Grief
How Children Grieve differently
From https://www.kidshealth.org.nz/bereavement-reactions-children-young-people-age-group
Bereavement Reactions Of Children & Young People By Age Group
Bereaved children and teenagers will need ongoing attention, reassurance and support. It is not unusual for grief to resurface later on, even well after the death.
Key points to remember about bereavement reactions in children and young people
how any child or young person grieves when someone they love has died will depend on many things
babies, children and teenagers tend to grieve in bursts, and at other times will look for reassurance and comfort in their normal routines and activities
bereaved children and teenagers will need ongoing attention, reassurance and support - it is not unusual for grief to resurface later on, even well after the death
How does a child or young person grieve?
How any child or young person grieves when someone they love has died will depend on many things, such as their:
age
gender
developmental stage
personality
ways they usually react to stress and emotion
relationship with the person who has died
earlier experiences of loss or death
family circumstances
how others around them are grieving
amount of support around them
Babies, children and teenagers may often seem unconcerned, playing or doing their usual activities, so adults can assume they are not properly aware of the death, or affected by it. They are, but in their own ways. Babies, children and teenagers tend to grieve in bursts, and at other times will look for reassurance and comfort in their normal routines and activities.
Bereaved children and teenagers will need ongoing attention, reassurance and support. It is not unusual for grief to resurface later on, even well after the death. This can happen as they move through different life milestones, and develop as individuals.
How do babies and toddlers grieve?
At this young age babies and toddlers don't have an understanding of death nor the language to say how they are feeling. However, they can definitely experience feelings of loss and separation and are likely to pick up on the anxiety or distress of close adults or others around them.
Common reactions
Common reactions can include:
looking for the person who has died
being irritable
crying more
wanting to be held more; being clingy
being less active – quiet, less responsive
possible weight loss
being jumpy, anxious
being fretful, distressed
How to help them
keep routines and normal activities going as much as possible
hold and cuddle them more
speak calmly and gently to them – and be calm around them
provide comfort items, such as a cuddly toy, special blanket etc
How do preschoolers grieve?
At this age children find it hard to understand that death is permanent. They are also at a stage of magical thinking, for example, thinking someone will come alive again or thinking somehow they made someone die. They understand separation though, and feel insecure and frightened when the familiar things around them change. This age group needs a lot of reassurance that they will be safe and looked after.
Common reactions
Common reactions can include:
looking for the person who has died
dreams, or sensing the presence of the person who has died
fearfulness, anxiety
clinginess
being fretful, distressed
being irritable; having more tantrums
withdrawing, being quiet, showing a lack of response
changes in eating
difficulty in sleeping
toileting problems, bed wetting, soiling
regressing in progress; for example, returning to crawling, wanting a bottle
How to help them
keep routines and normal activities going as much as possible
tell them you know they are sad – start to teach and use words that describe feelings
tell them they are safe, and who is looking after them
keep separated from them as little as possible
comfort them with hugs, cuddles, holding their hand, and by encouraging them
speak calmly and gently to them – and be calm around them
explain death as part of life, so they come to understand it bit by bit. Using some examples in nature may be helpful, such as watching plants grow, bloom and die or seasons change
provide comfort items, such as a cuddly toy, special blanket etc
encourage play – children can often use play to help them process what's happened; for example, sand play, puppets, dolls, writing, drawing, painting and various physical activities
How do primary school children grieve?
Primary school children are still learning to understand death and can have some confused thoughts about it. They may think death is temporary, or that the person who has died may still feel things, such as coldness, hunger or loneliness etc. They may ask where the person is now, and have blunt questions to ask about what happened to them and to their body. Explaining death to them is very important.
