Sunday, October 28, 2012

How to Help Grieving Children

    I have recently been trying to educate myself on how to help grieving children.  I have seen many of my friends who are having huge losses in their lives and trying to grieve appropriately, but have noticed that their children grieve differently.  In my work I'm often asked how to help grandchildren deal with the grief of losing a grandparent.  So I have been to a few seminars, read a few things, and tried to educate myself on how to help parents/caregivers help their little ones through grief and loss.
I am in no way an expert, but felt that I wanted to share some of this information in hopes of helping some of my friends and their children.

    The most important thing I have learned from all of this is to TALK TO YOUR CHILDREN ABOUT DEATH; ACTUALLY USE THE WORDS DEATH AND DYING.
Many parents feel like they are walking on egg shells with these words. Don't be.  It is good to talk about these words and normalize them, so that if there is a loss it is easier to talk about (and believe me there will be losses).  Even I know how to talk to children about this, I have no problem talking to my own son about it, but one day I was picking him up from daycare and one of the kids asked me what I do for work.  I sort of paused, fear raced through me.  Do I tell her I work with dying people?  What does she know about death?  Is she gonna be freaked out?  Will her parents be mad if I tell her what I do?  Adults don't talk about this stuff with their kids, but we need to.
Here is just a quick overview of some information to read and take in what you feel may be helpful.

INFANT and TODDLER

Children 0-2 years:
Often we think children under two do not grieve, that they are simply to small to understand what is going on.  
Piaget teaches us that this is the sensorimotor stage for children, where they learn that if something goes away it always comes back. Children at this age rely on their parents and caregivers to meet their needs; they depend on them.  So if they "disappear" they will notice.  If there is a loss of a close loved one or pet, observe your little one for non-verbal clues.  It is important to label their non-verbal clues for them.  If they are crying, clinging to you or an object, pointing to pictures, etc. be sure to label this by saying saying, "I know you are sad.  I'm sad too." "I'm sad Daddy is gone too."  They cant use their words, so it is important for you to label their feelings for them.

Children 2-5 years:
Piaget labels this cognitive stage as the Preconceptional Stage and Erikson labels this stage as the Initative vs. Guilt stage.    At this stage children are very egocentric. Everything is about them.  They are great at magical thinking, so they may have a difficult time understanding the irreversibility of death.  They are big on routines and they are literal thinkers.  It is important to use the words death and dying with them, but because they are so literal it is important to use these words in the correct context for them.  How often do we say, "oh my phone died." Then we charge it and it works again.  If we use the words like this, then our kids may think that if someone died they will be coming back.  We have to be careful on how we use these words.  I find myself much more conscience of how I use these words now.  Don't try to scoot around these words by using the words pass or no longer with us; these words will just confuse a child. If someone is no longer with us, a child can interpret that different ways.  But if you say they died, there is no room for interpretation.

Children in the infant/toddler stage of grief do not understand the three developmental and foundational concepts of death: Non-functionality, Irreversibility and Universality.  They don't understand that if their dog dies that he isn't going to play with them again.  They don't understand that he is never coming back and they don't understand what happens to somewhen when they die.  They struggle most with the irreversibility at this stage due to their magical thinking. Many times children this age will ask, "When is Fido coming home?"  It is important if this is asked repeatedly that parents should  put a feeling to the question for the child; "I miss Fido too." 

Children at this age respond very well to books and stories.

Recommended books for children this age are:
The Runaway Bunny by Margaret Wise Brown
"Turtle" poem by Shel Silverstein in A Light in the Attice
The Giving Tree by Shel Silverstein
Feelings by Aliki Brandenberg
Blow me a Kiss, Miss Lilly by Nancy White Carlstorm
Nana Upstairs & NanaDownstairs by Tomie De Paola
Kolie and the Funeral by Ralph L. Klicker
Finding Grandpa Everywhere: A Young Child Discovers Memories of a Grandparent by John Hodge
Saying Good-bye to Grandma by Jane Resh Thomas
My Grandson, Lew by Charlotte Zolotow
Tell Me Papa by Dr. Marvin Johnson
Our Special Garden: Understanding Cremation by Karen Carney

Not all of these books are about grief, but the goals of reading these books are:
-Establish Trust
-Show Unconditional Love
-Love Never Dies
-That it is okay to express feelings (to be sad or angry)
-It is okay to have "transitional objects" (it is what carries us through)

There are many more books as well, but the most important thing is that the PARENT READS THE BOOK FIRST TO MAKE SURE IT IS APPROPRIATE FOR YOUR CHILD.

