Placing a sick child in our midst: case study | Paul Nash [ANVIL vol 35 issue 1]

Portrait photo of Paul Nash
The Revd Paul Nash has worked at Birmingham Children’s Hospital since 2002 and since 2018 has been the chaplaincy and spiritual care team leader at Birmingham Women’s and Children’s Hospital. He manages a multifaith team with specialisms in spiritual care with children, bereavement care and staff support. Paul is the co-founder of the Paediatric Chaplaincy Network for Great Britain and Ireland and launched the Centre for Paediatric Spiritual Care, a hub for research, resources and study. He is a board member of the UK Board for Healthcare Chaplaincy and a lecturer for the Midlands Institute for Children, Youth and Mission.

Several years ago, I was given the opportunity to develop a series of four children’s books. The aim was to engage and support Christian children at Key Stage 1 while they visited hospital, stayed in hospital, learned they had a life limiting illness and became a bereaved sibling. We found a publisher who was interested, Christian Education, [1] who had a wonderful editor, Victoria Beech, who was passionate about the project.

We worked on the books with members of the Paediatric Chaplaincy Network and a talented illustrator. The editor and illustrator spent many hours shadowing the chaplaincy teams, spending time with patients and their families to get an insight into the world, views and feelings of children in hospital and bereavement. Small groups worked on each book, with the full spectrum of enjoyment, insight, frustration and writer’s and design block. We struggled with how we could communicate with young children aged three to seven about the potential worries and concerns they might have over their illness or bereavement. We consulted with children and other experts in the field as we sought to take equally seriously their age, developmental issues, medical conditions, grief, loss and faith. We worked hard to get the spread of gender, condition, treatments and time of year so as to appeal to as wide a spread of children as possible. We struggled and debated with what aspects of the Christian faith were essential to communicate with and to the children in these difficult, sad situations.

As the project moved along, we found we had achieved all we wanted and more in each book. Each book picked up an aspect of our Christian faith that engaged and encouraged the children: Jesus is always with us in hospital, there is a place prepared for us in heaven, Jesus still loves Jo when he is angry and lonely after his sister has died, for example. The publishers then realised we needed a series title for the books. If we thought we had done all the hard work, we now received a shock – we could not find anything we liked. It was not that we as individuals had suggestions that others disagreed with; we just had nothing. Time was running out as we approached our printing deadline for our launch date. Where is God and God’s word when children are sick, dying and bereaved? We prayed, threw silly ideas around, discussed objectives and values, but nothing stuck.

No methodology was working. What was the theological truth that would reflect our series? What is the Christian message to sick children if “theology is thinking and talking (logos) about, from, towards and with God (theos)”? [2] Helped by the story in Matthew 18, I began to realise the significance of putting a child in the middle of a theological argument. This concept has been developed in to a book, Entry Point, [3] which has continued to inspire my thinking as a chaplain at a children’s hospital.

It was suggested that all of us should meet together, so the publishers, writer, advisors and illustrator all met in a small room in the Emergency Department of Birmingham Children’s Hospital to try and resolve the issue. I thought and prayed about how we might find and discover a title that would explain the Christian message that covered all the different and varied conditions, expectations and voices of these children. I had been reflecting upon child theology (CT) and its values and objectives and had a growing confidence this would help us move forward. I arranged for the tables to be put in a square with a space in the middle. As we met and prayed, I suggested we imagined a poorly, dying, bereaved child in the middle of our space. We asked ourselves two questions:

  • what would, might the child want to say to us?
  • what would we want to say to the child about God and our faith that would always be true for these children?

I cannot say that initially the voice of the child was heard clearly, but we became more confident that by placing children from our hospital in our presence, in the middle of us, that we would hear the voice of the child. As we visualised this, we sought to imagine what these children would want to say to us, what we can always know, want to know, feel and trust in this? What would God always do for all these children in all these circumstances? The very ill, dying, petrified child; those whose development had been affected by their condition; the suddenly and long-term ill; those with certain and unknown diagnoses. 

We were not able to bring a real child into the room due to pragmatic health and safety and safeguarding issues, but as the CT Movement Cape Town consultation says in these circumstances, “we brought the children with us in our hearts and minds and made them present in our shared imagination”. [4] As we threw around potential universal words of comfort, support for all children, promises of salvation, peace and of God never leaving us, we reflected on biblical truths that we had used in the individual books.