Common reactions
Common reactions can include:
looking for the person who has died
having dreams about, or sensing the presence of, the person who has died
blaming themselves for the death
being easily distracted, forgetful
being anxious; having increased fears, such as of the dark, of others' safety
clinginess – wanting to be near you or others more
withdrawing, being quiet, showing a lack of response
being fretful, distressed, not wanting to go to school
feeling embarrassment; feeling different from others; may conceal their loss
physical complaints, such as tummy aches, headaches, aching
being irritable, having more tantrums, being defiant, or developing antisocial or aggressive behaviour
changes in eating or sleeping habits
toileting problems, bed wetting, soiling
How to help them
frequently reassure them they are safe, and who is looking after them
keep routines and normal activities going as much as possible
tell them you know they are sad – start to use words that describe feelings
keep separated from them as little as possible
allow questions and provide honest answers
comfort them with hugs, cuddles, holding their hand, and by encouraging them
speak calmly and gently to them – and be calm around them
explain death as part of life, so they come to understand it bit by bit. Using some examples in nature may be helpful, such as watching plants grow, bloom and die or seasons change
let them help in planning the funeral or something to remember the loss
provide comfort items, such as a cuddly toy, special blanket etc
encourage play – children often can use play to help them process what’s happened; for example, sand play, puppets, dolls, writing, drawing, painting and various physical activities
How do older children (10-12 years) grieve?
Common reactions
All of the above relate to this age group, but it's important to be aware that by this age children know death is final. They are also more aware of how adults and others around them are reacting to death. This group may also:
be especially anxious about the safety of family and friends, and themselves
try very hard to please adults and not worry them, and so not let themselves grieve
feel stronger emotional reactions, such as anger, guilt, sense of rejection
want to take on more adult responsibilities, trying very hard to please
feel embarrassment; feel different from peers; may conceal their loss
become more focused on what’s happened and ask questions, think about it a lot, have dreams about it, and perhaps want to talk about it often to others
How to help them
They need all of the help in the previous section plus:
time to talk with you and other trusted adults, when they need to
regular reassurance – spoken, and with encouraging physical touch (such as hugs, pat on the back etc).
honesty about events, and feelings
to know you understand their grief
regular encouragement
avoid expectations of adult behaviour – allow them to be the age and stage they are
How do teenagers grieve?
By adolescence, death is accepted as part of life, but it may not have affected a teenager personally yet. Their reactions may fluctuate between earlier age group reactions and reactions that are more adult.
Teenagers will often want to spend more time with friends than family as they seek support. They may find the intensity of emotion overwhelming or scary and not be able to find the words or ways to talk about them with others. They may want to feel they're coping, and be seen to be, but inside be hurting a great deal, or be putting their emotions on a shelf for a later time.
Death can so shake teens that some react with risk taking behaviour – to escape the feelings and reality and as a source of comfort; for example, drinking, drugs, more sexual contact or reckless driving.
Common reactions
Common reactions can include:
being easily distracted, forgetful
having difficulty concentrating at school
being unsettled in class, a change in class performance, not wanting to go to school
being overwhelmed by intense reactions, such as anger, guilt, fear
having difficulty expressing intensity of emotions, or conflict of emotions
blaming themselves for the death
anxiety – increased fears about others' safety, and their own
having questions or concerns about death, dying, mortality
dreams about, or sensing the presence of, the person who has died
wanting to be near family or friends more
withdrawing to be alone
physical complaints, such as tummy aches, headaches, aching
being irritable, defiant, more antisocial or displaying aggressive behaviour
risk-taking behaviour to escape, to comfort, or to prove they’re alive and strong; for example, drinking, drugs, more sexual contact or reckless driving
changes in eating, sleeping habits
bedwetting
jokes or humour, masking feelings
saying, or acting like, they don’t care
wanting to take on more adult responsibilities, trying very hard to please
strained relationships with others – fear or awkwardness about being close to others
feeling embarrassment; feeling different from peers; may conceal their loss
a sense of loneliness – isolation
a change in self-image, lower self-esteem
possibly suicidal thoughts
possibly moving from sadness into depression
How to help them
be honest and let them know what's happening
be willing to listen, and available to talk about whatever they need to talk about
acknowledge the emotions they may be feeling—fear, sadness, anger
it can be helpful for parents, or other adults, to share their own feelings regarding the loss
frequently reassure them they are safe, who is caring for them, and which adults they can trust to ask for further support
keep routines and normal activities going as much as possible
talk to them about grief – what it is, that it’s normal, that everyone is different
avoid expectations of adult behaviour – allow them to be the age and stage they are, encourage them to express their thoughts and feelings - give them ideas of things they could try, such as doing physical activities, writing, singing, listening to music, talking with friends, reading etc
allow questions and provide honest answers
comfort them with hugs, cuddles, holding their hand, and by encouraging them
speak calmly and gently to them – and be calm around them
talk about death together; answer any questions they may have
let them help in planning the funeral or something to remember the loss
What do bereaved children and teenagers need?
