Frequently Asked Questions about Loss and Child Grieving

Thoughts about childhood loss

• Children mourn differently than adults
• Children are children first
• Children may act (play) as if nothing happened and then suddenly become sad and express other emotions around the loss
• Child often express their feelings and emotions through their behavior and play
• Younger children do not understand the concept of irreversibility
• Children may feel guilty that they caused the divorce or even death of their loved one
• Children need to be reassured that you will take care of them or there is a plan for how they will be taken care of·

There is usually not just one loss that is experienced. There can be other losses such as routines, home, or lifestyle. Children in the same family experience the loss differently.

Beginning the grieving process

Should children be allowed to attend the funerals of parents and other relatives?

As soon as children are capable of some understanding (age two to three), they should be allowed to participate in the process of mourning. Attending the funeral of a parent or loved one is an important part of that process and is beneficial for several reasons:

• The child has a chance to deal with some of his or her feelings about the loss.
• The child has a chance to ask questions and talk about the death.
• The funeral may undercut fantasies that the person who died may return.
• The child is part of the family’s rituals and does not feel left out.
• Many adults who experienced loss in childhood harbor intense anger towards those adults who did not allow them to participate in the funeral as children. They feel deprived of an important childhood experience; they feel that they did not have the optimum chance to say goodbye to the one that died.

Ask a close friend or relative to be with the child at the funeral since you may be too involved in your own process to be available to the child. If a child refuses to go the funeral, this should be respected. The family can develop other ways for the child to say goodbye and express their feelings.

Discussing loss

What should I say about death to my children who are different ages?

• Address each child at his or her emotional and intellectual level.
• Don’t lie to the child, even though he or she many not be ready to hear all the factors related to the death (i.e., suicide, fire). Use your judgment about what the child can understand and what he needs to be told.
• Don’t use euphemisms like “sleeping” or “passing away” with children. This may cause sleep disturbances or other problems. Remember children can be concrete and take things literally.
• Show empathy for where each child is at.
• May need to repeat explanations about death being a part of life and that it is final
• Reassure your child that you will be there to take care of them or, if not, explain how the child will be taken care of. This may be needed to be repeated often. You may need to explain to them how you and they are different from the person who died; i.e. you are not sick and your body is working well.
• Share memories.
• Read books or see movies that deal with death may be helpful.

I can’t stop crying. What do I say to my children?

Showing children emotion will help allow them to grieve as well. It is okay to show your feelings. But if you are overwhelmed by them, try to take some private time so you can still be available to the child. Here are some words you might use in discussing your own grief:

• Mommy or Daddy is really sad about what has happened and and sometimes it makes me cry.
• With time the crying will become less and less.
• Just because Mommy or Daddy is crying doesn’t mean that that is the only feeling that they should or will feel.

Be honest with your children but keep what is said developmentally appropriate for your children’s ages.

What do I tell the school?

Give as much information as you feel comfortable about the loss to the school social worker or counselor who could potentially see your son or daughter. Make a plan for when child is having a hard time in class. Ask if they would be willing to let your son or daughter visit their office, as needed. Discuss how your son or daughter has taken the news. Inform the child’s teacher as well so he or she can be sensitive to the child. The teacher may want to discuss or share information about the loss with her class. Discuss with the teacher how she plans to do this and inform your child.

 

Understanding death, grief and mourning

What is grief?

Grief is the response that people have to loss. It is an internal response that can affect emotions, behavior and physical well-being. Mourning is the period following loss, which includes the rituals, beliefs and ways of coping. Reactions to loss vary greatly and include strong emotionally responses such as sadness, denial, guilt and detachment.

Grief can become problematic if it worsens overtime and interferes with everyday functioning, or when grief becomes chronic, is delayed and denied, exaggerated, or if the person becomes isolated or experiences other areas of psychological distress.

What do children understand about death?

Children’s understanding about death varies according to their developmental age.

