Children and Grief

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This article originated as a staff training seminar and evolved into a professional conference presentation that has been given in various venues across the United States. The research was a result of trauma in a preschool where the staff and children had experienced the deaths of several individuals within a relatively short period of time. The deaths ranged from sudden to expected, suicide to cancer. The results were the losses of two moms, a dad, uncle, grandmother, teacher, and child. Everyone connected with the preschool was impacted in some way.

Crisis         

When a family experiences a time of crisis, coping skills are severely tested. Often, there are feelings of anger, uncertainty, fear of the unknown, vulnerability, inadequacy, and being overwhelmed (Fox, 1988).  Research has demonstrated feelings experienced during or as the result of a crisis are predictable and experienced by everyone.

According to Fox (1988), a crisis causes a disruption in the psychological equilibrium of adults. Young children, though, are not normally in a stage of psychological equilibrium and should not be expected to be in one when a crisis is over. For the young child, a crisis is interference in the developmental process. The result of this interference can result in developmental suspension.

The goal of intervention with children is to help them during a confusing and frightening time in their life, encourage them to move through the stages of grief, and minimize any further negative impact in order to allow the child to successfully continue through their developmental stages (Fox, 1988).

Healthy Coping

There are three requisites to a successful intervention for those in crisis. First, there must be a realistic perception of the event (Fox, 1988). A child must have timely and honest information in a developmentally appropriate manner. This will significantly increase the chances of the child coping well with a crisis. Young children need to know they are not alone; their feelings are predictable and experienced by everyone.

The second requisite is an adequate situational support network (Fox, 1988). These are individuals currently or potentially able to assist with the various needs inevitable during and immediately following a crisis.

The final requisite for healthy coping is that of adequate coping mechanisms. Coping mechanisms are referred to by Fox (1988) as “well-functioning conscious and unconscious ways of dealing with the anxiety generated by challenging life events”. Naturally, children are not expected to have adequate coping mechanisms. Developmental immaturity makes it difficult for young children to effectively deal with potentially overwhelming life events. Instead, they will observe, sense and imitate the coping mechanisms of the adults around them. In doing so, they will begin the process of organizing information and experiences and integrating these so as to establish meaning and understanding (Fox, 1988).

Defining Grief

Grief is intense sorrow, great sadness, especially as a result of death, loss, and/or change. It is intense, deep, and profound sorrow, especially due to a specific event or situation. 

These events or situations are called “life transitions” and it can be anything that brings about a traumatic change; e.g. death, divorce, separation, marriage/remarriage, blending of families, moving, new environments, new situations, new people. Divorce is especially traumatic for children because in their mind, divorce means “I don’t love you anymore”- something they cannot begin to imagine

The normal stages of grief for an adult are denial, anger, bargaining, depression and finally acceptance (Kübler-Ross, 1973). The stages are progressive in nature, however, everyone moves through them at their own pace, often revisiting previous stages as they move toward healing (Kübler-Ross, 1973). Coping effectively with stress and grief requires a certain level of life experience and acceptance of reality. If the progressive stages of the grief cycle are difficult for adults to experience, surely there are lessons for us to learn about how young children deal with stress and grief with their limited life experiences and concrete thought processes. 

Developmental Milestones and Grief

Adults have varying degrees of experience when it comes to dealing with loss and grief. Some deal with it in a healthy way; some do not. When talking about young children – children under the age of 8 years – it is important to keep in mind that they do not have the experiences nor have they reached a mature developmental stage in which successful grief processing has been learned. When it comes to young children and grief, the expectations of adults are often exaggerated and unrealistic. Thus the purpose of this article: to provide a resource for adults who have the opportunity to help a child through the grief process.

Children are aware when there is a great sadness and stress, especially as a result of marital problems, death, loss and/or change (Kübler-Ross, 1983). A child’s fear and anxiety are very real, even though they may seem exaggerated and unrealistic to adults. They are afraid of what is strange and unknown. When their fears are not validated by loving adults, they experience the real fear of being left alone.