What was it the children would say they needed from Jesus, from God’s people, while they were vulnerable, susceptible to discouragement, fear, loneliness, stigma? Where are the words and actions of love, peace, hope, compassion, comfort, assurance, truth, liberation, blessing?

We heard words and phrases like carried, supported, never alone, always loved. None of these seemed the right voice with the truest message for all the contexts of all four books, from visiting hospital to losing your sister, brother or friend. We became more confident that our methodology was honouring to the children and God, but finding the common voice was still a little unclear.

The words we heard the clearest from both perspectives were that we will always be “Held in Hope”. This is the title we chose to use for the series. This voice, desire, need of the child, promise of Jesus, resonated around the room.

This seemed to capture what is always true. Healing in the most obvious physical sense may not always happen. Yet God always holds us. Feeling better, the pain going away is certainly not the experience or something that can be promised to a child with certain diseases or conditions. Yet we can hope for spiritual, physical and mental relief now and in the future. I can look any poorly child in the eye, heart and spirit and say they are always held tightly in and with hope. Children may be offered comfort and love, but may not always feel it, yet we assure them that God loves them, cares that they are in pain and wants to be with them in it. God holds them close, feels their pain and does not abandon them. This is why I frequently read the “Footprints” poem to many adults; it was then that God carried us. Some of these children will not get better, some will die, but surely there is a word from God to sustain us in the midst of all kinds of suffering? A child in the midst helps us with pain and suffering in the midst.

Reading and rereading the international reports from the CT Movement reminded me that all the contexts were ones where children were most obviously suffering by way of oppression, being ignored, exploited, misunderstood, abused, stigmatised, marginalised, victimised, abandoned, were stricken with poverty, lacked opportunity and were being prejudiced against. Perhaps being held in hope is a theological insight, considering Jesus and a child in the midst that is universally relevant. Perhaps this is the test, this is what children in these circumstances would say – the same as the poorly children in our hospital: we are always “Held in Hope”. We need this and further robust practical theology to ensure that we are liberators of children’s spirits, not oppressors.

CT was and continues to be helpful and directive in the thinking and practice of pastoral care with sick and differently abled children. As the chaplaincy and spiritual care lead for the children’s hospital in a city where the majority of children and young people are from a non-white minority ethnic background (over 60 per cent in 2011), it has become essential for us to engage with illness in children theologically and culturally. Too often children have picked up implicit and explicit messages that illness and death are their fault, that they have done something wrong and it is a punishment.

When we think about God’s promises for children in trouble while engaging with parents, the idea of a protective personal angel for their child gets mentioned. I have thought for a long time now there has not been enough exegesis, writing and reflection on Matthew 18:10: “their angels in heaven always see the face of my Father in heaven”. Are the angels as well as God and God’s people holding the children in hope?

I do not think we would have come up with such a profound theological, pastoral, spiritual and psychological truth if we had not invited and placed a child and Jesus dialoguing with us in our midst. In continuous reflection what else might I hear from these children in our midst? Perhaps it is most appropriate that I conclude with an encounter with a child in hospital. We have developed a discipline of Spiritual Play to facilitate the children and young people engaging in their spiritual needs, resources, pain, suffering and distress. These activities are very participative and help with assessment. One of the activities uses Russian dolls for the children to name, decorate, etc. One child in our hospital was offered and accepted this activity. She pulled them all apart and put them back together again. She then held two of them up and asked the chaplain, “So which one of them is God like – the small one that lives inside of me or the big one that surrounds me?” The chaplain, understandably, was stumped at the time; on reflection, we would want to ask her what does she think and gently suggest both.

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[1] See Christian Education website for details of the booklets discussed. They are also available on the Paediatric Chaplaincy Network website as free videos narrated by Bear Grylls.
[2] Haddon Willmer, cited in John Collier (ed.), Cape Town Consultation on Child Theology (London: The Child Theology Movement, 2004), 7.
[3] Haddon Willmer and Keith J. White, Entry Point: Towards Child Theology with Matthew 18 (London: WTL Publications, 2013).
[4] Collier, ed., Cape Town Consultation, 3.

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