• Infants and toddlers may not understand why they no longer experience the presence of a family member, but they sense the change of routine, the absence of the family member from a more sensory manner as well as being quite sensitive to the emotional climate in the home. Their response to the change may be expressed through disruptions in their eating and sleeping, with a potential increase in fretfulness. They may have separation anxiety, increased irritability and a need to be held and comforted. To help the child, provide nurture and support. Maintain routines and limits. Explain simply but truthfully what happened. Children mourn differently than adults and so need time to play.
• Pre-school age children do not understand the permanence of death and may repeatedly ask where the family member is. They may engage in magical thinking and fantasize about reunification with the absent family member. They may have great difficulty managing their intense feelings, particularly anger, which may find expression in oppositional and aggressive behaviors. They may be afraid of sleeping alone. Families may see dramatic regression at this age, with the child desiring to return to infancy, perhaps wanting to be held like a baby.
• Children at this age often worry about their own intactness and the intactness of others around them. Reassure your child that you or someone else will take care of them and they will be okay. Be consistent in routines and limits. Children tell us what they are feelings through their behavior. Listen to them. They may ask often what happened. At this age children do not have the concept of irreversibility so they may expect the person to return. You may have to often repeat what has happened and that the person will not return.
• School age children begin to understand the permanence of death. They may experience significant guilt and worry that they somehow caused the death or could have prevented it. They may experience a range of mourning-related issues such as loss of appetite or overeating, insomnia or an increase of nightmares, school phobia, frequent somatic complaints, whiney or combative behaviors with family, classmates and friends. They may withdraw or have difficulty concentrating.
• Be supportive and reassuring. Develop ways to help the child mourn or memorialize the person who died. Accept the child’s need to sometimes talk and other times wanting to be left alone. Be aware that children may act as if nothing happened while at other times be very emotional.
• Adolescents experience a loss in a similar manner to adults. If it is a parent who dies, the adolescent may experience a premature thrust into adulthood that they are not psychologically or emotionally ready for. These adolescents may seek out more exclusive and intimate relationships. They may assume the deceased parent’s role at the suggestion of others or as a coping mechanism. Allow the adolescent to have time his friends. Be available to talk but don’t impose your needs on him. Always be truthful and fill in the details as he asked for them.

What are the signs of mourning in children?

The more obvious signs are sadness, difficulty concentrating in school, sleep and eating problems and/or aggressive behavior. When children do not demonstrate any responses to a significant loss, there may be different reasons for this. They may wish to spare upsetting adults who are grieving the loss of the same person or they may feel they played a role in the death and are feeling guilt. Also children mourn differently than adults and thus may show signs of mourning and then go out to play as if nothing happened.

Children who are mourning may be struggling with active memories of the deceased as well as trying to take on some of the characteristics of that person as a way of preserving important aspects of the lost relationship. They may speak of becoming like that individual or simply act like them at times. It is helpful to support this work by staying involved with the grieving process during this period.

What should I expect at holiday time?

During the holidays, reactions to loss are likely to become more intense. Separation and divorce, whether friendly or not, bring up issues about visitation and abandonment. The death of a parent raises a totally different set of problems. In both situations children are likely to experience feelings of loss and sadness because the intact family structure is gone.

During the holidays, expectations may also increase about what each family should receive and experience. The media flood children with images of the intact perfect family exchanging warm feelings and expensive gifts. Feelings of deprivation get stirred up and may be expressed in intense yearnings, demands and greed. Teachers and parents will experience excessive demands for love, attention and material things. When these demands are not responded to, one may see aggressive behavior, fights and other forms of acting out. No matter what the parent offers or does, it will not be enough. At school, teachers may see problems with concentration and memory with a disinterest in school work. The children may spend their time daydreaming and dawdling.

In spite of such escalations, children’s reactions to holidays should not be taken personally by the adults. In the long run, children’s behavior will not impact significantly on their relationships with adults. After the holidays life will get back to normal, but in the meantime, consider the following:

It is difficult to watch a child mourn for a parent or sibling, especially during the holidays. Please remember that no amount of extravagant gifts can replace the person who has died. The best gift to give is your time. This includes time spent talking. During these times, it is important to talk to children about their feelings, including their unique responses to the loss. It is important to acknowledge their feelings, whatever they may be. Let them know that you too have distressing feelings in response to the loss. Finally, it is OK to cry together, as well as to share memories (to share photographs?) of times when that person was alive. You may want to develop your own traditions around the holidays, which may include some way of remembering the person who is no longer with you, or other traditions that reinforce that you are still a family.