What We Know

Research by Fox (1988), Kübler-Ross (1983) and others has demonstrated young children think spontaneously about death and they fear abandonment. Their understanding is progressive and developmentally and experientially based. The grief behaviors of children differ from those of adults, and children may or may not mourn. Magical thinking often fills in “the gaps” to help explain the strange and unknown, while thoughts and fantasies of a reunion include a misunderstanding of the permanence of death and sometimes suicidal ideology (Lyles, 2004). The death of a parent or sibling during childhood increases the risk of emotional disorders in adults (American Red Cross [ARC], 2001).

Generally, infants and toddlers will sense a loss. They will have a memory of the situation – a sensorial memory of smells, sounds, perhaps something they see, but most definitely they will remember the feelings and perceptions they experienced during the time of loss and adjustment. Infants will pick up on the grief of a parent or caretaker and may change their eating, sleeping or toileting habits. Babies may be more irritable, cry more often and need to be held and cuddled frequently. (ARC, 2001).

During the time of loss or significant change, young children (between 2-6 years of age) tend to feel helpless, powerless, unable to protect themselves, insecure and fearful. They take language literally and pick up on nonverbal communication. Still being very egocentric, they feel responsible for situations, consequences and others moods. These young children will often connect things not related and repeatedly recreate events and conversations in their play in an attempt to understand and internalize. Children this age cannot understand the concept of permanent loss or separation. They believe consequences are reversible. These are all normal reactions which can help provide opportunities for open discussion and sharing, opportunities for learning (ARC, 2001).

Case Study

Four year old Helen was dropped off at preschool by Grandpa, again. Before he left she began crying. Within minutes of his departure, she was hysterical: screaming, crying, refusing to be comforted. For the last two weeks, Helen’s behavior had continually deteriorated. Now it was time to talk to mom and dad; to find out what changes might be occurring in little Helen’s world.

During the parent/teacher conference, Helen’s parents were puzzled, if not dumbfounded, by their happy little girl’s recent behavior changes. “She’s always loved this preschool. She’s been coming here since she was a baby.” When searching for recent life changes, the teacher mentioned the fact that Grandpa was now the individual dropping Helen off in the morning and picking her up in the late afternoon. Helen’s parents were aware of the change – their new work schedules required his help. Helen’s teacher pressed: what kind of work schedule changes?

In a few moments, Helen’s parents realized that their work schedule changes equated to longer days at the office, leaving fewer hours at home. In fact, Helen’s mother admitted she had been leaving for work before Helen awoke in the morning and often returned home from work after Helen had already gone to bed for the night. Could Helen’s behavior changes be a result of not being able to see her mommy? Not spending time with her mommy? Helen’s mom promised to change her work schedule again and make more time for her little girl.

Within a week, the answer was very clear: Yes, Helen had been missing her mommy and the only way she could express her sorrow was through her tears.

Helping Children Through Life Transitions

For a young child, several questions need to be answered succinctly and honestly (Kübler-Ross, 1983; Lyles, 2004).  The young child needs to have as much confusion eliminated as possible. They need to know what has happened, why it happened, will it happen to me, mommy or daddy  or some other significant figure. They will also need permission to feel and appropriately express their feelings.

Knowing the facts and being aware of one’s own feelings regarding a situation will help provide a foundation for sharing and explanations. When we are honest with young children, it is much easier to deal with their known fears than it is to deal with nebulous, unknown fears. The young child does not understand grievous situations. Honesty is the only way to help them because (a) it gives the adult a reference point at which to start (b) it keeps a focus on the situation (c) it helps the child’s understanding as they mature and grow older (American Academy of Child & Adolescent Psychiatry [AACAP], 1997).

When adults listen to children, they often can find where the child’s needs most lie (Kübler-Ross, 1983). Perhaps there’s confusion about the situation. Perhaps the child needs reassurance they are not responsible for the event. Listening provides the adult with a starting point. Naturally, there is not an answer for every question; be honest about that, too (Kübler-Ross, 1983).

