children close their eyes and move around the room.You may instead want to blindfold the children. (It is easier to use a school hall or a fenced playground where there is no furniture in the way.) Age group: 6 years and older Number of players: The whole class Materials required: None Duration: Varies

The teacher whispers,Youre the fish!into the ear of one of the children. This means that this child must stay silent. All the other children move around and when they bump into each other they say, Fish!until they meet a child who keeps quiet. The child who bumped into the fish must keep quiet too. The game ends when every child is silent.

Time out
If the whole class is restless, let the whole class take time out. Tell the children to sit down. Ask the children to clear their desks and make sure that each child has enough space for himself or herself. Tell them that you do not expect them to do anything but to keep very quiet. Ask them to cross their arms on their desks and put their heads on their arms. Ask them to close their eyes and just lie silently until you tell them to sit up.

Age group: 6 years and older Number of players: The whole class Materials required: None Duration: Varies

Some children will find this difficult and will keep fidgeting. Quietly but firmly, tell them that you want them to lie quite still; you do not wish to see anybody move. If necessary, address them by name, saying,Sara, I want you to be very quiet now. Just rest your head on your hands. Try to keep your feet still. OK, well done. If you can play some quiet music, this would be even better. Then tell the children to open their eyes and sit up.You may want to add a breathing exercise at this stage.

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Games for help-seeking, autonomy and awareness

Children have to learn how to function in groups. They need to learn to respect other peoples thoughts and feelings. On the other hand, they need to learn to be assertive enough to express their own feelings, wishes and thoughts. The following exercises help children to respect other people, to work with other people and to co-operate in a group while retaining their unique individuality.

Siamese twins
The children work in pairs. They hold one hand, or place an arm around the waist or shoulder of their partners so that they each have one free hand to use. Together, they must complete various tasks: carry a bucket, open a bottle, tie a shoelace, put on a pair of socks the possibilities are endless! Try to adapt the difficulty of the tasks to fit the age of the children. Small children will probably find it impossible to tie a shoelace. Add interest by having the children hold one anothers ears or feet instead of holding hands. Age group: 5 years and older Number of players: 2 or more children Materials required: Paper, sellotape, crayons, a short piece of rope or some material, shoes with shoelaces materials vary according to the tasks you set Duration: Short

Discuss these questions with the children How did it feel to be so closely connected to another person? Is it more difficult to do things? What do you have to take into consideration in order to accomplish a task? How did you feel when you accomplished a task even though the other person seemed to be making it more difficult?

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Siamese twins for older children

Use the sellotape to stick the paper to the wall or the floor. Have two children stand beside one another and then tie their adjacent hands together. The children should hold their other hands behind their backs. Now ask them to use the joined hands to draw a picture of something. Suggest something straightforward to start with, like a house or a car. Both children should hold the same pen. Observe what happens. Who takes the initiative? Who chooses the colours? Is one child more assertive than the other or do the roles change? Do they communicate with each other?

Age group: 8 years and older Number of players: 2 or more children Materials required: As above Duration: Short

Discuss these questions with the children After the children have finished drawing, let them report back on how they felt. Make sure that both children express their opinions. Encourage them to discuss the questions below. How does it feel when someone else influences what you plan to do? Were you able to discuss what you planned to do? Who took the lead and who followed? Why did someone take the lead? Did you change roles? Can you think of a situation in real life where you have to discuss and plan what to do with another person? Is it ever possible for a person to do just what he or she feels like? What does one have to consider when working as part of a team?

Mirror game
The aim of this game is to encourage both leading and following in play Step 1 This game should be played in silence. The children will need to concentrate and anticipate what their partner is going to do next.

Age group: 7 years and older Number of players: 2 or more children, working in pairs Materials required: None Duration: Varies

The children stand facing each other. They hold their hands in front of them, palms facing each other, at a distance of approximately 10 cm. Their hands should not touch. One child starts to move his or her hands and the other should try to copy the movements, like a mirror image.

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Let the children try this for some time. Observe what changes when both hands are moved. What happens when both children start to take the lead? What happens if no one takes the initiative? Take a break and discuss these points with the children. Step 2 Form groups of three. Children should stand in a triangle, each one holding his or her hands out towards the other children in the group, once again approximately 10 cm apart. On your signal, the children start to move their hands. Once again, their hands may not touch. They must discover how best to follow in different directions and to accommodate their partners. Let the children try this exercise for a while, before taking a rest to discuss the questions below. Discuss these questions with the children How was working in threes different from working in pairs? If it was more difficult, what made it so difficult? How could you solve this problem? Is it possible to anticipate what your partners are going to do? How do you do this? What signs do you recognise? How did you communicate with your partners without using words?

Winking
The aim of this game is to encourage group cohesion and a sense of attachment vs distance Children get into pairs, but one child remains alone. Standing one behind the other, the pairs form a circle, both facing the middle of the circle. The children standing at the back hold their hands behind their backs. The child without a partner also stands in the circle and tries to steala partner by winking at any child standing in the inner circle. As soon as a child has been winked at, he or she must try to run to the person who winked. The winking is done as secretly as possible, since the partners standing in the outer circle must try to keep the partner standing in front. The partner at the back throws his or her arms around the partner in front to prevent the child from getting away. 117

Age group: 6 years and older Number of players: 9 or more children, an uneven number Materials required: None Duration: Short

Discuss these questions with the children How did you feel when someone chose you? How did you feel when you were held back? How did you feel when your partner ran away from you? How did you feel when you managed to get a new partner?

