A child in my care is self-harming

A child in your care hurting themselves is one of the most worrying and scary things any foster carer has to face, and it will have a big emotional impact upon you, even if you’ve experienced it before. As terrifying and incomprehensible as it can seem, it’s actually quite common for traumatised children to do this, and it’s not any reflection on the care you provide them, nor their feelings about you. I hope that this blog post might help by explaining why some children self-harm, and suggesting ways you can respond.

What is self-harm?

Different behaviours can be seen as self-harm. These can include scratching, bruising, burning and cutting themselves, by pulling their own hair, and by overdosing. Self-harming is not usually an attempt at suicide, and nor is it usually a cry for attention – it is a way of coping. Once a child begins to self-harm, and finds it brings some temporary relief to their emotional turmoil, it can become a compulsion. The child may feel an instant relief of pressure, but it is brief and often replaced by feelings of guilt and further pressure – this is how the cycle continues.

What causes a child to self-harm?

It’s not always easy to work out the causes, and the child may not know themselves. It’s often a coping mechanism for past or present trauma. The child may be being bullied, struggling to cope with separation and loss (often a particular issue for Looked After children), grieving, or perhaps they are feeling rejected, unworthy, lonely, angry, sad, out of control or even just numb, and worried about why they aren’t feeling anything at all. There’s a link between depression and self-harm – sometimes the physical pain that is caused by self-harming is easier to deal with than the emotional pain they struggle with. Sometimes, children punish themselves by self-harming, for something they have done, or for something they have been accused of doing.

How you will know if the child in your care is self-harming?

Sometimes they will tell you or show you, and it’s important that you respond in the right way if they do – I’ll come back to this later. More often though, children hide injuries caused by self-harming, sometimes going to great lengths to do so, and try to explain away their injuries as ‘accidents’ if they are found out.

Physical signs of self-harm are commonly on the child’s head (bald patches), chest, wrists, arms and thighs (cuts, bruises and burns). Some children will pick at wounds just as they are healing, and this can be a form of self-harm. Emotional signs are low self-esteem and self-blame, depression, tearfulness and low motivation, unusual eating habits (sudden weight loss or gain), drinking or taking drugs, and becoming withdrawn and isolated (perhaps isolating themselves in their bedroom).

How should you respond?

The first and most obvious thing to say is that if a child is physically injured, they may need medical attention. In this case try to stay calm and try not to voice disapproval whilst you provide first aid. It may be that you provide them with first aid supplies and give them verbal guidance – having control can help a child deal with the situation. If their wounds require medical attention, don’t delay going to the hospital.

Beyond this immediate response, which will undoubtedly be recorded on an incident form which you will pass on to your Placement Manager (don’t forget!), you need to involve the child’s Social Worker and your Placement Manager. You need to listen to their advice because they know the child in your care and will have their own views. They are best placed to help you try to understand what is making the child self-harm, and what the ‘triggers’ are. Dealing with the causes is much more effective than taking away the means by which the child is self-harming, because anyone who really wants and needs to hurt themselves will find a way to do so. That said, we have Health & Safety and Safe Caring policies for good reason!

Here is some general guidance on how to approach this issue:

  • Try to stay calm. Do not take it personally or blame yourself;
  • Let the child know you are there to support and help them – never give them the idea that their self-harming is a big problem for you. Tell them that you understand that self-harm helps them to cope, but that it is only a temporary relief. Explain that you want to help them with the problems that make them want to hurt themselves, so that they can feel happier in the long run;
  • Remember that the severity of the injuries doesn’t reflect the child’s suffering – minimising the extent of the injuries by giving the message that ‘they aren’t that bad’ could make things worse.
  • Sometimes it’s possible to reach an agreement with the child that they’ll come and tell you when they’ve self-harmed. If the child wants to talk about their self-harm and why they’re doing it, sit down and listen. If they’re finding it hard to speak to you face-to-face you could suggest they put their thoughts into an email or letter instead;
  • Instinctively you are likely to want to constantly monitor the child, but by allowing them their own space you’ll help build up their confidence and trust – try to find a balance between monitoring what they’re doing and respecting their privacy;
  • Build their confidence, which will build their resilience – support them in the pursuit of things they can do well and be praised for and become proud of, or help them find such things; and
  • Help the child find new ways to cope – instead of telling a child to stop self-harming, it’s often more constructive to suggest alternative coping techniques. Lots of children have said that the following activities have helped them: painting, drawing or scribbling in red ink; holding an ice cube in their hand (this can be very effective, but DO NOT suggest this without the prior written agreement of the child’s Social Worker); writing down their negative feelings then ripping the paper up; listening to music; talking to friends or family; taking a bath or shower; exercising; watching their favourite funny film. You might suggest that the child delays harming themselves for 15 minutes when the compulsion first arises, to see if it abates – if not, try to delay again. Some therapists suggest that a child place an elastic band on their wrist and ‘snap’ it against their skin as an alternative to self-harming. I’m wary of this suggestion because it’s still a form of self-harm (although the harm is likely to be ‘less’) – again, DO NOT suggest this without the prior written agreement of the child’s Social Worker.

Please remember that you do not have to face this difficult situation alone – your Placement Manager is just a telephone call/email/text message away! Let them know what’s happening – they’re there to support the child in your care, by supporting you.

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