When talking with a grieving child, share facts in a clear and understandable way developmentally appropriate for that particular child. Share your own feelings and encourage them to share theirs. Encourage questions. Allow for the expression of feelings and be aware of personal comfort and curiosity levels. Avoid pushing their comfort level simply because the adult feels the child needs to know certain information.

Reassurance is of paramount importance (AACAP, 1997). When adults around them are demonstrating intense emotions, young children need to know their basic needs will be met,  they will be cared for, they are not alone. The mind of a young child will explore magical thinking and fantasies – some of which are scary; they need help making sense of these thoughts.

Children express their feelings and reactions in various ways. Acceptance of this will make a difference in how the child recovers from the event. Young children will need to be more dependent for a period of time. Allow for more hugs and special moments. Let them keep the light on at night or not sleep alone or return to having their favorite teddy bear or blanket.

Once children have accepted the inevitable results of a traumatic event, they are likely to display their feelings of sadness on and off over a long period of time, often at unexpected moments and in unexpected ways (AACAP, 1997). Spend as much time as possible with the child, making it clear the child has permission to show his or her feelings openly or freely while at the same time, teaching them how to do so appropriately.

Tangible Reassurance and Commemoration

Young children learn through play and it is only natural for them to learn about grieving through play. By preparing the environment for them to engage in meaningful activities, they can act out or project their feelings without having to verbalize them or hurt others. Role-playing, puppets, artwork, clay, sand, dolls, medical “kits” and play telephones are just a few of the many ways teachers can help young children imagine and pretend as they work through the different stages of grief (AACAP, 1997).

Case Study

Before Mrs. Smith’s death from cancer, the preschool where her boys attended commissioned her to paint a mural in the main hallway of the preschool. After her passing, her two sons, husband, mother, and other relatives found it very healing to come and view the mural, taking pictures of it and reminiscing about the painting of it – most of which was done after her right collar bone had broken (she was right handed) causing her to paint either in intense pain while using her right hand, or with her left hand. What a legacy she left for those boys – both in her painting and in her perseverance.

Helping children to create happy memories can be a very rewarding experience. It can also provide valuable outlets for their confusing, often overwhelming, emotions (AACAP, 1997).

In the event of a death, make sure the child is allowed to have as much closure as possible. The young child does not understand what is happening; they need to be included. Describe upcoming events as best as possible and invite them to be included in a developmentally appropriate way. Funerals and memorials are just as healing for children as they are for adults, mainly because the ritualism holds meaning. Even if it is confusing and new, time and maturity will bring meaning and healing together. Encourage commemorative activities which can assist in the healing process through the use of memory making (AACAP, 1997).

As much as possible, children should stay with those whom they feel most familiar rather than being sent away for a time. This, along with consistent and predictable routines and schedules, will help the child feel more secure and in control (AACAP, 1997).

If the traumatic event is a marital separation or divorce, the adults need to realize young children do not understand why the two most important people in their lives seem to hate each other. The child loves both mom and dad! They do not understand the angry words and hateful looks. Neither can they comprehend a life without mom or dad. As far as possible, parents need to allow the child to continue a relationship with the estranged spouse; provided their safety will not be compromised.

The stages of grief are similar for adults and children, but the process is unique to each individual. Successful grieving is about accepting reality, experiencing the emotional pain, adjusting to a new environment or situation, and finally, braving the reinvestment of emotional energy. For the young child, they may confuse the reality of moving-on-with-life with forgetting. Commemorative activities and tangible reassurance can help bridge this conceptual gap. For a while, anniversaries might be necessary. Above all, plan for purposeful one-on-one time; it will help to foster trust and open communication.

Warning Signs

Remembering young children are egocentric, it should not be a surprise to discover they often believe they are responsible for, the cause of, what is happening around them. “If I were better, mommy and daddy wouldn’t fight so much.”

