Children Living in Institutionalised Care Facilities

by Kate Loring and Ella James
“It changed my life….”
As long term volunteers who are volunteering in an institutionalised care facility, we have heard this
sentence used many times to describe the experience that a volunteer has had after volunteering
their time to help care for vulnerable children. It is this sentence that has resonated with us and
caused us to reflect on our own approach to volunteering, and that of our fellow volunteers. Is it
possible that we are getting so caught up with our own emotions, that we are forgetting about the
emotional needs of the children? 
We would like to take this opportunity to explore the impact that short term volunteers and visitors
have on children who are living within an institutionalised care facility, and the long term effects on
the children who are being exposed to continual broken attachments.

We are both Early Childhood Educators from Australia with different looking resume’s, but similar
experiences. We met at the institutionalised care facility in Vietnam last year where we spent
several months volunteering with children who have multiple and profound learning difficulties,
some of whom are terminally ill. We returned home for Christmas and by the time April rolled
around, we had quit our jobs, sold our cars, left our family and friends behind and moved to
We have been here long enough now to watch the dry season turn wet, and as the seasons have
changed, so have the very many faces of the constant flow of people coming and going.
Some people visit the children for a minute, an hour, a day. Some pass through the rooms, only
stopping to pose with a child, or take a photo of a baby with a swelling head. Some are unable to
hold back their tears, and stand over the beds of these children and cry. Some pick children up,
only to put them back into their bed several minutes later. Some just stare.
There are people who stay longer, for a week or two or three. They are often encouraged to make
intimate connections with the children in care. They cuddle them, feed them, play with them,
change their nappies and inhabit a part of the children’s world… And then they leave. We are as
unsure as the children are, as to whether they will return or not.
In a life filled with so many inconsistencies, we have however noticed that there is always one

For anyone who has ever been to an institutionalised out of home care setting for children, you will
be able to identify the small smiling face of a child, eager to greet you, who is ready to climb onto
your knee, grab your hand or be swooped into your arms for a hug.
For us, this child is a ten year old girl. She is one of the only children amongst the sixty in the ward
where we work who is able to move and communicate independently. Despite her challenges with
steady walking, from the moment she hears voices on the stairs it takes just a few seconds for her
to cross the small room to greet them. She grins brightly with her arms raised, waiting for the next
visitor or volunteer to pick her up. She interacts with them as if she has known them for her entire
life, despite having never met them before. Most people believe that she is just a friendly kid
wanting or needing someone to play with, but it is so much more than just this…
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To really understand what is happening for this child, and children just like her, it is necessary to
first understand attachment.

The British psychiatrist, John Bowlby, pioneered the concept of attachment in the 1940’s, and used
the term ‘attachment bond’ to describe “a warm, intimate and continuous relationship with a parent
or consistent caregiver in which both find satisfaction and enjoyment. Having a secure attachment
enables a child to explore the world, learn new skills, regulate emotions and have confidence that
they will be protected. Children with secure attachments build mental models of a secure self,
compassionate people and a kind world. A secure attachment frees a child from fear and anxiety
that accompanies a sense of being alone and abandoned.”  
The United Nations Convention on the Rights of the Child (CRC) states that all children have the
right for protection against experiences that are harmful for them. This protection includes the right
to be protected against repeated broken attachments. The Guidelines for the Alternative Care of
Children are an extension of, or an implementation guide for the CRC, highlights this right by
including the guideline that “frequent changes in care settings are detrimental to the child’s
development and ability to form attachments, and should be avoided.” The guidelines also
recognise that a safe and continuous attachment to their caregivers, with permanency
generally being a key goal, is a basic need.  
While all volunteers generally have good intentions, when considering the United Nations
Convention on the Rights of the Child, it cannot be denied that the revolving door of short term
volunteers and visitors, causing attachments to be continually broken, is significantly compromising
these children's right for protection and reinforcing a cycle of abandonment.

This high turnover of visitors and short term volunteers, has been shown to negatively impact
children in care, who repeatedly try to form emotional connections with different adults. Few
tourists or volunteers are qualified to interact with traumatised and vulnerable children. Many
volunteers see it as their role to provide love and affection, thus building an emotional bond with
the children. However, when the volunteers leave, these bonds are broken and the children are
once again left feeling abandoned and confused.
According to Kali Miller, a Ph.D and researcher in psychology , some of the common effects of
insecure attachments for children experiencing constant abandonment within institutionalised care
settings are;

- behaves in an overly affectionate or indiscriminately friendly manner towards any adult (even
- willingness to go off with unfamiliar adult with minimal or no hesitation 
- superficially engaging and “charming”, phoney
- destructive to self, others and material things 
- no impulse control, frequently acts hyperactive 
- inappropriately demanding and/or clingy 
- extreme attempts to control and/or manipulate 
- has an excessive need for attention, praise and/or approval 
- heightening their emotion expression to gain attention from adults 
- overly clingy and/or proximity seeking 
- trying to please the adult in order to receive praise and attention 
- impaired play (often needs adult direction)
- impaired sense of trust (asking where you are going? are you coming back?)
- difficulty focusing 
Early insecure attachment does not necessarily predict difficulties, but it is a liability for the child,
particularly if similar caregiving behaviours continue throughout childhood. Compared to that of
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securely attached children, the adjustment of insecure children in many spheres of life is not as
soundly based, putting their future relationships in jeopardy.  

We are not against volunteering and we encourage and support volunteers who have given careful
consideration to the impact that they will have on the children.
For the ten year old girl we mentioned earlier, even a simple smile or a “hello” from a visitor or
volunteer can give her the expectation or false hope of creating a new attachment with them.
It is important for us to continually examine and adapt our own interactions and practices with all of
the children. While we are long term volunteers, it is still more important for us to reinforce and
support the attachments between the children and their primary Vietnamese caregivers who will
continue to be a constant and reliable source of care.
We have been lucky enough to witness some very genuine moments between the primary
caregivers and the children. These moments need to be celebrated and encouraged. Rather than
volunteers trying to take on a short term caregiving role, they should be advocating for the children
and their permanent caregivers to develop a more secure attachment. This means that the
permanent carers are the ones who should be doing the caregiving tasks such as; feeding,
bathing, nappy changing, comforting and playing with them. The interactions that occur during
these daily routine tasks are an important opportunity to build and secure the attachment between
the children and their permanent carers.
We ask you to imagine your own child, or a child that you love and care for, running into the arms
of stranger, attempting to secure an attachment with them, only to be left behind… 
This is the situation we see these children in everyday.


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John Bowlby (1988), A Secure Base: Parent-Child Attachment and Healthy Human Development. Great Britian and U.S.A. Perseus
Books Group.
United Nations (2013): Convention on the Rights of the Child. Adopted and opened for signature, ratification and accession by
General Assembly (1989) entry into force 2 September 1990, in accordance with article 49
United Nations, (2009) HUMAN RIGHTS COUNCIL Eleventh session. Agenda item 3.
UNICEF (2011), With the Best Intentions….: A study of Attitudes Towards Residential Care in Cambodia. UNICEF Cambodia Child
Protection Team
Kali Miller, Ph. D, 2014, Taming Tiny Tigers: Understanding and Treating Reactive Attachment Disored (RAD), Corinthia Councelling
Centre, Inc
Karen R. (1998). Becoming Attached: First Relationships and how they Shape Our Capasity to Love. Oxford and New York: Oxford
University Press