Coping with bereavement

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The death of someone special is never easy to deal with. Child Psychologist, Joanna Fortune, explains once you understand how children make sense of death and experience grief, you can help them to cope with their feelings

To understand how children cope with grief we must look first to how they understand and learn about grief. We know that as adults, we implicitly understand that death is universal, an inevitable ending of physical life. But children’s understanding develops more gradually and their understanding is dependent upon their age and development. While babies and young toddlers may not cognitively understand death or what it is, they will be attuned to the emotional responses of their carers. A grieving mother, mourning the loss of her parent may be crying and feeling very sad while caring for her baby; the baby will pick up on this and respond to them. Your baby or young toddler may regress and begin to cry without cause and/or withdraw from you. They are extremely attuned to the feelings of the adults around them and they take their lead from their carers – and grief is no different.

How children understand the idea of death
Children aged five years or younger have not yet developed a cognitive understanding or abstract notions like time, so concepts like ‘final’ and ‘forever’ do not hold great meaning for them. At this stage, dead simply means less alive and is likened to a long sleep or a long trip. They may ask you every now and then where the dead person has gone to, or ask why they don’t see them anymore – you will have to repeat many times that this person is no longer alive and won’t be coming back to help them understand. Between the ages of five and eight years, children do understand death as a final event and may even interpret death as a very scary person who comes to take someone away. Death is a frightening concept at this stage and is associated with violence and aggression. Children at this stage of development will often display an intense level of interest in the funeral rituals surrounding death and ask exploratory questions about heaven or the afterlife such as, “What happens to us when we die?”, “Where do we go?”. From the age of nine years and older children have developed a more adult-like awareness and insight into what death is and they understand it is final and means the end of physical life. From the age of nine years onwards, most children have what is essentially an adult understanding of death, though this is dependent on their developmental stage – if your ten year-old child is developmentally functioning at the level of a seven year-old then they will have a seven year-old understanding of death and you must approach how you tell them about the death and support them to grieve and understand what has happened at the appropriate level. A child’s past experience of death is also a factor in terms of their understanding, for example a younger child who has already experienced death and loss in the family may have a more mature insight into what it is and what it means. Essentially, the best way to gauge your child’s understanding is to listen carefully to the questions they ask and the way they talk about it and be guided by them

How do children experience grief?
In terms of how children experience grief it will not be so different from how adults experience it with feelings like shock, confusion, anger, sadness and guilt. The difference is that children may not be able to express these feelings in the ways that adults can and so it often appears to parents that they aren’t really that aware of or affected by the death.

What to look for
It is very important that you observe your child for any sudden changes in behavior or the display of new behaviours; this may include regression to earlier developmental behaviours such as; becoming withdrawn, bed-wetting, lack of concentration, sudden clingy-ness, uncharacteristic bullying, telling lies and/or making up fantastical fabrications, self-depreciating words or actions where they begin to describe themselves as ‘bad’ or ‘evil’ or ‘stupid’ or ‘not a good person’ and being aggressive towards themselves or others – all of which point to their upset state of mind and their own suffering.

How can I help?
It is important that you acknowledge this suffering and grieving when you observe these behaviours and say something like, “I know that you are feeling sad/angry/ confused about [whomever’s] death and I am glad that you found a way to show me how you are feeling through your behaviour. I’d like to talk to you about this so that I can understand your feelings and help you with them now.” Depending on age/development you might sit and draw a picture of how they are feeling now and another picture of their happiest memory with the person while you speak about the memory. You might also design a family memory board together using a board, some thumb-tacks and a selection of photos, letters (to spell out feeling words) and magazine pictures and have it hung in a visible space in your home. As I’ve mentioned already children will experience stages and feelings of grief very similar to those adults do, the distinct difference being that due to their more limited life experience their ability to understand and express their feelings of grief and loss are restricted and this is where they require support and help. Depending on their stage of development some they may still be in a magical thinking stage whereby they believe they could have caused the death by having ‘wished’ it to happen, ie between siblings if the surviving child had ever ‘wished’ the other dead “I hate you and I wish you were dead” in temper, they may now believe the death to be their fault and will require reassurance about this.

The stages of grief
The main stages of grief are denial (shock, numbness, “no, I don’t believe you”) followed by more acute grief (sadness, crying, withdrawal, anger, guilt, anxiety, fear, regression, emotional and physical distress – tummy aches/headaches associated with feelings) and leading onto a period of adjustment (though painful there is a gradual acceptance of this new reality and a reestablishment of life and a moving on) It is to be expected that your grieving child will act out and may display disruptive and challenging behaviours both at home and at school. Children need a lot of patience, reassuring and love at this time and yet the normality of everyday boundaries is equally important to assure them that their life is otherwise unchanged. I would advise a very gentle approach to discipline (not to be confused with no discipline at all) at this time combined with lots of reassurance and naming of how they are feeling, with kisses and cuddles and time together with you. Whether it is death of a family member or friend, a sibling or the terminal illness of someone close, it is imperative that we keep children as informed as is possible. We may think that we are protecting them by not telling them what has happened and not including them in the process but we are just kidding ourselves because they know something is wrong. It is not easy to manage your children’s grief when you are experiencing your own, so remember to draw on the support of family and friends and, if needed, the support and intervention of a professional. Death is not an easy subject to think or talk about but it is an inevitability in each of our lives at some stage

How to break the news of a death
It is important to think about the language you use when you have to tell your child that someone special to them has died. To explain, below is a little case study I’d like to share with you (names and details have been changed): Natalie was referred to me aged six years old when, six months after his death, she could not accept that her beloved grandfather was truly gone and persistently asked when he would return. Her parents worried she was not dealing with his death and it was starting to show in her behaviour, both at home and in school. This once happy and bubbly little girl had grown withdrawn, quiet and had become prone to sudden, unprovoked temper tantrums where she would kick and scream at her parents, “I hate you, you don’t love me, you don’t love granddad anymore, I wish I was with granddad instead of you.” This last part worried them, as they feared she was expressing a wish to die herself. I met with Natalie alone and told her that her mum and dad had talked to me about her granddad and that they were worried about how she might be feeling about everything that had happened, I wondered if she’d like to talk to me about it. The problem was quickly and immediately clear when Natalie turned to me with her hand on her hip and yelled, “They told me that we had lost granddad and I just can’t understand why nobody is looking for him, he must be so scared on his own and wondering why we aren’t trying to find him and bring him home again.” Natalie had no idea that her granddad was actually dead. Her parents had talked to her about having lost granddad, “We’re sad to tell you that we have lost granddad and he is not with us anymore”. This is too abstract for children who still have a very literal understanding of language and concepts. My work with this family quickly changed to facilitate a conversation between Natalie and her parents whereby they told her, in clear and unambiguous language, that granddad was in fact dead and not lost as she had feared. The surprising thing for her parents was the absolute relief in Natalie’s face and previously tense body and she exhaled and said, “Oh no, that’s so sad, why didn’t you tell me, I thought he was missing.” From here, Natalie could begin to negotiate her own stages of grief and start to move on. So you can see the importance of using very clear and unambiguous language when telling children that someone has died, we tend to use more abstract and softer language thinking it is easier for them, but actually it is easier for us due to our own feelings of shock and numbness and our anxiety at saying aloud that someone we love is dead.