The experience of loss affects each child differently. The child's age, emotional maturity, the circumstances of the loss, and the 'connectedness' with the person or whatever the child has lost are important factors. It is important to look at each child individually and work out what will best help that child. Preschool children usually see death as temporary and reversible, and children between five and nine begin to think more like adults about death, yet they still believe it will never happen to them or anyone they know. Teenagers grieve in much the same way as adults but because at this stage of their development they often have emotional 'ups and downs' they can become deeply distressed. It is normal during the weeks following a loss for some children to feel immediate grief or persist in the belief that it didn't happen. However, long-term denial of the death or avoidance of grief can be emotionally unhealthy and can later lead to more severe problems.
Infants grieve the loss of a loved one they were used to being with. Before children can talk, they communicate with sounds of crying, cooing, body language, and physical symptoms such as colic and fretfulness. Grieving babies can be difficult to console. If you are grieving, too, chances are that the baby will sense your distress. It may also be difficult to remember all the needs of an infant when you are upset. Ask family, friends or your church community to help with a toddler's or baby's care when you are in the midst of intense grief.
As children learn to utilize our symbolic language of words, they can begin to share feelings verbally. They learn what sad, mad, and scared mean. They communicate about the concrete world: what they can see, touch, hear, taste and smell. The future, the idea of “never”, is outside their understanding. They fully expect the return of their loved one.
Around the age of six, children begin to understand that the loved one is not returning. This can bring about a multitude of feelings at the time of other significant changes in a child's life, including entering first grade. Children who do not remember their parent may feel an acute sense of loss as they see peers with their parents and hear their family stories.
Elementary age children are interested in biological processes about what happened to their loved one. Questions about disease processes and what happens to the body are of keen interest. When asked questions, it is important to clarify what it is the child wants to know.
Children's worlds are sometimes messy and have a high level of energy. Grief is also messy sometimes. It does not always take a form that makes adults comfortable. Allowing your child to express feelings through creative, even messy, play can be helpful (i.e. finger painting, making mud pies and throwing them, etc). You may want to join in the creative play.
Peer group support is helpful for children of this age.
Middle schoolers are faced with a tumultuous time of body changes and increased performance expectations. When a death loss is added to that, it increases their sense of vulnerability and insecurity.
Grades may be affected by the death. Middle school is also a time when abstract thought begins to accelerate. Children may be considering spiritual aspects of life and death, perhaps questioning their beliefs. Be open to talking with them or support them in finding someone who is comfortable discussing these issues.
Teens are usually in a place of growing independence. They may feel a need to hide their feelings of grief to show their control of themselves and their environment. Teens often prefer to talk with peers rather than adults when they are grieving.
Teens are more likely to engage in high-risk behavior, especially after a death loss. One young person expressed that her mom was always careful and followed all the safety rules, but died anyway. She asked, “Why should I be careful?”
- physical pain such as stomach aches or headaches
- sleeping problems, bad dreams
- eating problems, eating too much or too little
- being destructive
- acting like a younger child
- angry play or playing the same thing over and over
- not being able to concentrate for long
- problems with school work
- being easily upset
- being mean to others
- 'switching off', acting as if they haven't taken in what has happened
- acting more like an adult
- showing fears
- anger or aggression to friends, parents or toys
- temper tantrums
- being unhappy and blaming themselves
- tending to think the person who has gone is perfect
- crying and giggling without obvious reason
- not wanting to separate, clinginess, wanting to be near adults
- running away, avoiding school, stealing.an extended period of depression in which the child loses interest in daily activities and events
What is your typical approach to treating grief and loss?
With a thorough assessment, we seek to understand the experiences your child had beginning intrauterine and throughout childhood. This helps us understand how the brain developed and the level of coping skills your child has developed. Our focus is on creating a therapeutic environment of trust and openness to change. Dealing with grief and loss is very personal and requires a great deal of trust to engage in the healing process. The assessment includes:
- Review of current symptoms, concerns, duration and intensity
- A thorough review of child development and past medical history
- Review of family systems
- Additional important family background information including history of mental health issues
Then the best course of treatment is decided together with the caregivers. Parents and caregivers play a crucial role in treatment because family plays a crucial role in restoring balance to a child's perceived sense of insecurity. Coping skills and emotional attunement will be learned together with the parents and child, in order to assist in instilling coping skills with the affected child. Treatment may include a combination of the following:
- Theraplay® to promote attachment and balance with a new primary caregiver
- Play therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.
- Family therapy including play to explore existing family dynamics
- Bibliotherapy to help normalize reactions to grief
- Traditional "talk therapy" to create a therapeutic environment of safety and unconditional acceptance