Children are more apt to express their feelings openly: anger, fear, guilt, rejection, isolation, jealousy. Expression is good; appropriate expression is learned. Some children, though, may not be openly expressive. Instead, they may become depressed, withdrawn or develop physical symptoms. Other danger signals may include:

  • Extended depression
  • Poor concentration
  • Inability to sleep
  • Disturbances to sleep
  • Nightmares
  • Loss of appetite or energy level
  • Prolonged fear of being alone or separation problems
  • Uncharacteristic, prolonged behavioral changes such as aggression or withdrawal
  • Nausea, headaches, weight gain or loss, unexplained pain
  • Excessive imitation
  • Intense anxiety or avoidance behaviors
  • Refusal to engage in daily activities
  • Inappropriate coping skills
  • Wanting to join the dead person.

If any of these behaviors persist, professional help may be needed (ARC, 2001).

Religion and Death

When it comes to death and dying, many people find comfort in their religious faith. The majority of religious teachings about death, though, are very confusing to the literal little child. Mixed messages can compound confusion resulting in misunderstandings about the issue of death (ARC, 2001). Here again, honest factual information is most beneficial. Because the young child listens to the exact words of adults, there will be some amount of misunderstanding which will require time and effort to be adequately explained.

The use of concepts, words and types can help create meaning for literal minds. There are examples of death in nature – plants, insects, birds and pets. There are examples also in the temporal world such as a broken toy that must be thrown away. There are stories about death in literature, s books for young children and, most importantly, the Bible. There are also stories of God resurrecting people in the Bible and these can provide the young child with a sense of hope even in the face of sorrow.

Summary

Sadness is part of the human experience. Each individual deals with sorrow in a unique manner. Perhaps the best summary of what we know about young children and grief can be summed up in a short paragraph written by Dr. Elisabeth Kübler-Ross (1983, p. 2):

Letter to Parents,

“They are aware of your pains and worries, your sleepless nights and concerns, and you should not hide them. Don’t go into their room with a false “cheerful” smile. Children cannot be fooled. Don’t lie to them… Tell them you are sad and sometimes feel so useless… They will hold you in their little arms and feel good that they can help you by sharing comfort. Shared sorrow is much easier to bear than leaving them with feelings of guilt and fear that they are the cause of all your anxiety.”

 How to talk to the literal thinker
Reality
 Suggestion
 
Mommy has cancer.

 
Mommy’s body is sick. It is not working right.

Mommy and Daddy are getting a divorce. Or,

Mommy and Daddy don’t love each other anymore.


Mommy and Daddy need to stop fighting. Fighting is wrong. Mommy and Daddy need to be apart from each other. They need to stop fighting.

Grandma has fallen asleep in Jesus. Or,

Grandma is in heaven. Or,

Grandma went away. Or,

Grandma is at rest. Or,

Grandma died because she was old.





Grandma has died. Her body was old and tired. Her body stopped working and she died.
 

Traumatic death…

Something very bad happened to _____________ .

It hurt his/her body so much, that s/he died. His/Her body stopped working and s/he died.


© 2011, C. Gillan Byrne

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To schedule a speaking appointment with Dr. Gillan Byrne, please use the email link or call (479) 216-9771.




References

American Academy of Child & Adolescent Psychiatry [AACAP]. (1997). Facts for families. Retrieved from http://aacap.org/page.ww?name=Children+and+Grief&section=Facts+for+Families

American Red Cross [ARC]. (2001, September). Helping Young Children Cope with Trauma. Compiled from Keynote Addresses by J.W. Worden, PhD at 1991 ADEC Annual Meeting. Retrieved July 7, 2005 from: http://www.njredcross.org/safetyCenter/childCope.pdf  

Fox, S.S. (1988, August). Helping child deal with death teaches valuable skills. Psychiatric Times, 10-12.

Kübler-Ross, E. (1983). On children and death: How children and their parents can and do cope with death. New York, NY: Simon & Schuster.

Kübler-Ross, E. (1973). On death and dying. London, England: Routledge. See: http://www.ekrfoundation.org  ISBN 0415040159

Lyles, M. (2004). Children’s grief responses. Retrieved June 17, 2009, from Children’s Grief Education Association website http://www.childgrief.org/howtohelp.htm.



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