The children at the back may not follow if their partner runs to the winker. If a partner has been stolen away, it is then the turn of the partner left behind to wink in order to steal another child. Each child must be very attentive and maintain eye contact with the child who has no partner.

Games to see how feelings appear physically

Catching fleas
One child plays the flea catcher and all the others are fleas. The fleas squat on the ground and make chirping sounds. Each flea may jump ten times. The flea catcher is blindfolded and tries to catch the fleas. The fleas are allowed to jump away, but if a flea uses up all of its ten jumps, the flea may not jump any more. When the flea hunter catches a flea or touches a flea by accident, the flea catcher has to identify the flea by gently touching his or her face. If the flea catcher correctly identifies the flea, they swop roles and the flea becomes the flea catcher. The new flea has ten jumps to use and the game begins again. The observer must make sure that the blindfolded flea catcher doesnt hurt him or herself or leave the premises. Age group: 7 years and older Number of players: 5 or more children, 1 observer Materials required: A cloth to use as a blindfold, plenty of space with no rocks or trees to walk into Duration: Varies

The human camera

The aim of this game is to foster trust and to encourage observation skills, accurate perception and visual focusing. The children agree who will be the camera and who will be the photographer. The camera closes his or her eyes and the photographer leads the blindcamera around until he or she finds an interesting subject.

Age group: 7 years and older Number of players: 2 or more children, working in pairs Materials required: None Duration: Short

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The photographer adjusts the camera and, by pulling on the ear of the camera, opens its eyes. Without moving his or her head, the camera looks closely at the subject, trying to observe as much as possible. After a few moments, the shutter closes (the cameras eyes close) and the camera is led to a new subject. The same process is repeated. The child pretending to be the camera must try to produce inner pictures of what he or she sees. After taking pictures of three to five subjects, the camera and the photographer sit down and the child who played the camera describes, with the help of the inner pictures, what he or she saw. Then the two children swop roles and the game is repeated.

Discuss these questions with the children What was the most difficult part of this exercise? Was it more difficult to be the photographer or the camera? What did you experience when you tried to memorise/create an inner picture of what you observed? (Be aware that some children will find it more difficult than others to create inner pictures.) How did you feel when you recalled your inner pictures or watched your inner movies? How close was the image you described to reality? How much did you see? How much could you remember?

Give me your hand and Ill give you a message

The aim of this game is to encourage concentration, awareness of bodily feelings. One child uses an index finger or a twig to gently writea letter on the palm of the other childs hand. The second child has to feel what the first child has written. In the beginning you may want to allow both children to keep their eyes open and watch what is happening. After the children get used to the game ask the child who is receiving the message to close his or her eyes and to feel the writing. To make it more difficult, the child who is writing may decide to write a whole word, one letter after another. The receiving child must concentrate and combine the letters in his or her head to form a word. This version can only be played with children who are fluent readers. Age group: Children who can read Number of players: 2 Materials required: None Duration: Short

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Secret messages
The aim of this game is to encourage concentration, awareness of bodily feelings. The children stand in a long line. No one may talk. The children should concentrate on their bodies. This helps to prevent the secret message from being revealed before reaching its goal. As group leader, you draw a shape with your index finger on the back of the last child in the line. The shape could be a square, a circle or a triangle with smaller children; letters or numbers with bigger children. The child must concentrate, try to memorise what he or she felt and then draw the same form on the back of the child standing in front of him. The game goes on until it reaches the front of the line. How much information was lost along the way?

Age group: 5 years and older Number of players: 4 or more children Materials required: None Duration: Short

Weather report
The aim of this game is to encourage concentration, awareness of bodily feelings and relaxation. It helps the children to follow this game if you participate as group leader. The children line up and form a circle, so that each child faces the back of the child in front of him or her. (The group leader is part of the circle as well.) Each child places his or her hands on the shoulders of the child in front of him or her. The group leader starts the game by saying,And now we all feel the sun rising and shining gently on our backs,while gently massaging the shoulders of the child in front of him or her. The other children follow suit, so that everybody is gently massaging the child in front of him or her while having his or her own shoulders massaged as well.

Age group: 5 years and older but this game doesnt work with adolescents! Number of players: 6 or more children Materials required: None Duration: Short

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Then the group leader continues,Suddenly big clouds appear in the sky.(Stroke the shoulders of the child in front of you very strongly.) All children follow suit. Group leader: And suddenly it starts to rain very gently. (Tapping gently on the shoulders of the child in front of you.) Group leader: And the rain grew harder and harder. (Tapping harder and faster.) And more and more.(Tapping firmly with all fingers.) And still harder!(Tapping hard and fast.) Then suddenly there is a huge flash of lightning!(Draw a line on the childs back with your finger.) And a loud roar of thunder!(Gently clap with both hands on the childs back.) And more lightning!(Draw another line.) And more thunder!(Another clap.) And rain!(Tap.) And then a strong wind blows. It blows the clouds away.(Making whooshing sounds and stroking firmly left to right, and back again.) And suddenly the rain grows softer.(Tap more gently.) And softer,(tap with fingertips only),and suddenly it stops.(Pause.) And slowly, quietly, the sun comes out. (Massage the childs back gently.) Comments When playing this game, touch should be restricted to the shoulders and the upper part of the back. Some children may feel uncomfortable since the game requires a lot of bodily contact. Children who dont want to participate should not be forced to do so. Other children will love the game since it allows them to relax and be active and focused at the same time.

