Understanding Grief and Loss in Children

There are seasons in life that are more difficult than others, but it can be said that the harshest seasons of all are those that bring with them death. It matters not how death comes, whether with forewarning or without, we are never ready to say goodbye to the ones we love. Death is the most painful form of loss we will ever experience, and while life experiences help prepare us for loss, the work of grief is never easy.

Grieving is especially hard on children, because unlike adults who have former experiences to teach them how to process grief, children have few life experiences and are not prepared. Younger children are not able to complete thought processes about death and are therefore unable to verbalize them. They rely heavily on the adults in their life to help them through the confusion and disorganization that follows the death of someone they love. Much about a child's understanding of the loss depends on the developmental stages of the child and the depth of the loss. It is these developmental stages in mind that we are able to better understand the grief children experience.

DEVELOPMENTAL STAGES OF THE GRIEVING CHILD

Infants

An infant does not recognize death, but he will have a sense of separation and loss from the person who is normally there. Infants are incredibly perceptive to the moods and atmosphere around them, and while his depth of understanding is limited, he will need reassurance from caregivers.

Toddlers

Toddlers, up to age three, are aware of death, but may view the deceased as sleeping. A child may relate the death to sleep and think that the person will become alive again, just as one awakes from sleep. There is also a tendency with children of this age group to think that the person they loved is away on a long trip and will be back soon. Some children have even waited each day by the window for their loved one to come. Children of this age group may need to be told many times, gently and kindly, that the deceased is not coming back.

Four to Six Year Olds

Four to six year olds will have a small understanding of what death means. However, they often do not understand how it fits in with their lives and their future. A child of this age may understand that Grandma is gone, but he doesn't yet realize that it means Grandma won't be able to attend his birthday party next month or play games with him tomorrow. Children in this age group can easily become afraid of death. Fear of other loved ones dying is often an issue as is the belief that death is contagious.

Seven to Ten Year Olds

Seven to ten year olds have a much better grasp on death and may have experienced the death of another loved one or of a beloved pet. Children of this age group often have intense fears of their caregivers or other family members dying too. A recent death will bring up fear and the realization that other loved ones will die one day as well.

Pre-teens and Teens

Preteens and teens have a clear understanding of what death is, but, like adults, they may also go through an initial stage of denial. It is common for children in this age group to refuse to admit or deal with emotions that are lurking just under the surface. While it helps in all cases, it is especially wise to obtain grief counseling for a child of this age group.

TALKING TO CHILDREN ABOUT A TERMINAL ILLNESS

The impact of a terminal illness on a family is significant. Often, long term care is provided by the immediate family and it is normal for exhaustion, depression, and frustration to set in. It is not uncommon for family members to face conflict with each other during this time, which adds further strains the family as a whole.

All of these sudden changes in the structure of the family are confusing for children. Caregivers should speak openly with children about the illness so that they understand what is happening to their loved one. Children should be informed of the illness and the prognosis as well as given the opportunity to ask questions. It may be counterproductive to the grief process to prohibit the children from seeing the sick family member. After all, in circumstances of a drawn out terminal illness, the grief process starts long before death occurs.

COMMUNICATING WITH CHILDREN ABOUT THE DEATH

Often, well meaning adults will shelter children from the pain of the loss. This sheltering can occur in many ways, such as circumventing discussions about the deceased, denying that the deceased is really gone, avoiding activities that the deceased usually took part in, and even saying the deceased is "just away on a long trip". This sheltering can confuse and even stunt the healing of children in the long run.

We cannot always protect our children from tears and sadness. The process of healing begins when the pain of death is first inflicted. It is necessary for your child to know the truth so that he can begin to process the loss and the emotions that come with it.

The verbal child, upon learning about the death of a loved one, will have a lot of questions as his mind tries to wrap around what you are telling him. Strive to create an atmosphere where the child is comfortable asking questions. As you answer questions and communicate with him, death will become less scary. Refusing to talk about what happened or the attempt to shelter him from the harsh reality of death will only make death more frightening and confusing. Adults should be straightforward and honest with their children about what has happened.

