Like adults, children have unique personalities: some are anxious, some are fearful, others are more resilient. Children do not have the ability to apply reason and logic to situations like adults can.
Many people worry about the amputation traumatising their children and while this may happen most children are very resilient if reassured that they will be safe.
Children are quite intuitive and will take on the emotions of adults around them. If adults show fear, anger or sadness relating to the amputation a child will assume they should feel the same. Demonstrate to the child how they should feel by behaving in that way yourself.
When you discuss the issue with children their age plays a major part in what to say. A child under four will not be able to comprehend amputation so simple explanations will often work. Very young children are usually satisfied with answers such as “Granddad had a big ouchie”
Children of preschool age have difficulty with logical thinking and separating fantasy and reality. A young child may fear losing a limb because “Granddad’s leg fell off so mine could too”. They do not have the ability to rationalise the situation. When talking to young children think about how you describe the limb loss, if you are vague such as “I was sick so the doctor cut my leg off” a young child may become fearful of doctors or minor illness.
At this age explain as best you can what happened, reassure them it is not going to happen to them and give them enough details to satisfy their curiosity. You can use art and play to assess their feelings such as drawing, storytelling and role playing. You could also find books about disability to read with them.
From preschool age to about seven children have ‘magical thinking’ where they believe that their thoughts or actions cause things to happen in the real world. If they were ever angry at you before the amputation they may blame their thoughts for your amputation. They may try to behave very well or act as if nothing is different in the hope the amputation will go away. At this age you can ask a child why they believe something happens and they can usually explain their thought process to you.
Children often hide their magical thoughts so talk about nobody being at fault even if your child has not raised the subject.
You cannot change these types of thinking so reassure a child that they have not done anything wrong and describe the amputation in simple clear language. Some children worry more than others so take cues from the child, if they seem worried or fearful reassure them.
Children are distressed by a lack of stability and appear to have worries that, to an adult, seem selfcentred, for example “If daddy can’t walk he can’t teach me to ride a bike”. Children fear abandonment and loss of routine; they need to know that the adult is still the same person and they will still love and nurture the child. Children like to help, this can be used to make them feel more comfortable about the amputation. Allow them to help if they want to but do not overburden them or expect them to take on adult tasks.
If a child wants to know about prosthetic limbs show them how your’s works. You can make games out of learning new words related to prosthetics. You can take the child to meet your prosthetist and watch the casting. To desensitise the child read stories about differences or make a scrapbook of pictures of people using mobility aids. If the child is not comfortable with your prosthetic limb or stump do not push them into looking at or touching them.
Once a child reaches about eight years of age they can have the situation explained to them in detail. From this age on a child is more likely to be upset about not being told what is happening then develop fears about losing their own limb. They still need reassurance that you will be the same person and their needs will be met.