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Fingertip reading
The aim of this game is to encourage bodily sensation, concentration and perception. This game needs some preparation, but once you have prepared all the materials, they can be used over and over again. 1. Divide one piece of cardboard into 16 equal squares. 2. Draw a different shape on each square (small circle, big circle, small triangle, big triangle, small square, big square, small rectangle, big rectangle, etc). 3. Give each shape a different texture. Distribute glue carefully onto the interior of the shape and then glue the various materials (like sand, lentils, or a piece of cloth) onto the shape. Use only one material for each shape. Let the glue dry completely. 4. Now take a second piece of cardboard and follow the same procedure to make it identical to the first one. Allow the glue to dry completely. 5. Once you are sure that the two sheets of cardboard are identical, cut along the lines of the second sheet of cardboard so that you have sixteen small cards, each containing a different shape. Now the game can begin. Ask the child to close his or her eyes (or use a blindfold). Put the first sheet of cardboard in front of the child and then place one of the smaller cards into the childs hands. Without looking, the child must feel the shape and texture on the small card with his or her fingertips. The child then uses his or her fingertips to find the matching shape on the big sheet of cardboard. If correct, the child gets one point and may either 122

Age group: 5 years and older Number of players: 1 child and the person who guides the process Materials required: Scissors, glue, ruler, pen, 6 pieces of cardboard measuring approximately 20 cm x 20 cm, sand, soil, small stones, lentils, maize or rice, cotton wool, wool, different types of material, sandpaper (if available) Duration: Short

keep the small card or it is returned to the bottom of the pack to be used again later on. Comment For younger children, ten shapes to choose from will be sufficient. Older children (children older than 6) are usually interested in more challenging puzzles.

Variation To make the game more interesting, you could make extra small cards with shapes that are not on the big card.

Make sure that the shapes and textures are not repeated. For example, do not have two small circles with the same texture this causes confusion.

Games to help autobiographical memory

The Remember! game
The aim of this game is to share common memories, to remember special moments, to enhance the autobiographic memory, and to encourage observation skills and verbal expression. This is an easy game that helps children to remember and to express their thoughts. It can be played when a parent has died, but playing it before the parent dies increases the autobiographical memory of the child. As the parent or caregiver, think of something that you and the child experienced together. With younger children, choose an event that happened no more than a week ago. You start. Say something like,Remember when your aunt came to visit us on Tuesday. She came into the house... What happened next? The child should now try to complete the sentence and describe what happened while you listen. The child will indicate when he or she needs more prompting.You continue by saying something like, After we had a cup of tea, what happened then? In this way, the narration of the story changes until it is completed. When you (the parent or caregiver) feel that major parts of the story are missing, you could interrupt Age group: 5 years and older Number of players: 1 or more children, with the parent/caregiver Materials required: None Duration: Short

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and say,You forgot something important!If the narrator remembers what was left out, he or she may continue with the story. If not, the roles swop again and you continue with the story while the child listens. There will be days when the child prefers to be the narrator. At other times, the child will prefer to listen. This may depend on the content of the story but may also be affected by the mood of the child. The What happened next? and the You forgot something! interventions allow the child to control whether he or she wants to talk or to listen.

Variation After the conclusion of the story you could add a second component: the How did you feel? question.

Choose one element of the story and ask the child how he or she felt at that moment. For example,How did you feel when Auntie said you should go and play outside?or, How did you feel when I spilt the sugar?Allow the child to put questions to you as well. Comment There are many important events in the life of a child, but some are special either because they have good associations or because they are associated with negative feelings. It is good to talk about these experiences. This game if practised with unimportant matters may help children to talk about more upsetting and stressful situations. To help your child become more resilient it is especially important to talk about special occasions you have together (Do you remember when we went to town together by taxi? Do you remember when we attended the big function at the community hall? Do you remember when I took you to school on your first day?) It is important to play this game when you and your child can have some undisturbed, quality time together. It gains extra value when you share really good or really bad memories. This game can even be played while you are busy with daily chores that dont take too much concentration and attention. The Remember! game with lies This is a special version of the Remember! game. Children love to make up stories its one way of testing their awareness of reality versus fantasy. Each one of you is allowed to add one lie to the story! The narrator tries to hide his lie somewhere in the story and the listener must listen very carefully to detect it. The listener can call out,Got you! You are lying! It happened like this!and then tells the story the way it really happened.

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Journalists report
Older children may resent focusing on conflict situations that have to do with their own lives. Often they are reluctant to talk about their own feelings and try to keep emotionally distressing memories at a distance. To make them reflect on their situation and express themselves, it helps find ways to engage in the topic without the discussion becoming too personal. One method worth trying is the journalists report. Collect headlines from newspapers referring to difficult situations, like School fees for AIDS Orphans. Have several headlines prepared and spread them out so that everyone can see them. Ask the adolescents to imagine that they are newspaper reporters and that they have to compile a report on one of the headlines. In order to make it more interesting for the reader, they should invent a story about a child facing a situation that relates to the headline. Invite the adolescents to choose one of the headlines that interests them most and ask them to compile the story. The stories can be shared later on with the whole group and can be used as a basis for a group discussion. The next step is to distribute the original article that was attached to the headline. Ask them to compare their story with the original article. What are the differences between the two stories? Is one more personal? Less realistic? Fewer characters involved?

