After a Loved One Dies - How Children Grieve - CT.gov (PDF)

After a Loved One Dies — How Children Grieve And how parents and other adults can support them  After a Loved One Dies —How Children Grieve And how parents and other adults can support them Written by David J. Schonfeld, MD and Marcia Quackenbush, MS, MFT, CHES Dr. Schonfeld is Director of the National Center for School Crisis and Bereavement at Cincinnati Children’s Hospital Medical Center, which was established by a generous grant from the September 11th Children’s Fund and National Philanthropic Trust. www.cincinnatichildrens.org/svc/alpha/s/school-crisis Copyright © 2009 New York Life Foundation. Permission is granted for educational and non-profit use of these materials, with acknowledgment. All other rights reserved. Published by the New York Life Foundation, 51 Madison Avenue, New York, NY 10010. email: [email protected] This publication was supported by a generous grant from the New York Life Foundation. The information contained in this booklet is not intended as a substitute for your health professional’s opinion or care. You and your children have unique needs which may not be addressed in this book- let. If you have concerns, be sure to seek professional advice.  Dear Reader, Protecting families and providing them financial security is at the heart of New York Life’s mission. But we also recognize the tremendous emotional toll suffered by family members – especially children – when they lose a parent, sibling or other loved one. We believe this informative booklet can be of value to parents and other caregivers as they help children cope with their grief and fear following a death in the family. It was prepared with the assistance of some of the nation’s most respected authorities on this important topic. I think you will find their suggestions sensible and their wisdom reassuring. Helping young people grieve, heal and grow is part of New York Life’s long-term philanthropic commitment to assisting children in need. I wish you the comfort that can be found in helping young hearts heal. Theodore A. Mathas Chairman, President and CEO New York Life  What’s Covered in this Guide • Helping children, helping the family pg 1 • Helping children cope over time pg 16 • Why a parent’s role is important pg 2 • Getting help pg 21 • Helping children understand death pg 3 • Taking care of yourself pg 24 • How children respond to death pg 7 • Looking to the future pg 26 • Attending funerals and memorials pg 14 After a Loved One Dies —How Children Grieve And how parents and other adults can support them [ 4 ]  When children get support from parents and other adults around them, it helps the entire family cope. Helping Children, Helping the Family The death of a loved one is difficult for everyone. Children feel the loss strongly. Parents are coping with their own grief. If a parent dies, the surviving parent faces the new responsibility of caring for the children alone. Grandparents, aunts, uncles and family friends are affected too. Because children and teens understand death differently from adults, their reactions may be different. Some of the things they say or do may seem puzzling. This guide reviews how children grieve and how parents and other caring adults can help them understand death better. It offers suggestions for helping children cope. These suggestions are not meant to rush children through their grief or turn them into adults before their time. Rather, they will give them an understanding they can use now, as children, to grieve in a healthy and meaningful way. When children get support from parents and other adults around them, it helps the entire family cope. There is less confusion, and more understanding of one another. The family sees that it can stay close even though the feelings of grief might be very strong. How to Use This Guide This guide covers a lot of information. Some of it will apply to your situation, and some of it may not. You can read just the sections that seem most important to you right now. As things change or new situations come up, you may want to read the other sections. Note: In this guide, “children” refers to children of all ages, including teens, except when talking about a specific age. Other Caring Adults This guide is geared toward parents and family, but others who work with children may also find it useful. Teachers, coaches, childcare providers and other caring adults can offer better support to a child who has lost a loved one when they understand more about how children grieve. [ 1 ]  Why a Parent’s Role Is Important Your children are experiencing powerful and difficult feelings. They want guidance about what these feelings mean and how to cope. More than anyone else in their lives, they look to you for that guidance. Your children are concerned for you too. They wonder how you are coping. They may also worry about your health and survival. Your support and reassurance are most important for them, and can have more impact than anyone else’s. When a Parent is Grieving Talking with your children about a death is especially difficult when you’re dealing with your own grief. Children often ask the same questions adults ask themselves at such times: How could something this unfair happen? How can I go on if I will never get to see this person again? Who wants to live in a world where this can occur? What’s going to become of our family now that this person is gone? Especially in these difficult moments, your love and support are very important to your children. They learn how to deal with their grief by watching what you do to cope. However, if the task of explaining death feels overwhelming to you right now, you may want to have someone else assist you with the discussion. Think about giving that person this guide to read. You can still have these conversations with your children when you are ready. They will need to discuss this more than once, and it will matter to them because it comes from you. [ 2 ]  Helping Children Understand Death Children see and hear many of the same things adults do. However, their understanding of what these things mean may be quite different. This is true with death. Adults can help children understand death accurately. This involves more than simply giving them the facts. It means helping them grasp some important new concepts. Support of this type allows children to understand and adjust to the loss fully as they continue to move forward in their lives. Four Basic Concepts About Death Everyone, including children, must understand four basic concepts about death to grieve fully and come to terms with what has happened. Teens, and even adults, may have a full and ratio- nal understanding of death, yet still struggle to accept these basic concepts when faced with the death of a loved one. It is even harder for young children who do not yet understand the concepts to cope with a loss. There is wide variation in how well children of the same age understand death based on what they have experienced and the things they have already learned about it. Don’t assume what your children know based on their age. Instead, ask them to talk about their ideas, thoughts and feelings. As they explain what they already understand about death, you’ll be able to see what they still need to learn. Even toddlers can begin to understand some of these basic concepts. [ 3 ] More than anyone else in their lives, they look to you for guidance.  