Author: Cheryl Wallace

Introduction Managing the unknown Ideas to support your child’s return to school Practical tips Decision-making Top tips for decision-making Top tips when feeling stuck Managing worry when returning to school Making space for emotions Postponing worry ideas Looking after yourself Workbook

Hospital Education Service is part of Glasgow Virtual School

Returning to school after illness
Introduction
This leaflet provides some advice about coping with the feelings your child might have when returning to school after being unwell in hospital.
Support your child to stop, take a break and try something else if they have any significant discomfort or distress while trying any of these exercises. Talk to your child’s consultant if there’s any medical reason why deep breathing exercises may not be appropriate.
Returning to school can be very worrying for young people. If they’ve missed any school milestones, they may worry about things being different to how they remember.
For children, being at home or in hospital can feel really safe, compared to being in the outside world. In the short-term, staying away from real or possible threats can make worry smaller and make us feel safe.
Unfortunately, when we avoid a perceived threat, it often increases the worry in the longer term. While in hospital, your child will have had to stay away from the outside world and they’ll have had fewer chances to be apart from you. Therefore, they may be worried about being away from you when they’re back at school doing normal activities.
Managing the unknown
For many young people and their parents, a period of ill health means getting used to not knowing what will happen next and having to adapt to new medicines, medical teams or environments. This can lead to more ‘What if …?’ thoughts, which can make us feel even more worried.
Unfortunately, with some illnesses the treatment and prognosis can be very hard to predict. This can make us feel worried, angry or sad.

Ideas to support your child’s return to school
Talk to the school
Speak with your child’s school to find out what changes have been made and what steps can be taken to help your child to prepare for their return. Speak to your child’s medical team about any adaptations they would recommend.
For some children, it will be appropriate to arrange a ‘phased return’, involving a gradual increase in the amount of time your child is at school.
Talk to your child
Talk to your child about what going back to school might be like and what might be different. For most children, preparing in this way helps them to feel less worried.
Encourage your child to talk to you or another adult they trust about any worries they have. As well as being open to their worries, think with your child about what they might be looking forward to about going back to school.
A few tips for talking to your child about returning to school:
Talking about returning to school doesn’t have to be a one-off chat. Instead, take pressure off and think of it as an ongoing conversation. Some children find it easier to draw or write things down rather than talk face-to-face about difficult things. Sit next to, not opposite, your child and help them to draw or write down their thoughts.
Make sure that you can find a time when you can listen without any distractions. Notice your child’s worries and experiences, and accept them as true. Try to understand where the feelings come from rather than moving to problem solving immediately.
Use clear, factual language suitable for your child’s stage of development. Use open questions (questions not answered with ‘yes’ or ‘no’) if your child can answer these (this will depend on your child’s age and understanding). It’s OK to say that you don’t know the answer to a worry or concern.
For some children, it can be helpful to prepare a few lines that they would like to use to explain to their classmates about why they’ve been off school. If your child would like to do this, think with them about what they’d like their friends to know and practise ways that they can share this information.

Practical tips
Get back into a routine.
Practise the route to school.
Build up confidence by trying a ‘worry ladder’ (see workbook).
Your child might be nervous about doing things outside the home after being inside for a long time. It’s best to build up their confidence slowly, using a structured approach, such as a worry ladder. A worry ladder can help to break up the goal (such as spending a day at school) into many smaller steps that can be tried at your child’s pace. For example, the step 1 might be going outside for a short walk.
Your child might find it difficult to be apart from you. When goodbyes are difficult or upsetting for them, it can be tempting to ‘sneak off’ when they’re distracted by friends or teachers. For some children, realising their parent has left without them knowing can be scary. Instead, agree a way to say goodbye before getting to school and make sure that your child is aware that you’re leaving.
Decision making
Making decisions as you adjust to a new routine can feel
overwhelming, especially when we’re trying to decide how to keep ourselves and our families safe. Though difficult, it can
also give us a sense of choice and control.
To make decisions, people often weigh up the pros and cons of each option. It can be helpful to write these down (see workbook).
Top tips for decision making
Think of how much each positive and negative means to you, your child and your family.
Use sources of support and information that you can trust. Think of people and places you can find this (family, friends, support groups, medical team). Think about what support you might need if choosing to make a change (or not to) and how easily you can access this.
Older children may want to make decisions for themselves. Try brainstorming, which your child might be used to doing at school already. Help them to write the options available and think of positives and negatives. Support them to talk to friends who might be making similar decisions too.

Top tips when feeling stuck
When we face lots of change, we can get stuck in the decision-making process:
If you’re choosing between two options (e.g. ‘A’ or ‘B’), try planning for the best and
worst possible outcomes of both, thinking about what you and others can do in each
case. Talk it through with someone you trust. Put your worries into words with some
one who understands your point of view. They might help you consider different
ways of thinking.
Remember that it’s OK to not have the answers and to ask for help, or to change your
mind based on new information or experiences. Take a break. Feeling stuck can
make us feel unable to move forwards, as though we’re frozen. You might feel there
are lots of decisions you need to make every day.
Don’t forget to keep some time for you and your child to do something that feels
safe, enjoyable or reminds you of all of your skills.
Managing worry when returning to school
Below are some techniques to use with your child. It’s helpful to try these first when your child is calm so they’re used to them.
Deep belly breathing
When we feel worried, our breathing becomes quicker and more shallow. Taking slow, deep belly breaths tricks our body into thinking we’re calm.
Get your child to sit comfortably in a chair with a hand on
their chest and the other on their tummy. When breathing in,
the tummy hand should go out; when breathing out, their tummy hand should go in.
The hand on their chest should not move too much.
Or, get them to lie on their back and put an object on their tummy (e.g. a
small toy). Have them breathe in to move the object up and out to bring it back
down.
Using their hand as a guide, support your child to trace the outside of their hand with
the fingers of their other hand, breathing in while going up the finger and out while
going down until all fingers have been traced. Make sure their breathing rate is slower
than normal but still comfortable.