Age group: adolescents Number of players: manageable group Materials required: newspaper articles Duration: Varies

Discuss these questions with the children How do you think the newspapers should report on children affected by HIV/AIDS? What are the important points that have to be made public? Which would be the best way to accurately represent children in the article? Why is it important for all articles on HIV/AIDS related issues to be published?

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Exercises that help to build self-confidence and self-esteem and thus foster resilience

Worksheet 1
The aim of this game is to encourage self-confidence and self-esteem. Hi! I am Nangula! I am 8 years old. I live in Katutura in Windhoek with my granny, my sister Maggie and my brothers Benjamin and Harry. I go to school in Katutura. I am in Grade 3. There are 35 children in my class. We are all in one class, but we are all different. Some children are tall; others are short. Some children are big and others are small. Some children have dark skin; some children are light in complexion. Some children have short hair; others have long hair. We all look different. Each of one of us is special. Here you see a picture of me. This is what I look like. Im wearing my favourite shirt.

Next to my picture youll find an empty box. Thats for you to paste or draw a picture of yourself. After drawing your picture, how about writing a short story about yourself? Dont forget to say whats special about you.

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Worksheet 2
The aim of this game is to build self-esteem by acknowledging skills and capabilities (I can) Here you see me with some of my friends. Not only do we look different, but we each have different strengths and skills. Some things I can do better than Freddy. But some things Rebecca is best at. I am proud of the things I can do!
I am good at Maths. I can count and subtract. I am good at dancing. I even can invent dances on my own. I am also good at making up stories. People like to listen to my stories! I am a good runner. Im the fastest runner in my school. I am good at climbing trees. I can draw well. And I am good at playing soccer. I am proud to be a member of the school soccer team!

I know how to knit. I am good at reading! And I can ride a bicycle.

Here you can write what you are good at:

I can do some things better than Freddy. Freddy can do some things better than I can. Rebecca can do some things better than either of us. Sometimes its good to know youre not the best. Rebecca and Freddy can help me and I can help Freddy and Rebecca. Together, we are a great team!

Do you also have other people on your team too? Write down their names and write down what they are good at.

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Worksheet 3
Even if we are a team and we are good at different things, we are still different from one another. Not only on the outside but also inside. Each one of us thinks, feels and acts differently. This makes us special. We call this personality. Each one of us has a different personality.

For example: I am a very creative person. I love to invent things. I am very friendly. And I try to be very honest. My friend Freddy is a very energetic person. He is full of ideas. He is a good friend and a very helpful person. My friend Rebecca is a gentle and quiet person. She is very thoughtful, but also very curious and inventive. She is fun to be with. What kind of person are you? Which things would you use to describe yourself? You can pick them from the list below. But you can also add others we havent thought of before.

I am a ______________ person. I am also a_____________person.

kind, friendly, honest, strong, brave, creative, fun, quiet, gentle, energetic, knowledgeable, helpful, responsible, sensitive, humorous, a good friend, a good listener, faithful, hardworking, curious, full of ideas, active, understanding, thoughtful, respectful, intelligent, clever, loving, musical, sporty

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Worksheet 4

I have

I have many things to be happy about. I have a house to live in. I have a bed to sleep in. I have my good friend Rebecca. I have a sister and two brothers. But the best thing in my life is my granny!

People have things that make them happy and that help them to enjoy their lives. Some people have things they are proud of, like a certificate showing how well they did at school. Other people have things that are very important to them and that they need to survive. Nangulas granny, for example, has a sewing machine. The sewing machine is important because Granny uses it to make clothes that she sells at the market to earn money. Nangula has her schoolbooks. She knows that they are expensive, but more importantly, Nangula loves her schoolbooks because she loves to read and write. Harry, Nangulas brother, has a puppy. Nangula doesnt like the puppy, but the puppy is very important to Harry. Harry cant think of a better friend than his puppy. Nangula has something else that is very important to her.You wont guess what it is! It is a photograph of her mother. Nangula keeps this photograph hidden beneath her mattress, so that nothing can happen to it. Each time she misses her mum, Nangula looks at the picture. This makes her feel better. The photograph of her mother is very important to Nangula. Do you have special things that are important to you? It is important to have special things in our lives, but it is more important to have people whom we love and trust, and who help us. Nangula has a list of people she likes and a list of people who help her. Nangula has Rebecca she tells Rebecca all her secrets. And she has Freddy he protects her and helps her with her homework. She has Maggie Maggie shares her clothes with Nangula.

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She has her brother Harry he likes to hug her. Nangula has Mrs Kakona she is her teacher and she helps Nangula when she has problems at school. And Nangula has Ms Shikongo who is the social worker. Ms Shikongo comes to visit the family and helps Granny to collect her pension money. And there is Mr Blom who owns the bookshop and allows Nangula to look at the books in his shop. There is the nurse at the clinic who helps Nangula when she has to collect Grannys medicine. And there is Mrs Smith. She is Rebeccas mum. She likes Nangula very much. Sometimes when Nangula misses her own mum, she can go and visit Rebeccas mum. Rebeccas mum always sees when Nangula is sad. Mrs Smith asks Nangula why she looks so sad. She listens to her. She tells Nangula stories about her own mum. Mrs Smith is a very good friend, even though she is Rebeccas mum. And Nangula has Granny. Granny is just the best! Do you have someone you like very much? Someone you can trust? Someone you can go to when you are sad or hurt? Why dont you make a list of the special people in your life?