1. Death is irreversible. In cartoons, television shows and movies, children see characters “die” and then come back to life. In real life, this is not going to happen. Children who don’t fully understand this concept may view death as a kind of temporary separa- tion. They often think of people who have died as being far away, perhaps on a trip. Sometimes adults reinforce this belief by talking about the person who died as having “gone on a long journey.” Children may feel angry when their loved one doesn’t call or return for important occa- sions. If children don’t think of the death as permanent, they have little reason to begin to mourn. Mourning is a painful process that requires people to adjust their ties to the person who has died. An essential first step in this process is understanding and, at some level, accepting that the loss is permanent. 2. All life functions end completely at the time of death. Very young children view all things as living—their sister, a toy, the mean rock that just “tripped” them. In day-to-day conversations, adults may add to this confusion by talking about the child’s doll being hungry or saying they got home late because the car “died.” Imaginative play with children is natural and appropriate. But, while adults understand that there’s a difference between pretending a doll is hungry and believing the doll is hungry, this difference may not be clear to a very young child. Young children are sometimes encouraged to talk to a family member who has died. They may be told their loved one is “watching over them” from heaven. Sometimes children are asked to draw a picture or write a note to the person who died that can be placed in the coffin. These comments can be confusing and even frightening to some children. If the person who has died could read a note, does it mean he or she will be aware of being in the coffin? Will the person realize he or she has been buried? Children may know that people can’t move after they’ve died, but believe this is because the coffin is too small. They may know people can’t see after death, but believe this is because it is dark underground. These children may become preoccupied with the physical suffering of the deceased. When children can correctly identify what living functions are, they can also understand that these functions end completely at the time of death. For example, only living things can think, be afraid, be hungry or feel pain. Only living things have a beating heart, or need air to breathe. [ 4 ]  3. Everything that is alive eventually dies. Children may believe that they and others close to them will never die. Parents often reassure children that they will always be there to take care of them. They tell them not to worry about dying themselves. This wish to shield children from death is understandable. But when a death directly affects children, this reality can no longer be hidden from them. When a parent or other significant person has died, children will usually fear that others close to them—perhaps every- one they care about—will also die. Children, just like adults, struggle to make sense of a death. If they do not understand that death is an inevitable part of life, they will make mistakes as they figure out why this particular death occurred. They may assume it happened because of something bad they did or some- thing they failed to do. They may think it happened because of bad thoughts they had. This leads to guilt. They may assume the person who died did or thought bad things, or didn’t do something he or she should have done. This leads to shame. These reactions make it difficult for children to adjust to the loss. Many children don’t want to talk about the death because it will expose these terrible feelings of guilt and shame. When you talk to your children about this concept, let them know you are well, and that you are doing everything you can to stay healthy. Explain that you hope and expect to live a very long time, until your children are adults. This is different from telling children that you or they will never die. 4. There are physical reasons someone dies. Children must understand why their loved one died. If children don’t understand the real reason their loved one has died, they are more likely to come up with explanations that cause guilt or shame. The goal is to help children feel they understand what has happened. Offer a brief explanation, using simple and direct language. Take your cues from your children, and allow them to ask for further explanations. Graphic details aren’t necessary and should be avoided, especially if the death was violent. [ 5 ]  [ 6 ] [ 7 ] Explaining Death to Children Sometimes, children don’t react to news of a death the way their parents and other adults expect them to. There are many ways explanations about death can confuse children. Explanations and terms may not be clear. Adults often choose words they feel are gentler or less frightening for children. They might avoid using the words “dead” or “died,” which seem harsh at such an emotional time. But, with these less direct terms, children may not understand what the adult is saying. For example, if an adult tells children that their loved one is now in a state of “eternal sleep,” the children may become afraid to go to sleep. What to Do Speak gently, but frankly and directly to children. Use the words “dead” and “died.” Children may only understand part of the explanation. Even when adults give clear, direct explanations, children may not fully understand. For example, some children who have been told that the body was placed in a casket worry about where the head has been placed. What to Do Check back with your children to see what they understand. You might say, “Let me see if I’ve explained this well. Please tell me what you understand has happened.” Religious concepts may be confusing. It is appropriate to share the family’s religious beliefs with children when a death has occurred, but remember that religious beliefs may be abstract and difficult for children to understand. What to Do Present the facts about what happens to the physical body, as well as the religious beliefs held by the family. For example, children might first be told that the person has died. His or her body no longer thinks, feels or sees. The person’s entire body has been placed in a casket and buried. In some faiths, the adult might then explain that there is a special part of the person that cannot be seen or touched, which some people call the spirit or soul, and that this part continues on in a place we cannot see or visit, which is called heaven. Talking with your children provides a chance for them to show you their feelings.  [ 7 ] How Children Respond to Death Children’s reactions to a death may communicate their thoughts, feelings and fears. Sometimes these reactions are confusing to adults. But, when adults understand what children are communicating, everything makes more sense. Here are some common reactions children may have. Children may become upset by these discussions. Keep in mind that it isn’t the conversa- tion causing distress, but the very painful loss felt from the death of a loved one. Talking with your children provides a chance for them to show you their feelings. When you understand their feelings, it’s easier to help them cope with the experience. What to Do Pause the conversation if that seems best. Provide support and comfort. Plan to continue the talk another time soon. Let your children know it’s OK to show their feelings. Otherwise, they might try to hide their feelings and deal with them without your support. Let them know it’s OK to cry. Crying may help them feel better. Show them your own feelings. Demonstrate how you are coping. Let your children see you crying, talking with friends, seeking spiritual comfort or remembering good things about the person who has died.  Children may be reluctant to talk about a recent death. Often this happens because they see that the adults around them are uncomfortable talking about the death. Children may with- hold their own comments or questions to avoid upsetting family members. They may believe it’s wrong to talk about such things. Older children and teens may turn to peers to discuss the death. They may tell adults close to them that they don’t want or need to talk about it. What to Do Avoid forcing the issue or getting into power struggles about it. Continue to invite your children to talk on several occasions over time. Acknowledge that these conversations can be difficult. Let your children know you find talking helpful. Help older children and teens identify other adults in their lives with whom they can talk. Look for people who are not as directly affected by the death, such as a teacher, chaplain, school counselor, mental health professional, or a pediatrician or other health care provider. Maintain an emotional and physical presence with your children. Hug them. Talk about your feelings. Ask about theirs. Even older children and teens need your support and assis- tance as they cope with the loss. Children may express their feelings in ways other than talking. Children may use play or creative activities such as drawing or writing to express their grief. Often, they come to a bet- ter understanding of grief through play and creativity. These expressions can give you some important clues about what children are thinking, but be careful not to jump to conclusions. For example, very happy drawings after a traumatic death might give adults the idea that a child is not affected by the death when, in fact, this is more likely a sign that the child is not yet ready to deal with the grieving process. [ 8 ]  What to Do Offer your children opportunities to play, write, draw, paint, dance, make up songs or do other creative activities. Ask them to tell you about their artwork. For example, you might say, “Tell me what’s hap- pening in this picture you drew.” If there are people in the drawing, ask who they are, what they’re feeling, whether anyone is missing from the picture, and so on. If you’re worried that your children’s play or creative work shows they are having trouble coping with the death, seek outside help. (See the section “Getting Help” on page 21.) Children may use play or creative activities such as drawing or writing to express their grief. Comfort Zone Camp [ 9 ]  Children often feel guilty after a death has occurred. Young children have a limited under- standing of why things happen as they do. They often use a process called magical thinking. This means they believe their own thoughts, wishes and actions can make things happen in the greater world. Adults may reinforce this misconception when they suggest that children make a wish for something they want to happen. Magical thinking is useful at times. Being able to wish for things to be better in their lives and in the world can help young children feel stronger and more in control. But there’s also a down- side, because when something bad happens, such as the death of a loved one, children may believe it happened because of something they said, did, thought or wished. Older children and teens also usually wonder if there is something they could have done, or should have done, to prevent the death. For example, the parent wouldn’t have had a heart attack if the child hadn’t misbehaved and caused stress in the family. The car crash wouldn’t have happened if the child didn’t need to be picked up after school. The cancer wouldn’t have progressed if the child had just made sure the loved one had seen a doctor. Children may feel guilty for surviving the death of a sibling. They may also feel guilty if they are having fun or not feeling very sad after a family member has died. When Guilt Is More Likely Children are most likely to feel guilty when there have been challenges in the relationship with the person who died, or in the circumstances of the death. Here are some examples: • The child was angry with the person just before the person died. • The death occurred after a long illness, and, at times, the child may have wished the person would die to end everyone’s suffering. • Some action of the child seems related to the death. For example, a teen got into a heated argument with his mother shortly before she died in a car crash. Children and teens usually wonder if there is something they could have done, or should have done, to prevent the death. [ 10 ]  When talking with children about the death of someone close, it’s appropriate to assume that some sense of guilt may be present. This will usually be the case even if there is no logical rea- son for the children to feel responsible. What to Do Explain that when painful or “bad” things happen, people often wonder if it was because they did something bad. Reassure your children that they are not responsible for the death, even if they haven’t asked about this directly. Children often express anger about the death. They may focus on someone they feel is re- sponsible. They may feel angry at God. They may feel angry at the person who died for leaving them. Family members sometimes become the focus of this anger, because they are near and are “safe” targets. [ 11 ]