I have also heard wonderful things about this episode of PBS's Sesame Street discussing grief. (full disclaimer, I have not watched this to tell you my opinion)


Watch Full Episode on PBS. See more from When Families Grieve.


When talking to children this age about death and dying, or about someone who had died, be sure to get eye level with the child to talk to them, not down to them.

CHILDREN AGES 5-9 YEARS

Piaget teaches that at this Cognitive state children are at the Preoperational stage where they are really learning about language and symbols and well as have magical/wishful thinking.  Often times children at this age will feel guilty due to their magical thinking.  If they felt anger toward someone, or said, "I wish you were dead." or said, "I hate you." and then someone dies they can often feel that it was their fault.  They are learning about cause and effect at this stage and will often feel like a death was their fault somehow.  It is important to skillfully correct the magical thoughts; you can do this by not shaming them, but discussing how a dream could never make some die.  Explaining that even though they were mad in that moment, they had many more moments where they loved the person who died and that is what is most important. 
They are also going through the Concrete Operational Stage, where they have inconsistent thinking and reversibility of thought.  They are really learning to process things in this stage and it may hit them that they can die too, or that other people they love can also die.  If your child asks you, "Are you going to die too?"  It is important to be honest with them and not sugar coat things.  An appropriate answer might be, "Yes, I am going to die, but I plan to live a long life."
Children at this age understand the non functionality and irreversibility of death, but still struggle with the concept of universality.

At this age children start to evolve a concept of death:
-Death is final but escapable
-Death personified
-Death as a punishment for wrongdoing
-"I can cause death with my thoughts"
And they may start to ask questions like: How did they die?  What do they look like when they are dead?

Developmentally children are in the Industry vs. Inferiority stage.  They are learning to love to read, write, build and draw.  When talking about death and dying with a child at this age, again, be sure to get eye level to talk with them.  When talking to them have paper, markers, crayons, etc available when you talk.  This allows them to be industrious while talking.  They will not do well just sitting down to talk, but if they have something to do with their hands they can more comfortably talk about something difficult.  They will also need a lot of praise during this loss.  They need to know that they are grieving appropriately and point out the things they are doing well.  Focus on their strengths and not what they aren't doing well.
During this stage they are also very dependent on their parents, siblings and extended family.  They will look to these people to know how to act and for comfort.

I often hear parents say they have to be "strong" for their family.  By this, they usually mean that they don't cry, show emotion or let their loved ones know how their grief is affecting them.  It is actually very healthy for a child to see their parents cry; it helps normalize grief and lets them know that it is okay to cry.  It is good for children to see their parents be emotional and creates a situation where families can talk about their feelings.

So, what to do about the funeral.  I have heard many friends talk about how traumatizing their grandparents funeral was for various reasons.  So here are some tips on how talk with your child about a funeral.  Talk with them about what they can expect to see at the funeral.  If possible take them to the funeral home before hand so they know what it is like.  If there will be an open casket, explain what that will look like and how the body will be cold.  Give your child options, DON'T make the child do something they don't want to do.  Give the options of not having to attend the funeral and staying with someone they feel comfortable with, or going to the funeral for a short time and then leaving with a loved one when they are ready, or staying at the funeral/wake/viewing with their parent the entire time. If there is a casket, give your child the option of going to see the body or not.  Do not force the child to touch or kiss the body if they do not want to.  Don't force your child to do anything.  Give your child options and let them chose what they feel comfortable with.

When your children ask how and why questions, be prepared to answer them.  If you are not ready as a parent/caregiver to talk about this mentally or emotionally don't shut your child down.  You can say, "It's hard for me to talk about it right now."  If you can't talk to your child about their how and why questions be sure you have someone who can that they trust.  It is very important that their questions get answered.

Using books to discuss grief is also helpful at this age.
The goals of reading books to children at this age are:
-It's okay to be scared or have nightmares
-It's okay to have mixed feelings
-It's not your fault
-Death is part of life
-Loss and separation are part of life

Helpful Books:
Charlotte's Web by E. B. White
How Can I Help, Papa? by Elissa Al-Chokhachy
Samsara Dog by Helen Manos (if you believe in reincarnation)
Alexander Who's Not (Do you hear me? I mean it!) Going to Move by Judith Viorst
Pancakes for Breakfast by Tomie DePaola (Discusses how things dont always go our way)
When Dinosaurs Die: A Guide to Understanding Death by Laurie Kransy Brown and Marc Brown
Lifetimes: The Beautiful WAy to Explain Death to Children by Bryan Mellonie and Robert Ingpen
I Heard your Mommy Died by Mark Scrivani
I Heard Your Daddy Died by Mark Scrivani

Remember to read these books before sharing them with your children to make sure they are appropriate for your child.  Many of these books don't directly talk about death and dying but are a great way to start important conversations.