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Some children may experience extreme reactions to grief. In other children, the normal stress and grief reactions described in Chapters 4 and 5 may become more intense and prolonged as time passes, rather than subsiding (slowly going away).

How do you know when a reaction is extreme?

These are the characteristics of severe or extreme reactions. The reaction is very intense. The reaction lasts for a long time and does not change in its intensity. It may become chronic (extremely severe) and lead to behaviour changes. The childs behaviour changes dramatically. The child does not seem to have inner resources or protective mechanisms. If you think that the childs reaction is severe, the child will probably need more specialised help than caregivers and teachers can offer. Pay particular attention to the following extreme reactions: complicated grief, severe depression, delinquent or antisocial behaviour and physical sickness. These are signs that the child needs specialised help.

Complicated grief
Complicated grief refers to grief and mourning reactions that cant be expressed. Although the child may accept that the parent has died, he or she may not be able to experience the pain and the emotional response to the death almost as if his or her feelings have been frozen. This is known as prolonged emotional numbing because the whole grieving process freezes and the child is unable to experience feelings. 131

Severe depression
A child suffering from severe depression feels sad all the time and cries a lot. The child may refuse to eat and lose a lot of weight. The child feels tired all day long, wants to stay in bed all day but finds it difficult to sleep at night. The child seems to withdraw from all activities, may talk a lot about wanting to die and has suicidal thoughts (thinks about killing himself or herself). The child says over and over again that he or she wants to be where the deceased parent is. The child may show self-destructive and auto-aggressive behaviour like cutting himself or herself, pulling out his or her own hair, deliberately causing hurt to his or her own body, destroying objects that were formerly precious to him or her.

Disturbing intrusive memories

When unhappy memories crash into a childs mind too often, the child cant cope with the memories, cant concentrate and cant relax. The intrusive images affect the childs life so severely that the child cant do the things he or she usually does and cant fulfil normal tasks.

Severe and persistent feelings of anxiety

A child may feel fear and anxiety all the time so that he or she cant carry on with a normal life. Children affected by this withdraw from others and become isolated. With some children, the fear becomes so irrational (lacking in reason) and so great that it leads to irrational anxiety and recurring panic attacks.

Delinquent or anti-social behaviour

Delinquent or anti-social behaviour varies from child to child. If you see a child in your care doing one or more of the following things, it would be wise to seek specialised help. Behaving sexually promiscuously (sleeping around) or engaging in prostitution (having sex for money). Remember that for some children this is the only way that they can earn some money. Missing a lot of school. Engaging in risk-taking behaviour and impulsive behaviour (refer to Chapter 4). Breaking into houses and stealing. Staying out all night, or staying away from home for several days in a row. 132

Showing signs of substance abuse this could be alcohol, drugs, gluesniffing or smoking. Signs of substance abuse include restlessness, being unable to sleep and slurred speech.

Physical complaints
As explained earlier in this book, psychosomatic aches and pains are physical complaints for which a doctor can find no medical reason. If psychosomatic illnesses carry on for a long time, you need to take the child to a childcare specialist (psychologist) so that the child can get professional help.

What can you do to help?

If you know of a child who is experiencing these severe problems, you need to speak to the child and explain that you have noticed he or she is going through a difficult time. Mention to the child that you want to help him or her by talking to their caregiver and suggesting that the child be referred to a specially trained counsellor or a social worker. It is important for you to make the child realise that you are not criticising his or her behaviour. If the child feels that you are being critical, your help may be refused.

Child abuse and neglect

Sometimes children, especially those who are vulnerable, become subject to abuse or neglect. This is more likely in situations in which a childs caregiver is overwhelmed and the childs needs do not receive enough attention. Girls are especially at risk, but boys may also be abused or neglected. Sometimes the child will not tell you that he or she is being abused or neglected, but you may notice some of the signs or symptoms that have been described in this chapter.

What is neglect?
Neglect means that the childs basic needs are not properly cared for, even within the limits of what the household can afford. Neglect can be physical. A child is physically neglected when he or she is not properly looked after: the child doesnt receive food, shelter or medical care. Neglect can be educational. A child who is neglected in this way does not go to school or is not taught the basics of reading and writing. Many neglected and abandoned children end up as street children, fighting for survival with little chance of going to school. The resulting lack of education makes it more difficult for them to improve their situation in life. 133

Neglect can also be emotional. A child who is emotionally neglected does not enjoy a caring, nurturing home environment or may be exposed to violence at home. Being exposed to violence also hurts a childs normal emotional development. Neglect is a difficult form of abuse to recognise. Circumstances sometimes make it difficult for children to attend school they may live far away from the nearest school, or they may have to help at home because a parent is too sick to look after the family. Children affected by HIV and AIDS often have to take on responsibilities that would normally be shouldered by their older brothers and sisters, or their parents. It is often clear that parents do not intentionally neglect their children, but the children are neglected as a result of the situation at home.

Signs of children in need of care

Signs of malnutrition Reddish-looking, dry hair Loss of hair Dark patches on the skin A child who seems small for his or her age A swollen or very thin body Peeling skin Little energy, the child cries easily Signs of poor hygiene: Skin problems Filthy hair Ingrown nails Strong body odour Signs of poor health: Coughing and/or very rapid breathing Sores and itchy patches on the body Sores around the eyes, mouth or on the legs Swollen belly Diarrhoea Vomiting Pus in the childs ears Runny nose Sore, irritated-looking eyes Behavioural signs: Withdrawal Sadness Crying Increased anxiety Aggressive or delinquent behaviour 134

Clinging Trying to please everyone Using abusive language and swear words; vocabulary that is not appropriate for the childs age

What is physical abuse?