Grounding exercises
These help us tune out from worrying thoughts by helping us focus on the present moment. When worried, your child could try:
Naming 5 things they can see, 4 things they can feel, 3 things they can hear, 2 things
they can smell or taste, and taking 1 deep belly breath.
Jumping up and down on the ground, noticing the feelings this makes in their feet
and legs.
Rubbing their palms together quickly, noticing the sound and warmth this makes,
then reaching their arms up to the sky. They can stretch like this for 5 seconds, then
drop their arms and relax.
Taking a special object they can keep in their pocket. When they’re worried, they
can focus on everything about this object using their different senses (e.g. touching it,
looking very closely at it, knocking it to hear the sound, smelling it).
Making space for emotions
Children need to understand that whatever they are feeling is okay. They should know that other people have probably felt the same as them at some point.
For example, try telling them, “I know you feel disappointed because we can’t do our normal summer activities. I feel
disappointed too”. Equally, it’s important for children to be aware that it’s okay to feel differently to others. There’s no ‘right’ way to feel.
Understanding what we can and can’t control is important. When we focus on things we can’t control, we can feel worried and overwhelmed. If we focus on what we can control, it can help us feel calmer and less worried.
With your child, you could draw around their hand, or draw a big circle, writing inside what is ‘in my control’ and outside the shape what is ‘outside of my control’.

Postponing worry ideas
Sometimes we worry about things that are out of our control. These thoughts often start with “What if …?” Instead of getting into a ‘tug of war’ with these thoughts, we can choose to recognise the worry but to deal with it later.
Support your child to write down their worries (they could even make a ‘worry
post-box’) to post it in. Agree a time, later that day or week, to think about this worry.
Agree to think about any worries that have been written down for a set amount of
time (e.g. 15 mins).
Focus attention on the present by trying a grounding exercise or something more fun
than worrying (e.g. watching their favourite show, playing a game, doing some drawing
or chatting to friends or family).
Come back to the worry together, at the agreed time, to think about what would be
helpful to reduce this worry.
Looking after yourself
As parents, you are very important in helping your child to understand their emotions. It’s important that you look after yourself, so that you can calmly and consistently respond to your child when they get angry, upset or worried. We often call this self-care.
Self-care takes many forms and it’s important to take time to find what helps YOU to feel calm. Think about ways to include these it as regular activity in your week. Good self-care helps you address your physical, psychological, social or spiritual needs.
Examples of self-care habits that you could try are:
Eating regular meals
Speaking to, or asking for support from, friends and family
Listening to music or reading a book
Finding time to yourself
Practicing mindfulness or meditation
Expressing emotions
Doing exercise
Practicing some of the strategies included in this booklet

Workbook
Facing my fears
To develop confidence facing your fear, you need to build up slowly, just like climbing a ladder.
Write your big fear (this might be ‘going back to school’), then on each step, write down a smaller step you can take to work towards this. For example, one step might be ‘practise the trip to school’, or ‘spend an hour away from Mum and Dad’.

I am working towards:

Decision making
Use this worksheet to help with decision making. List all the positives and negatives of making or not making the change.

Support and more information
Websites
Childline Calm Zone
www.childline.org.uk/toolbox/calm-zone/
NSPCC
www.nspcc.org.uk/keeping-children-safe/support-for-parents/talking-about-difficult-topics/
www.nspcc.org.uk/keeping-children-safe/away-from-home/at-school/
YoungMinds
https://www.youngminds.org.uk/young-person/coping-with-life/problems-at-school/
Story books
The invisible string, by Patrice Karst (2018)
My back-to-school bubble, by Hilary Rogers (2020; available online only)
How to contact us:
You’re welcome to visit us at Hospital Education Service and meet our staff.
If this is something you’d like to do, or if you have any questions, please don’t hesitate to contact the HES Leadership Team at::
Anne Gillespie
(Lead for ILS and Hospital Education Service)
Hospital Education Service
Stobhill School
Stobhill Hospital
133 Balornock Road
Glasgow
G21 3UW
Tel: (0141) 232 6630
E-mail: office@hes.glasgow.sch.uk

OUR VISION, VALUES AND AIMS

Glasgow Virtual School’s Vision, Values and Aims are under development

Hospital Education Service

VISION
Hospital Education Service will work in partnership with medical staff, schools and parents to support the learning, health and wellbeing of each young person while they are in hospital.
VALUES
Nurture
Believe
Achieve
AIMS
HES will:
Provide high-quality teaching to raise attainment and achievement
Meet each pupil’s needs regardless of any barriers to their education
Build positive partnerships with our Multi-Disciplinary Team, parents and schools

Date	What you did really well	How it made you feel

Positives of making a change	Negatives of making a change
Positives of not making a change	Negatives of not making a change