Bereaved children and teenagers will need ongoing attention, reassurance and support. It is not unusual for grief to resurface later on, even well after the death. This can happen as they move through different life milestones, and develop as individuals.
What should I do if I'm worried about my grieving child?
If you are concerned about any extreme reactions, or if you think your child or teenager may have become depressed, contact your doctor or other trained adviser, such as a counsellor, senior staff member from their school, social worker, community or youth worker or a local family support agency.
ACKNOWLEDGEMENTS
The content on this page has been developed by the Paediatric Society New Zealand in collaboration with Skylight. It is used here with the permission of Skylight. The content has been approved by the Paediatric Palliative Care Clinical Network.
© Skylight 2017
Ways to make contact and keep going
From https://www.scholastic.com/snp/childrenandgrief-3.htm
Communication
Ways to Make Contact and Keep It Going
WAYS TO MAKE CONTACT
A number of steps can help set a positive foundation for making contact with
grieving children. This section highlights four steps that are helpful for teachers.
Make the Commitment
When teachers hear that a student has experienced a loss, they should make the commitment to make contact. If teachers know the student or family well, they should consider contacting the family at home by telephone after first hearing about the death to offer condolences and support. It is important to remember that even when teachers do not know students well, expressing condolences and acknowledging the loss can be very powerful and helpful. It will also make it much easier for students to return to class when they know that their teachers are already aware and ready to provide appropriate support.
Find (or Create) the Opportunity to Talk
Usually, this is a private conversation, so it is best if teachers can find a moment when they can interact with the student one-to-one. Perhaps the student could be approached privately before or after class, in common areas of the school, or in some other setting. Teachers might also choose a regular school activity that provides one-to-one contact, such as while discussing a report or project. The student could also be asked to come in a little early or stay after other students have left for a break.
If teachers do not work directly with the student and do not have an opportunity for a one-to-one conversation, they can approach the student more generally and express concern. For example, a teacher might approach a student sitting with a couple of friends and say, "It's good to see you back at school. You and your family have been in my thoughts."
Offer Condolences and Support
A simple expression of concern and caring lets students know that their teachers are aware of their situation and thinking of them. The following are some examples of condolences and offers of support that teachers have made to students:
"I'm sorry to hear about your father."
"I just wanted to let you know you've been in my thoughts. I am sorry about your brother's death."
"I'm glad to see you back here at school. I was thinking about you while you were at your mom's funeral."
"How are you doing? I've been wondering how things have been for you since your grandmother's death."
Students' responses to these offers of condolence and support can guide teachers. The most important thing teachers are offering in this first contact is a compassionate presence, that is someone who is willing to provide support if students want or need it. It is important to listen, but it is not necessary to force a discussion. Remember, there is nothing anyone can say or do that will take away the pain or the loss. What people who are grieving usually find most helpful is someone who can listen openly to whatever they have to say.
Promote Ongoing Communication
Students who are interested in talking more may ask questions, talk about their experiences, or keep the conversation going in other ways. Teachers should continue to be guided by their comments. Students' questions should be answered in simple, age-appropriate ways. Some questions may need to be answered many times, especially (but not only) with younger children.
Teachers should offer honest answers to questions. Often, "I don't know the answer" is the best response. Teachers should also be mindful about using euphemisms and remember that it is okay, even preferable, to use the terms dead and death. Responses should be open and nonjudgmental. It is important for students to feel that they can honestly express their thoughts and feelings to their teachers. They may not have similar opportunities at home if they feel they must protect a grieving parent.
Children often do not have a sense of what they want to say or what would be helpful, so teachers should ask open-ended questions that give students an opportunity to share more about their experience if they wish. The following are some examples of open-ended questions teachers have used that keep communication going:
"How have you been doing over the past couple of weeks?"
"How's your Mom (sister, brother, family) doing?"
"What's it like coming back to school?"
"What has this past week been like for you?"
"What sorts of things are you thinking about these days?"