Younger children are not always able to put their thought processes into words. Caregivers can help them verbalize their feelings by getting down to eye level with them and using questions such as "You really miss Grandpa don't you?", or "Are you sad because Aunt Sue isn't here for your party?" as discussion starters.

Because they are grieving too, it is very easy for adults to get caught up in their own bereavement and be unaware of how the affected children are coping. It is important to initiate conversations with the children. Purposefully bring up the deceased in conversations. One of the best gifts you can give them during this time is to be honest with them about your own grief. This opens the door for them to talk about how they are feeling and increases forward movement in the grief process.

THE DEATH OF A SIBLING

Children who lose a sibling to death are more vulnerable to feeling guilt over the loss. Older children, in particular, will wonder why their sibling died instead of them. Sometimes, guilt occurs due to the surviving child's struggle with feelings of inadequacy and jealousy, as the deceased sibling is often idealized. Parents can be proactive in protecting their surviving children from this additional distress by spending quality time alone with each child and focusing solely on his or her needs.

FUNERAL AND RELIGIOUS SERVICES

While you should never force a child to attend a funeral or memorial service, it is age appropriate for him to attend when he expresses a desire to go. As death becomes understood as permanent, participation in services and religious activities will help with closure, much as it helps a grieving adult.

Though caregivers find it alarming, it is not unusual for children to reenact the funeral service because children typically act out their feelings in play. It is important to allow children to role play in this manner. Refrain from discouraging or scolding a child who does this, as this is his way of processing his feelings.

FEARS TO BE AWARE OF

Younger children tend to take death personally. Because children relate bad things to bad behavior, a grieving child may think that the loved one's passing is his fault. He may believe, for example, that anger toward or bad thoughts about a loved one caused the death. The younger child will need reassurances that the death isn't his fault.

In addition to fearing the death of other loved ones, children may also question the possibility of their own death. Children should be assured that the likeliness of that happening is very small.

OUTWARD SIGNS OF INWARD TURMOIL

Adults do not have the strength to deal with all the emotions that come with the loss of a loved one at one time. After an initial period of denial, we process our loss in bits and pieces. The grief ebbs and flows. At one moment, the pain may seem overwhelming, and at another, it is held at bay, just off the shore.

Grieving is much the same with children. However, the key difference is that they lack the strength and coping skills to deal the intensity of the pain. The result is that the pain manifests itself physically and behaviorally.

It is not unusual for very young children to revert back to an earlier developmental stage. For example, a child who slept through the night may begin waking during early hours again. A four year old may go back to sucking his thumb or become more possessive of objects. A toddler who walks may go back to crawling. A verbal child may begin talking like a baby again, or refrain from talking at all. Other common symptoms of inner turmoil in children include: trouble controlling their bladders or bowels, temper tantrums, inconsolable crying, change of appetite, trouble sleeping, stomachache, headache, aggression, clinginess, behavioral issues, school problems, and concentration difficulties.

Caregivers should be aware that behavioral issues occur when children are overtired, in public, or in highly stressful atmospheres, as that is when they feel the loss the most. Children rarely are cognizant of the connection between the loss they have suffered and negative behavior. Though the caregiver is likely worn down and going through difficult emotions as well, it is critical that the grieving child be shown grace, compassion, patience, and a lot of extra love.

THINGS CAREGIVERS SHOULD DO

Caregivers should see that the grieving child spends time outside in the sunshine each day. It is vital that both the grieving caregiver and child get enough rest, proper nutrition, and exercise. In addition, the grieving child should have a regular routine, as routines help children feel secure in their environment. Most importantly, openly express genuine affection.

Speak frequently about the deceased. Look at pictures and talk about favorite memories. Encourage talk about feelings. In fact, share how you feel. When the emotion comes, cry. Tears are a gift, not a sign of weakness. They have a purpose and that is to help cleanse the soul.

THE LENGTH OF BEREAVEMENT

For adults and children alike, bereavement knows no time frame. The process can continue for years, though the intensity usually lessons over time. It is always wise, and in some cases necessary, to consult with a child psychologist or grief counselor who can walk you through this season of bereavement.