Physical abuse is when the childs body is hurt. This ranges from small bruises to broken bones or even death. The childs body may be hurt by punching, beating, hitting, biting, shaking, burning, throwing, choking or stabbing. Whether the person meant to hurt the child is not important. Such injuries are considered abuse, even if the person who hurt the child tells you,I didnt mean to hurt him (or her).

Signs of physical abuse

Children may show the following marks: Bruises Burns (cigarette burns) Patches of hair missing Cuts Fractures Pinch marks Bite marks Old scars (not fresh ones)

Behaviour that an abused child may demonstrate

Role-playing scenes in which children are beaten frequently or pushed around Increased aggressive behaviour Running away Withdrawal Concentration difficulties Sleeping problems

What is sexual abuse?

Sexual abuse includes fondling the childs genitals, penetration (inserting the penis into the childs mouth, anus or vagina as well as inserting objects into the childs mouth, anus or vagina), indecent exposure (another person revealing his or her sexual body parts to a child), using a child to earn money through sex and producing pornographic (dirty) pictures or videos of children.

What physical signs may idicate sexual abuse?

Bruises (especially in the genital areas and on the thighs, but also anywhere on the body) 135

Redness of genitals Pain while urinating Itchiness of genitals Genital infections Genital discharge

What behaviour may indicate sexual abuse?

Withdrawal Loss of interest Clinging to one person; unwillingness to be left alone with a person Increased anxiety Mood swings Concentration difficulties Sleeping problems Nightmares Using words with sexual connotations that are not age-appropriate Increased knowledge of sexual terms and acts Aggression Auto-aggression (self-mutilation like cutting and burning) Feeling dirty, needing to wash him or herself over and over Attention-seeking behaviour Frequent drawing or acting-out of sexual scenes Playing sexual games (fondling), usually with other children (usually with younger children) A sudden increase in gifts or money Absenteeism from school Decreased school performance Secretive behaviour Sexually abused children may act or speak in a way that shows that they have sexual knowledge that is unusual for children of their age. Abused children learn that sexual behaviour is a good way to get attention and rewards. These rewards may include money, food or clothing. As abused children move towards young adulthood, some of them become promiscuous (have sexual intercourse with many people) because they believe that their bodies are for others to use.

What is emotional abuse?

Emotional abuse covers many different behaviours, but we can say that any repeated behaviour that harms a childs emotional development, or the childs sense of selfworth (the childs feeling that he or she is a valuable person who deserves to be loved and to be happy), is abusive. If a child is criticised all the time, repeatedly threatened or pushed away, you could say that the child is emotionally abused. If a caregiver always refuses to be loving and affectionate, or refuses to support or guide the child, 136

you could say that the child is emotionally abused. Children have the right to be valued and supported. Children are safest from abuse and neglect if they are raised in environments that value and support children.

Signs of possible emotional abuse

A decrease in self-esteem and self-respect Feelings of inadequacy Poor school performance Aggression

Is there a type of child who may suffer abuse or neglect?

No. Remember that children often know the people that abuse them. Being a victim of child abuse has severe long-term consequences and can still have an impact on the person as an adult. It is critically important that child abuse cases are reported. After being abused, children usually need the help of a specialist in order to cope with their thoughts and reactions to the abuse. Child abuse is a very serious offence and perpetrators need to be reported and dealt with appropriately.

Who abuses children?

There is no typicalchild abuser. Usually the abuser is known to the child and very often comes from the same family as the child or is a person in authority, like a teacher or a priest. Children are at higher risk of abuse and neglect if their caregivers: abuse alcohol or drugs are isolated from their families or communities find it difficult to control their anger or their stress dont seem to take any interest in caring for their children seem to have serious financial or personal problems. Children affected by HIV and AIDS are even more vulnerable. Children who are orphaned often lack the means to support themselves and their families. They are vulnerable to adults who promise to help them but who request sexual acts in exchange for the help. Such people are commonly known as sugar daddies.

What can we do to prevent abuse?

Make sure that each child has his or her own place to sleep. If a child refuses to stay alone with a certain person, do not force him or her to do so. 137

Make time for your child. Show an interest in what your child is doing. Talk with your child about things that happen in his or her life. Ask the child what he or she did at school and after school. Get to know your childs friends and your childs teachers. Teach your child that his or her body belongs to him or her alone. Teach your child about feelings: which feelings are OK and which feelings are not OK. Childhood is a very important learning time for children. It is an important time for children to learn to be confident and assertive. Sometimes children think that because they are justchildren, they dont have rights. Children need to understand that rights are things that they are allowed to do and no one may stop them from doing them. One of these rights is the right to feel safe. Another is the right to say No!when someone touches him or her in a way that makes the child feel uncomfortable. Most children are very trusting. It is important for children to learn the difference between good secrets and bad secrets. Good secrets are OK to keep. Bad secrets need to be told to someone who can help. In the same way, a child needs to understand the difference between a present given to him or her because they are loved and a present that is given in exchange for something that the child must do in return. The issue of sugar daddiesmust be discussed with children. Gifts and support may be very tempting for a child, but you need to talk about the emotional and physical consequences for the child and the reason why men like these offer their help. Children must be made to understand that men like this want to harm the child, not help him or her. Talk about safe places where children can find help and support from people who will not hurt them.