What kinds of things do families do after a loss? I don’t know what to expect and want to do the right thing.

Each family is different and will react differently to a loss. Here are a few of the many ways families deal with loss:

• Sleep together initially
• See people on the street that look like the person who died
• Think they hear the person who died
• Smell things that remind them of the deceased
• Create a memory box
• Create a shrine (pictures, stuffed animals, etc) or a collage of the person who died
• Talking about the person and good memories
• Feel anger and guilt about their loss
• Dive right into schoolwork or work; or, let schoolwork and work fall by the wayside
• Turn to their faith in a higher power
• Take on traits of the deceased
• Want to be surrounded by family and/or friends, or may shun family and friends
• Purge the deceased’s items and clothing - done on each person’s timetable
• Not realizing that they have set the table or counted the deceased when planning an event
• Having recurrent dreams about the decease
• Reenactments by younger children of the death in their play, to help them master what had just happened

What are children’s reactions to loss?

• Children may become more clingy or not as social as they used to be
• Children may play and go on like nothing has happened - but they will process it when they are ready
• Cry a lot, get angry
• Lose energy and feel fatigued
• Changes in appetite
• Changes in sleeping: either nightmares, trouble falling or staying asleep or sleeping more hours than they normally did

 

About Counseling and Treatment

What is grief counseling?

• Provides support for a child who is having difficulty in adapting to the loss of a loved one
• Helps a child process complex feelings
• Validates a child’s feelings
• Allows a child to talk about their feelings in a safe environment
• Helps a child move from grieving to cherishing memories of the loved one

What is play therapy?

For children and even some adults who are not ready or have difficulty expressing themselves verbally, play of a varied nature allows the expression of inner feelings in a nonthreatening way.

Drawing, painting, sculpting or other kinds of artistic expression like journal writing and poetry allow feelings to be expressed and worked through. Playing games and accepting losing as well as winning, seeing that some games involve chance that is out of one’s control, that patience can be developed and that it is OK to have fun, serve to help one through the grieving process. Building and tearing down, playing with a doll house, toy animals and trucks all help to tell one’s story in a way that guides the counselor to help the person understand what is being experienced and move him or her along in the process of grieving.

How long does treatment take?

The length of treatment varies for everyone. Bereavement is a normal response to loss and is not necessarily a mental health issue. In the early weeks following a loss, one may experience a range of powerful emotions, have difficulty sleeping and eating and may feel unable to face typical activities and responsibilities. A traumatic loss may intensify this experience. Any treatment during this phase of the bereavement process should be supportive and assist in shoring up one’s own coping capabilities. This would generally be brief in duration. However, many life situations may complicate the bereavement process and require a longer period of treatment. It is not uncommon as the child grows, he may return to counseling to rework his loss in a new way or for children to seek counseling a year of more after the loss. As the child develops his needs change.

What is the benefit of group treatment for loss?

Group treatment is a process in which the individuals in the group are able to discuss the feelings they have experienced and may be afraid to express openly, as well as reduce feelings of emotional isolation sometimes associated with a loss. Members of a group share their experiences and support each other in mourning. Sometimes groups engage in activities intended to help them understand feelings. At other times, groups may be less structured, and a more spontaneous approach to discussing thoughts and feelings is encouraged. Some groups are led by professionals and others are led by trained volunteers or peers.

Types of Loss

Death due to illness

When talking to children about death due to illness it is important to be very clear in distinguishing the ill person’s symptoms from what the child has experienced or could experience. Children worry that they can catch the illness even when it may be obvious to you that they can’t. Children also worry about whether you will die and they need to know that you are okay and do not have the illness that the ill person has/had. Explaining how everything in the body stops working can be helpful. If the person was ill before dying, be sure to use language like “very, very sick “ to distinguish between that illness and the ordinary sicknesses we all get from time to time.

You need to tell your child the truth both about the illness and if it is terminal. The child will know that something is happening and that his world has changed. He will also be impacted by what is happening. Keeping the information from the child or distorting it will make things worse later on. Being honest can be painful but remember it will help the child. It is important to let the child know that the doctor and Daddy tried very hard to get him well. Some children may want to see the ways Daddy was or will be treated and others will not.

