Social relationships play an important role in normal child development. Children develop their sense of identity and self esteem through their relationships with others. Parents and teachers need to be sensitive to signs of anxiety, depression or low self esteem if a child is struggling to make and keep friends.

Lack of inhibition, impulsiveness, intolerance, reduced anger control, poor judgement, a drop in motivation and insensitivity to others can be issues for some people for varying lengths of time following a brain injury.

The effects of these behaviours can have an impact on a child's ability to make friends, and puts them at risk of alienating peers and others. Sometimes these changes are less visible and interactions may change in more subtle ways.

Strategies to help children make and keep friendships

At school

Teachers can:

• let classmates and friends know of the changes they can expect before the child returns to school. The rehabilitation team at the hospital can help with this preparation
• organise a 'buddy' system with different students to help the child with things like getting to different classes, preparing for the next class/subject, lunch time/playground activities
• model 'inclusive' behaviour in the classroom and playground
• change activities and tasks for the whole class to include the child with the brian injury
• include, use and encourage activities that promote social interaction and appropriate social skills into class time
• ensure the child has opportunities to rest at school because difficult behaviour can happen more when the child is tired
• keep in close contact with parents and deal with any discriminatory or bullying behaviour immediately if it arises

At home and in the community

Parents and carers can:

• discuss with your child their interests, what they would like to do and the sort of people they might like to meet. Sport and leisure activities, community centres and groups, specialised social clubs and churches are some of the places where friendships can be fostered
• you may need to help your child make social arrangements if they have difficulty planning activities. This may involve inviting friends over to your house, suggesting activities and helping with supervision
• social skills can be practiced through role plays. For example, you can practice 'greeting skills', taking turns, listening and talking, humour, etc.
• inform the appropriate people about your child's brain injury so they understand the behaviour and respond appropriately
• give your child time, patience and help to relearn appropriate social interactions and social skills

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.