Talking to children about abuse

In this chapter we have looked at very basic definitions of child abuse and neglect. Helping children to live through such difficult experiences and encouraging their resilience often demands more than ordinary caregivers are able to offer. If a child tells you that he or she has been abused, listen to what the child has to say and treat the information seriously. Take time to listen. If you are busy doing something that cannot wait, say to the child,I am listening to you. We should talk about this. Can we talk about it in half an hour (choose a time that suits you both), so that I can sit quietly and pay attention to you?Make sure that you stick to this arrangement and make sure that you can listen to the child without any disturbances. Bear in mind that the child will only reveal as much information as she or he feels that you, the listener, are comfortable with. Try to avoid making judgmental comments or 138

strongly emotional remarks even though you may find it difficult. The child needs to feel that he or she is safe with you and that you are able to cope with the information that he or she is sharing. It is important for the child to feel accepted and respected in whatever he or she tells you.

What to do when you suspect child abuse

It is very seldom that children tell someone whom they trust that they have been abused, but you may notice that their behaviour or reactions change (as discussed earlier). If you notice such changes, pay close attention. It may become necessary to discuss this with the child. Recognising these signs doesnt necessarily mean that the child has been abused, but there is a risk and you need to investigate it carefully. Accepting that a child has been abused is not always easy for the person that the child talks to. It may be that you know the person who is abusing the child. This makes it difficult for you to know what to do. It is best to find specialist help for the child. An abused child will need help for a long time and it is best for this help to come from a person who has specialised experience.

Important points to remember

The child may not want to talk about the abuse. This is quite normal and may be for different reasons: The perpetrator (the abuser) may have threatened the child, saying that something terrible will happen if the child talks about it. The perpetrator may tell the child that you (the parent or caregiver) wont love the child any more when you hear what the child has done. The perpetrator thus tries to transfer the responsibility for the abuse on to the child. Abuse is always the fault of the perpetrator. Tell the child that you dont blame him or her. Make sure the child understands that it is the perpetrators fault and that the perpetrator needs to be punished! Children who have been abused may feel too ashamed, dirty and guilty to talk about it. Once again, you need to say that it is the fault of the perpetrator and that the child has no reason to feel guilty or ashamed. The child may want to protect the perpetrator this often happens when the child has been abused by a family member. Although the child understands that the perpetrator did something terrible, he or she still likes the person and does not want to lose him or her. It is important for the child to understand that although the person may be likeable, what that person did was wrong. Very often children do not have the vocabulary to describe what happened to them. They may not know how to describe body parts and bodily fluids and they may use images or pet names to describe 139

them. We need to listen very carefully and to find out precisely what the child is referring to. Sometimes it helps if you ask the child to draw a picture of what happened.

Child abuse and HIV/AIDS

As if abuse wasnt hard enough to deal with, the AIDS pandemic adds to the dangers of child abuse and neglect. Children who are orphaned or impoverished (have no money) are more likely to turn to sex work in order to provide an income for themselves and for their dependants. This greatly increases the chances of the child being infected by HIV. This sort of situation needs you as the caregiver to be very sensitive when talking to the child. The child may be able to think of no other way to earn money. Many children like this are weighed down by the responsibility of looking after brothers and sisters. Sometimes children like this dont understand why their mother or father has died. Being able to earn money to look after their brothers and sisters may give them a feeling of control and achievement.

What should you do if a child has been raped?

Take the following steps immediately: Contact the police, preferably someone who has been trained to deal with rape. Some countries have women or child protection units. Find out whether a social worker will be available. A social worker will follow up the case and arrange for the child to be taken for a medical examination. The social worker will provide ongoing support throughout the investigation and the trial proceedings. Dont try to take matters into your own hands. If the rape has just taken place, dont allow the child to wash, but go to the police immediately. If a child is HIV negative, taking post-exposure prophylaxis (PEP) within 48 hours of being raped and then taking it for 28 days afterwards reduces the risk of the child becoming infected with HIV. (PEP is an anti-retroviral medicine.) This medicine helps to stop the HIV from entering blood cells if it is taken correctly. Trained police, hospitals or support groups can provide more information about this. It is important to act quickly.

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8
Children have rights, but they are often not aware of their rights. This makes children more vulnerable to abuse and exploitation. Thus it is very important for children, caregivers, community leaders and teachers to know about childrens rights. Each country has its own laws and (in many cases,) Constitution which defines childrens rights in that country. Most countries in Africa are also signatories to the United Nations Convention on the Rights of the Child. In this chapter we will discuss this Convention, and provide guidance on how it can be used in conjunction with the laws of individual countries by local community leaders, educators and volunteers to advocate accordingly for the rights of children in their own areas.

Background to international childrens rights

In 1989, the United Nations (UN) drew up a treaty called the Convention on the Rights of the Child. This is often referred to as a Bill of Rightsfor children. One hundred and ninety-one governments have signed the treaty. Once a government agrees to support a convention by signing it, it becomes the same as law in that country. In other words, those governments must make sure that the rights mentioned in the convention are upheld in their countries. The only African member of the UN which did not sign the treaty was Somalia as it had no recognised government. The convention defines children as people under the age of 18. It describes a new vision of children who now have legally binding rights. It says that children are neither the property of their parents nor are they helpless objects of charity. They have rights, just like other human beings: their rights are not an option or a favour. The document was drawn up over a 10-year period and was negotiated by governments, non-governmental organisations, human rights advocates, lawyers, health specialists, social workers, educators, child development experts and religious leaders from all over the world. Because it was so broadly based, it reflects the main legal systems of the world. It also recognises the importance of tradition and cultural values for the protection and harmonious development of the child. 141

What it does is provide the framework for the protection and promotion of basic human right for all children, all the time. It covers the civil, economic, social and political rights of children.