Sudden or accidental death

Sudden or accidental death often is harder for a child to cope with because of the initial shock and overwhelming experience.

When death is due to an accident or happens suddenly , one can expect many of the same reactions that occur when a parent or loved one dies from other causes. However, in a sudden death, there are several reactions that may be more extreme. The child may exhibit more shock at what happened and sometimes be in denial because of being overwhelmed by the event. He may be unable to talk about what happened and act as if things are normal. Other children may withdraw or become depressed. The child may feel that this could happen to him, or to others whom he depends on, and thus he may be very frightened and vigilant. Being supportive of the child and reassuring him of how the death happened is helpful. Sometimes there is no explanation and the child needs to be told this. The child may also feel if only he had been there he could of made a difference. This can cause guilt and shame. Again the child needs to know what happened and to be reassured that he could not have changed things. The child may have repeated dreams about the accident especially if he witnessed it. The accidental death of a parent can put the child at greater risk for depression and PTSD. The child should be watched for his behavior worsening and not changing over time and also the extreme of his reactions.

Death in the line of duty

With the recent war on terrorism and the greater numbers of American armed forces serving overseas, more children are experiencing the loss of a parent as a result of war. Younger children are more likely to lose a parent in this way than older children. Also, many children of firefighters and police lost parents in the terrorist attacks on the World Trade Center and the Pentagon.

The child’s reactions to the loss depend on the child’s understanding of death, level of cognitive and emotional development, the relationship with the parent before the loss, and how the important adults in the child’s environment are dealing with the loss.

It is the reaction of adults that set this type of loss apart from other deaths that the child may experience. While most deaths are senseless, this type of death can be seen as having a purpose. There is a noble quality to it, as the parent in the armed forces died for his or her country so that others may be free or safe. Similarly, police or firefighters who die in the line of duty were trying to help others.

As a result, such a parent is idealized beyond the usual idealizations that are part of losing a parent under any circumstances. The increased idealization may make it easier to mourn. However, idealization may also be a handicap in mourning, since excessive idealization may make it impossible to acknowledge the parent’s shortcomings while alive.

The level of community support is usually greater than with other losses. This support is usually helpful in facilitating the mourning process.

A family member committed suicide. What should I tell my children?

Those surviving a suicide in the family often experience overwhelming feelings and may think that they should protect the children from the truth, hoping to spare them the emotional distress associated with the suicide. Children generally know (if they did not witness the suicide) that something really significant and distressing has occurred by the emotional turmoil they witness in the home. It is generally best to tell them the truth. However this needs to be done in an age-appropriate way. It may be that this is something that you will tell over time. Remember, children ask questions but they often just want a simple answer.

You do not need to go into the details of the suicide, but to acknowledge that this is how the family member died. Children often find out this information from others or later in life, and often feel greatly betrayed by the family for not letting them know. Suicide is a result of an (mental) illness. If you think about it in this way, it may be easier to talk to your children about it.

Children will have many questions and emotional responses to this type of loss. Supporting the child’s feelings and discussing their concerns with them should help the child work through this tragedy.

About separation and divorce

What are some issues for children of divorce?

Loyalty issues are most often present as is the wish that parents will reunite. Parent alienation can occur if one parent is hostile toward the other, making it particularly difficult for the child to remain loving or caring about or with the other parent. For older children, visitation often conflicts with peer activities; the wise parent is sensitive to this important development for the child and plans accordingly. The child may feel the need to be a pseudoparent to the hurting parent. Schoolwork may suffer. Trust issues often present themselves when the security of the intact family is shattered; the internalization of feelings of betrayal may have serious ramifications for children’s relationships at the time and in the future.

When does a child of divorce need treatment?

Each situation is unique, but general guidelines would suggest that when a child’s functioning deteriorates, when parents are so engrossed in their feelings and lives that they cannot have empathy for the child’s feelings, or when the support system for the child is weakened, an evaluation of the child’s needs should be undertaken to determine the help the child may need to adjust to the changes that inevitably occur when parents divorce.