As mentioned in Chapter 4, teachers may also recognize that some of the questions children ask are essentially rhetorical-they do not need a direct answer. They express a sort of philosophical dilemma about human suffering, rather than a search for concrete answers. Even elementary school-age children might ask questions, such as, "Why do people have to die?" "Why couldn't it have been somebody else's mom?" "Why do we even bother loving people if they're just going to die?"
Questions such as these often benefit from comments that give students opportunities to continue expressing frustration, confusion, and pain. The following are some examples of responses that can keep communication going if students make these kinds of comments:
"It's really hard to understand why these things happen."
"So many things about death don't seem to make any sense at all."
"I can only imagine this loss leaves you with a lot of confusion and questions."
"You're asking the questions everyone asks when someone they love dies. It's hard to make sense of it."
Reprinted with permission from The Grieving Student: A Teacher's Guide, by David Schonfeld, M.D., & Marcia Quackenbush, M.S., M.F.T., C.H.E.S. Baltimore, MD: Paul H. Brookes Publishing Co., Inc. 2010. www.brookespublishing.com
Identifying Vulnerable students
Identify Vulnerable Students
Feelings, behaviors, and symptoms can come and go. There may be good days and bad, and an on-and-off sense of being "stuck" in grief. Sometimes children and adolescents show remarkable resilience at first, and then the ordinary tasks of life become unbearable months later. The American Academy of Child and Adolescent Psychiatry (2013) outlined warning signs that indicate the need for increased mental health intervention:
▪ Persistence or intensification of any of the symptoms named above.
▪ An extended period of listlessness in which the student loses interest in daily activities.
▪ Statements of wanting to join the dead person.
▪ Withdrawal from friends and family members.
▪ A sharp drop in school performance or refusal to attend school.
▪ Increased risk-taking behavior.
As with any risk to mental health, some factors place students at higher risk of "childhood traumatic grief," (Mannarino & Cohen, 2011). Students who start out with a weak safety net or those with difficulty socializing with peers will need increased support. Higher risk students will also include those who have extra stressors at home, such as substance abuse, homelessness, poverty, parental depression, uncertain immigration status, previous traumas or violence in the home or neighborhood, and stigma associated with the cause of death.
To respond effectively, we need to keep in mind the particular needs of students with disabilities, students in foster care, military families, and families who experience prejudice based on various "differences." The ideal scenario would be to identify students at risk before a loss occurs and then help them to build resilience by strengthening their social and personal assets. This goes a long way in preventing prolonged and debilitating disturbance.
Who should tell the child?
If at all possible the person delivering the sad news should be the person closest to the child, even if that person is a parent who is also grieving. It is okay if the person sharing the news is sad or crying, but she shouldn’t be so overwhelmed that she doesn’t have control over her emotions, which would alarm the child even more in an already scary and difficult situation. If the grieving parent is too upset to deliver the news somewhat calmly then it should be the next closest person to the child who breaks the news.
What to say and how to say it
What to Say and How to Say It
There’s no perfect time to share the news so children should be told as soon as possible, within reason. Wait until the end of the school day if that’s only a few hours. The main consideration is that you don’t want your child hearing the news unexpectedly from some other source or walking into a situation where there are a bunch of adults standing around crying or in shock, which could be very scary for him.
Be thoughtful about where to have the conversation. You want to tell your child about the death somewhere where he can feel free to have whatever reaction he is going to have, and that is probably not going to be a public place. You might have the impulse to lessen the blow by sharing the news in a happy location, like a favorite ice cream parlor, but know that a treat won’t make the news any less sad or difficult for the child.
Try to use direct language and be prepared to give a brief explanation of how or why the death occurred because children will be curious. You don’t have to go into a lot of detail, however. With kids you want to start with the minimum amount of information and then add more based on the questions they ask. As long as it’s done in a calm and compassionate way, it is best to keep explanations shorter, simpler and more direct.
Guidelines to keep in mind
The words you choose will vary depending upon the child’s age and developmental stage, but experts agree that no matter what the age of the child there are certain guidelines you should stick to.
Follow their lead. The kinds of questions and concerns that children have can be very different from those of adults. Giving children too much information can overwhelm them. It is better to let them ask questions and then answer in the best (and most developmentally appropriate) way you can. Don’t be surprised if young children are mostly concerned about themselves. That is simply how young children are.
