Children and Grief

Parents and caregivers usually do everything they can to protect children from the realities of pain, illness, tragedy and death. However, with the increases in violence, poverty, separations and divorce, the rise of drug-resistant illnesses, not to mention the loss of pets, and the loss of friends due to relocation, it is often unavoidable to prevent children from experiencing loss. As children experience these losses, they will grieve. By supporting them, as they work through their grief, parents and caregivers help the children to not only adapt to the immediate loss, but also to learn adaptive skills that will help them face inevitable and subsequent losses.

Death is a difficult concept for most young children to grasp. As they grow cognitively, emotionally, socially and spiritually, their concept will change. The age of a child/adolescent and a child's/adolescent's perception of death must be understood before any interacting can begin.

The ways in which a child grieves is similar and yet different from an adult. Children can experience grief physically, emotionally, cognitively, spiritually and behaviorally. They, like adults, can experience the fluctuating emotions. However, they may revisit their grief as they develop and as their understanding of death deepens. The child's expression of grief may be intense and episodic, and it may manifest in regressive behavior, acting out, sleep disturbances and/or changes in grades or attitudes. A grieving child will need assistance at each level of development. He/she will need assistance in building coping skills and in finding a sense of closure surrounding his/her loss.

The following is a broad example of how children at different chronological and emotional levels experience grief.

Birth to age 3: Children that are younger than four can sense that something is wrong, as they experience the grief of their primary caretaker. Anger, crying, searching, lack of appetite, and finally quiet resignation are some of the ways in which a child will grieve. A child this age should not be passed from caretaker to caretaker. The grieving infant or toddler needs large doses of care that include holding, cuddling, and stroking. A child of this age may view death as a loss, separation or abandonment. They are less disturbed by losing someone than an older child might be, due to their difficulty in understanding the entire concept. As long as their security remains intact and schedules remain as normal as possible, they eventually make it through. Children at this age take their cues from the security or lack of it that is around them. They gain security and transition based on the living caretakers' response to grief.
Ages 3 to 6: At this stage, a child sees things as reversible and temporary. They have a limited and literal understanding of death. These children may believe in what is called "magical thinking" and may believe that their thoughts can cause things to happen. They may blame themselves unnecessarily or believe if they were "good", enough perhaps the one who is gone will return. Children at this age often experience nightmares, confusion, revert to an earlier stage of development or may even seem to be unaffected by the death. Caretakers can facilitate therapeutic role-play by sitting with the child as he/she plays with dolls, stuffed animals, puppets, toy cares, and dollhouses. By looking for aggression in the play, the caretaker can then explore the anger with the child. Because thinking is literal at this stage, death may be explained in physical terms.
Ages 7 to 8: Although "magical thinking" still plays a role in this age group, seven to eight year olds often become fearful because they can begin to see the finality of death as they realize for the first time that it is real. At this age, children have begun to gain self-identity through their peers, although they are still very family-oriented. They can now grasp more abstract concepts such as truth, time, space, and death, and may be able to express themselves orally, especially the primary feelings of mad, glad and sad. Because a child of this age may fear that death is a punishment for improper behavior, they may need to be reassured repeatedly that they did not cause the loss. They may show an unusual interest in knowing the details surrounding death. They may ask what happens after death. On the other hand, they may act as though nothing has happened. They often watch how others respond and may want to know how they should act. They may begin to feel fearful at losing a parent, even though the loss may not involve the child's parents. They are also often fearful of their own death at this stage. The child should feel free to express his/her fears and feelings.
Ages 9 to 11: At this age, children are now understanding that death is final and irreversible. They know it could happen not only to someone else, but also to himself or herself. They begin to exhibit more adult like reactions, including shock, denial, anxiety, fear, anger, depression and even withdrawal. They may act out their grief by behavioral changes at home or school. Children at this stage are not only sensitive to their own feelings, but also the feelings of others. Although they still need support and comfort for themselves, they can show empathy and can be a source of support and comfort for others. The ability and the opportunity to help others during this time may actually help them deal with their own feelings.
Ages 12 to 17: The adolescent is at a stage in life where death is something they do not want to look at. Sometimes self-destructive behavior, such as alcohol or drug abuse is a means of telling others that they are not afraid of death. The real meaning beneath the behavior, however, is the need to control their fear and insecurity by making death a game. Loud music, moving fast are ways that adolescents escape from having to face their fears. When met with the loss of something or someone important in their lives, the adolescent's self-centered values may cause them great fear, guilt, anxiety, and anger. They have the capacity for empathy with other grieving family members or friends, so their pain is doubled. They may respond well to another adult such as a pastor, school counselor, or a support group of their friends. They may be reluctant to participate in their own family grief or support groups. It is normal at this stage of development for the adolescent to reach out to someone other than a family member.

Children who are having serious problems with grief and loss may show one or more of the following signs:

An extended period of depression in which the child loses interest in daily activities and events
Inability to sleep, loss of appetite, prolonged fear of being alone
Acting much younger for an extended period
Excessively imitating the dead person
Repeated statements of wanting to join the dead person
Withdrawal >from friends
Sharp drop in school performance or refusal to attend school

Children of the new millennium have been exposed to life situations and information that were not issues in the lives of children of the past centuries. Along with non-death related situations such as divorce, separation, foster care and abandonment, the children of the late nineties and early in this millennium have been exposed to terrorism, abuse and violence. The main consideration is how do parents and caregivers help these children learn coping skills that will help them adapt in a positive way as they grow into adulthood. There are many resources in communities nowadays that can help lend support in the aforementioned areas. These resources can be found in churches, synagogues, human resource organizations, some hospitals where counseling is offered, school counselors, and through private counseling or therapy.