Types of childrens rights

The rights can be grouped into four categories: Survival rights which include adequate living standards and essential health care. The rights focus on the childs rights to live, grow and enjoy good mental and physical health. Developmental rights which include the rights to education, play and cultural activities. (A childs life must not only be saved, it must be worth living.) Protection rights which safeguard children against harm and address the needs of children in especially difficult circumstances for example those children who are abused, neglected or exploited as well as children with special needs, children without families and children with disabilities. Participation rights which relate to self-determination, such as the right of children to be heard on matters affecting their own lives, and the right to play an active role in society.

Have these rights been upheld?

In 2002 the UN held a special international conference on children, the Special Session of the UN General Assembly on Children, at which the nations of the world committed themselves to a series of goals to improve the situation of children and young people. Opening the General Assembly, UN Secretary-General Kofi Annan said much work had been accomplished but much still remained to do. Unfortunately, adults had failed children deplorably, he said.One in three of you has suffered from malnutrition before you turned five years old. One in four of you has not been immunised against any disease. Almost one in five of you is not attending school We, the grown-ups, must reverse this list of failures. A plan of action was adopted,A World Fit for Children. Among its pledges were to protect children and their families from the devastating impactof HIV/AIDS. There are four priorities for children in the coming decade: promoting healthy lives. providing quality education. protecting against abuse, exploitation and violence. combating HIV/AIDS.

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Obligations of 191 countries

The 191 countries which signed the Convention on the Rights of the Child should have legislation in place which promotes its aims. Even if they dont, they are bound to uphold the principles of the treaty. What are some of the principles which must be upheld? Put children first. The convention states: In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. This is of particular importance in the case of children who have suffered the loss of one or more parents. It also means that institutions, services and facilities responsible for the care or protection of children have to conform with certain standards, particularly in the areas of safety and health. There must be enough staff and suitable staff. Supervision has to be competent. Listen to children. It is not unlikely that children affected by HIV/AIDS may have other bodies make decisions about their lives. Those involved must assure the child, who is capable of forming his or her own views, that he or she has the right to express those views freely in all matters affecting him or her. These views should be listened to, with due weight being given in accordance with the age and maturity of the child. It also means that children have to be given the opportunity to be heard in any judicial and administrative proceedings affecting him or her. Protect and report children in need. Even if children are in the care of an adult, they still need to be protected. They need to be protected from mental or physical violence, injury or abuse (including sexual abuse), neglect, maltreatment or exploitation. Each of us has the duty to act when we suspect that a child may be in need of care or protection.Your country should have ways of identifying and reporting children who have been maltreated. These cases must be investigated, followed up and taken to court where appropriate. Care for children without parents. Children with one or more parent with HIV/AIDS face having to live without their natural parents, temporarily or permanently. These children should be entitled to special State protection and assistance. This could be in the form of foster families, adoption, suitable institutions or kafalah of Islamic law. When decisions are made about the childs future, thought should be given to placing the child in the same ethnic, religious, cultural and linguistic background. Children have a right to enjoy their own culture, to practise their own religion and use their own language.

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Right to education. When children are affected by the trauma of having ill and dying parents, or if they have HIV/AIDS themselves, sometimes schooling can suffer. The State is obliged to take measures to encourage regular attendance at schools and the reduction of drop-out rates. Even if children can no longer afford school, the convention states that primary education should be compulsory and free to all. No child should be discriminated against. The stigma of HIV/AIDS means children with infected parents or who are infected themselves are frequently subject to discriminatory treatment. No child shall be economically exploited. Often children with sick parents or who are orphaned find themselves trying to earn a living. They have a right to protection from any work which is hazardous, interferes with their education or harms them in any way, whether physically, mentally, spiritually or socially. Children have a right to rest, leisure and play.

What you can do

People who know their rights are better able to claim them. Promoting the Convention on the Rights of the Child and making its provisions widely known are essential steps to realising childrens rights. If you have a computer, you can look at the Unicef (United Nations Childrens Fund) website http://www.unicef.org/crc. Find out what legislation exists in your country. Childrens rights may be enshrined in the constitution, such as in Namibia, Ethiopia, South Africa and in the draft constitution of the Democratic Republic of the Congo. It could be separate legislation such as the ratification in Mozambique of the landmine-ban convention, a review of the Child Care Act in South Africa or the passage of the Sexual Offences Special Provisions Act of 1998 in Tanzania. Or it could be plans of action. Zambias Human Rights Commission formed a subcommittee on child rights in 1998 which has identified child abuse and education as key issues of concern. In South Africa, the National Programme of Action is designed to achieve co-ordination of governmental and non-governmental plans in favour of children. Mozambique has an Agenda for Action, identifying goals to be achieved for childrens rights. Uganda has developed subnational plans to guide actions at municipal level to improve the situation of children. Rwanda has created the National Assembly for Child Rights, Madagascar has established the Independent Commission on Human Rights and South Africa has established the Child Rights Committee, a statutory body of the South African Human Rights Commission. Besides finding out about legislation, you can boost awareness in your community, working with churches, schools and community groups to create grass-roots support for childrens rights. 144

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