Encourage children to express their feelings. Do not try to “protect” or “shelter” children by attempting to hide your own sadness. They will invariably know that something is wrong, but will be left feeling alone and confused. Hiding your own grief can also make children feel like the sadness they may be feeling is bad. However, try not to let children see you at your most upset moments, as they may begin to worry about you or feel insecure.
Don’t use euphemisms. Avoid phrases like “passed away,” “gone,” “we lost him.” Kids tend to be very literal, and this kind of fuzzy language leaves them anxious, scared and often confused. Or conversely, it may lead them to believe the deceased will come back and that death is not permanent.
Maintain normal routines as much as possible. Grief takes time but children benefit from the security of regular routines and knowing that life goes on.
Memorialize the person who died. Remembering is part of grieving and part of healing. This can be as simple as sharing memories of the person who died or bringing up the name of the person who died so that your child knows it’s not taboo to talk about and remember that person. It is important to keep photos around, too.
Advice for death of a family member
Advice for the Death of a Family Member
Death of a grandparent or other relative
The death of a grandparent is often a child’s first encounter with human loss of life and grieving. If your children have lost a grandparent, you can explain that most people do not die until they are very old, to assuage any fears they have that you or they may die next. If the relative who has died was a younger person like an aunt or an uncle, explain that they had an illness (or accident) that does not usually take the lives of younger people.
Death of a parent
This is a much more difficult and traumatic event for a child of any age to comprehend and cope with. The remaining parent is likely to be very upset, and showing sadness is fine. But choose a time when you feel you can share the news without feeling out of control of your emotions. Explain the death using developmentally appropriate words and make sure children know that they will still be taken care of. In the case of the death of a parent, no matter what the child’s age, professional counseling is often a good idea.
Terminally ill parent
If you are a parent or caregiver, keep the child up-to-date on the status of his parent’s health so that nothing comes as a surprise and so that he is not kept wondering and worrying about being there when his parent dies. If possible schedule regular one-on-one time quietly reading, playing cards or just talking with his sick parent so that he has some good memories of how they spent their time together toward the end of his parent’s life.
If you are a teacher or counselor at the child’s school, know that he may need more support and flexibility at this time. Keeping some routines and expectations is still important, as they can help normalize things for a child, making him feel more secure and giving him a break from his worries. Stay in touch with the child’s family and let a caregiver know if you believe the child needs additional support or even to share good news if he has had a particularly good day.
Death of a sibling
It is very unexpected when children die, whether by accident or due to illness. In young children such a loss often brings up questions from the surviving child of whether he is also in danger. Parents who suffer the loss of a child are likely to be inconsolable themselves, but it is important to reassure your children that they are safe and you will be there for them. Let them ask questions and know that they may go in and out of grief for many months while you as the parent are more likely to feel it continuously. Do not hesitate to bring in additional adult caregivers, such as a grandparent, aunt or friend for support.
https://childmind.org/guide/helping-children-cope-grief/
Advice for Death by suicide or overdose
Advice for a Traumatic Death Such as Suicide or Overdose
A traumatic death is particularly hard to talk about, but children will be curious about how their loved one died and you should not avoid giving an explanation. Try to give children developmentally appropriate information without overwhelming them. For example, you might explain that the person had a disease that caused her brain to stop working the way it should, and that the doctors tried to solve the problem but they weren’t able to cure the disease.
As children get older you can begin to give more information. If the loved one died by overdose, you can explain that the disease was addiction, which made that person want more of a substance than was good for her. For teenagers, you can let them know what the specific substance was, and assure them that having this addiction didn’t make their loved one bad. As kids get older they may also hear that addiction runs in families. While this is important to keep in mind, you can explain that addiction is a complex disease that is caused by a combination of genes and environment. Having a relative who struggled with addiction does not necessarily mean that they will also struggle with it.
If the loved one died by suicide, you might explain that she had a psychiatric disorder, which is a disease in the brain, and it caused her to die. For older children, do share more information if they ask for it, but avoid sharing troubling details. Assure children that their remaining caregivers are healthy and will take care of them.
Expect children to be processing this death over the course of many years as their understanding of it changes with age. Dealing with such a difficult and traumatic loss may very well require the help of a professional.
https://childmind.org/guide/helping-children-cope-grief/