The information should be aimed at the emotional and developmental age of the child. A carefully thought-out explanation regarding a death or illness is preferable to an emotional blurting-out, although that may be difficult for family members who are dealing with their own pain. While younger children may respond to symptoms of illnesses as causes of death, elementary children may need more concrete and exacting examples. Telling a child only what he/she can comprehend, without being evasive is often the best technique. A too-complicated explanation might confuse the child. Use language that the child can understand.

The manner in which the information is given is important. Be aware of the tone of voice. Try to answer the questions in a matter-of-fact way without too much emotion. A child may ask the same question repeatedly. Repeating questions and getting answers helps the child understand and adjust to the loss of someone loved. Therefore, patience on the part of the caregiver is of utmost importance.

Funerals, memorial services, and other such rituals can be important events in helping children accept the finality of death. Attendance at these services provides an opportunity to show respect and say goodbye. It is crucial to prepare children, however, for what will happen, what they will see, and how people present are likely to behave. Families should not force the children to attend visitations or viewings or to be involved in other rituals. Families should give children information with which to make their own choices, as much as possible, and those choices should be respected. Being aware of the importance of connections made by visiting the cemetery, or by having an object owned by the loved one is also important.

There is another type of grief that has been identified as "Complicated Grief". The grief process is normal and natural after a loss, however, when children become stuck in the grieving process, they are denied access to the flowing process and can loose touch with their feelings, or these feelings can become ambivalent and in conflict.

The following includes some of the issues that might contribute to Complicated Grief:

Sudden or traumatic death: this would include murder, suicide, fatal accidents, or a sudden fatal illness. In these instances, there is an immediate change in the stability of the home, leaving the child feeling insecure and confused. Desire for revenge is often experienced after a murder or fatal accident. Children may experience rage and/or guilt against the person who commits suicide, and may also feel shock and disbelief that this death has occurred.
Social stigma of death: Social stigma and shame sometimes accompany deaths related to AIDS, suicide, and homicide. Children often feel too embarrassed to speak of these issues. They remain silent and suppress their feelings. These feelings in turn are inwardly projected towards themselves in the form of self-hatred. These children feel lonely and isolated. They cannot grieve normally because they have not separated the loss of the deceased from the stigma.
Multiple losses: Multiple losses, as in the death of both parents can cause removal of the child from his/her home. The child is often moved not only from the home, but is also moved from the rest of his/her family and friends, the school, and the community. The child is often shocked at this sudden and complete change of lifestyle and may withdraw or become terrified of future abandonment. Nightmares and/or bedwetting could appear.
Past relationship to the deceased: When a child has been abused, neglected, or abandoned by a loved one, there are often ambivalent feelings when the loved one's death occurs. Part of the child might feel relieved, even glad to be rid of the abuser. However, these children often feel guilt, fear, abandonment or depression if the grief is complicated by an unresolved past relationship.
Grief process of the surviving parent or caregiver: If the surviving parent or caregiver is not able to mourn, there is no role model for the child to follow. If the parent or caregiver is unable to recognize their own pain, they may not be able to recognize the child's pain. These children might feel an overwhelming feeling of abandonment and isolation. They may become overprotective of the surviving parent or caregiver because of the fear of abandonment.

Some ways that parents or caregivers can help children with complicated grief include the following:

Reading stories to children that allow them to project their feelings onto the story characters could open a dialogue that is non-threatening
Allowing children to visualize their hurt, fear or pain through artwork
Finding professional help for the child when it is of utmost importance

Suggestions for dealing with trauma and/or terrorism or media news that affects children would include the following:

Define terrorism for children using accurate, real and age appropriate language avoiding clichŽs and euphemisms. Children take information literally; therefore, the responses to questions should be kept simple.
Affirm to children that they survived this trauma. Clarify what the adults around them are doing to restore safety and protection into their lives.
Help children reestablish their sense of order. Try to keep the daily routine as much as possible.
Remember that adults are role models. The way that a parent or caregiver deals with trauma will serve as a guide for the children.
Monitor media coverage for children. Carefully consider whether the child should watch the unfolding news coverage. Restrict the viewing until adults can be present to help the children process and interpret their observations, thoughts and feelings.
Accept children's reactions. These reactions might range widely. Some children may go out and play. Others will want to stay near the caregiver and may become fearful of being alone. Reassuring the child and encouraging them to talk, draw, or write about their reactions and feelings will help.
Remember young children have "magical thinking". Kids may believe that they somehow "caused" the problem. Reassuring them that there is nothing they could have done to cause it or prevent it may help relieve these feelings.
Prepare children for dialogue. Talk about the disaster, keeping in mind the age of the child and awareness of society around them.
Watch for symptoms of heightened anxiety. These symptoms might include stomachaches, nightmares, and difficulty in carrying on the regular "routine". Bedtime should be a reassuring time, and the caregiver might consider an increase in transition time, story telling and book reading to get the nighttime off to a better start.

In closing, a child needs a great deal of support and understanding to deal with grief and loss. Others in a grieving family may be too involved in their own grief to fully support the child. Counseling, groups, grief camps, and solid support from friends and family may be helpful. The child's primary healthcare provider or even a local hospice may be a good source of information that can provide further resources for obtaining help for the child.