CHILDREN AGES 10-12 (PRE TEEN)

Developmentally Erikson states that these children are at the Industry vs. Inferiority stage; they are very into hobbies, athletics and their body changing.  Cognitively Piaget claims these children go from the concrete operational stage to the Formal Operations stage.  Children develop abstract and hypothetical thinking.   They usually understand the three foundational concepts of death: Non functionality  Irreversibility, and Universality. They get it.

This stage is tricky because this age the children are often less feeling-focused than you might expect.  Often parents may be shocked at the questions they get at this age, which are more about the "details" of the death.  Don't be startled by this.  Your child may appear not to be grieving, but don't be fooled.  Be patient with your child and yourself.

You can also use books as a way of talking about death with children this age.
The goals of reading for this age group are:
-Change is a part of life
-Friend (and others) may disappoint
-It's okay to ponder the mysteries of life
-Useful metaphors

Helpful Books:
Harry Potter (books 1-7) by J.K. Rowling
Where Do Balloon Go? by Jamie Lee Curtis
The Fall of Freddie the Leaf by Leo Buscaglia
Tear Soup by Pat Schwiebert
How it Feels When a Parent Dies by Jill Krementz

TEENAGERS

At this stage cognitively according to Piaget teens are at the Formal Operations stage; they have more abstract and hypothetical thinking, and their reasoning skills advance.  Developmentally, according to Erikson, they are at the Identity vs. Role Confusion stage; they wonder who they are and how they fit in.
Often teens have intensified feeling reactions, a renewed struggle with the universality of death and may delay their grief due to conflicting priorities.  For teens their family, school and peers are all very important part of their culture.  It is very important to make sure they have a strong support network within each system.  It is important for these supports to normalize their teens feelings and acknowledge their courage to share.

The goals of giving teens books to read during death and dying are:
- So they know they are not forgotten
-They know their grief is unique
-They know it is okay to ask "why?"
-it is okay to question their religious upbringing
-That their parents love them when the teen rejects them

Helpful books:
Night by Elie Wiesel
Weird is Normal When Teenagers Grieve by Jenny Lee Wheeler
Straight Talk About Death for Teenagers: How to Cope with Losing Someone You Love by Earl Grollman
Healing Your Grieving Heart for Teens: 100 Practical Ideas by Alan Wolfelt
Facing Change: Falling Apart and Coming Together Again in the Teen Years by Donna O'Toole
How it Feels When a Parent Dies by Jill Krementz

10 Things Grieving Children Want You to Know

1. Grieving children want to be told the truth
2. Grieving children want to be reassured that there will always be someone to take care of them
3. Grieving children want you to know that their grief is long lasting
4. Children often cope with grief and loss through play
5. Grieving children want you to know that they will always miss the person/pet that died
6. Often, grieving children want to share their story and talk about the person who died
7. Every child grieves differently
8. Grieving children often feel guilty
9. Even though I might be acting out, what I'm really feeling is intense emotions of grief
10. If you're not sure what a grieving child wants, just ask him!

10 Ways to Help Grieving Children
1. Take Care of you
2. Be honest with your child
3. Listen
4. Acknowledge your child's grief
5. Share (tell your children about times you were sad, afraid or angry. how you dealt with hard situations)
6. Be creative (let your child express grief through drawing, writing, crafts, music or games)
7. Maintain clear expectations (keep rules and boundaries consistent, children will often use their pain as an excuse for inappropriate behavior)
8. Reassure your child (let them know they are loved)
9. Create rituals and new family traditions
10. Be patient





This is just a not so brief overview of how to help children grief.  My hope is to be able to help parents who have children who are grieving.  I know many of us, as parents are dealing with this; it is often difficult to navigate how to deal with our own grief and even trying to address what our children are going through is overwhelming.  I do hope this gives you some helpful hints.

Even if you don't have a child who is grieving, it is never too late to start talking about death and dying with children.  It is an important topic to be open and honest about.  Even though it is often thought of as a "scary" topic, we must realize that it effects us all at one point or another (or many points) in our lives.



1 comment:

Ami said...

This is a great guide. Thanks for making it available to us!