Helping Children Cope with Loss and Grief

by Irene M. Swerdlow-Freed, Psy.D.

I recently treated a 7-year-old boy, who, following his father's death, was refusing to sleep at night. He would climb out of bed, turn on the lights, and play with his toys, or sneak downstairs to watch television. His mother had tried to address this behavior, but the boy continued to refuse to go to sleep. In addition, he began misbehaving at school and was no longer completing his schoolwork.

It was immediately evident upon meeting this child that he was overtired, distraught and sad. As our first session progressed and he relaxed, he poignantly stated that his father was sleeping comfortably in heaven. As we discussed his father's death it become evident that this boy understood the finality of death, but incorrectly believed that his father had fallen asleep and was now unable to wake up. This child was afraid that, he too, would fall asleep forever, and this fear generated his refusal to go to sleep. After communicating this information to the mother, she and I together explained to the boy the difference between falling asleep and dying. We then explored the boy's thoughts and feelings about his father's death, and answered his questions about this experience.

Helping a child grieve is understandably difficult for parents and relatives who are themselves experiencing a myriad of emotions associated with the death of a loved one. Yet a basic understanding of how children conceptualize death and handle grief and the support they require can reduce both the adult's and child's experienced stress.

Very young children are usually unfamiliar with death and lack the cognitive sophistication to conceptualize its meaning. When talking to a toddler or pre-school aged child about death, it is helpful to begin by talking about life: live people and animals breathe, talk, eat, sing, and sleep, while in death none of these activities occur. It is instructive to reference situations that occur naturally. When a dead animal is sighted on the road it can be explained that the animal has died and is no longer capable of life's normal activities. Since very young children do not have an adult's sense of time and lack the capacity to conceptualize what "forever" means, it is common for them to ask when Daddy or Mommy is going to stop being dead and come home. Despite the passage of weeks and even months, some small children continue to anticipate that death is reversible and that the deceased parent or loved one will be returning.

Very young children are better able than adults to set aside upsetting emotions and focus on other aspects of life. It is normal, for example, for them to quickly move beyond their sadness and to re-focus attention on enjoyable daily activities, such as playing with friends. Although they will continue to experience occasional periods of sadness or loneliness, if adults meet their overall needs, they will overcome feelings of sorrow and resume normal life.

Children do not encounter the daily reminders of an adult death, such as funeral arrangements, the will, reorganizing finances, or filing insurance claims. They are, however, very perceptive to signs of unusual activity; hushed tones, numerous phone calls, a parent crying, and a general feeling of tension within the home. Young children often respond to the emotional tone of the household with aberrant or immature behavior. It is important that parents, close relatives or family friends make time to spend with the child, and assist the child's return to his or her normal day-to-day routine as soon as possible.

School-age children are better able than younger children to conceptualize the finality of death. However, school age children may also feel responsible for a parent's death or they may dwell on ways that they could have treated the deceased parent better. Children at this age often have many questions and concerns. They often need to talk about the person who has died, and to express fears that they or another loved one may die. It is common for children who have experienced a parent's death to wonder what will now occur in their own lives.

In the context of missing a parent, a child may imagine him- or herself joining that parent by dying too. It is useful for adults to understand that this idea is a fantasy, and usually does not signify that a child is suicidal. Furthermore, it is important to stress to the child that he or she is loved and valued by people who are alive, and that these people would be extremely upset if something bad happened to him or her.

Older school age children often have complex reactions to the death of a parent or loved one, and may not know how to effectively handle their own emotional reactions. They may be reluctant to discuss the deceased, in order to avoid painful feelings. They may seek escape into solitary activities and wish to remain apart from others. Still other children may withdraw from family members, with whom they have become close out of fear of losing that person. However, isolation and avoidance are not adaptive ways of coping because these methods do not enable children, or adults, to resolve feelings of grief, loss, or sadness. Finally, it is not uncommon for children this age to experience nightmares or somatic complaints, such as headaches and stomachaches.

Teenagers, because of their greater cognitive maturity and sophistication, are the most likely to deal with death in a manner similar to adults. Adolescents are likely to experience a variety of feelings including denial, anger, and sadness, which vary in frequency and intensity.

The normal adolescent developmental tasks of separation and individuation can be profoundly impacted by the death of a loved one. Some adolescents may become unusually dependent and seek excessive comfort from their family unit. Others may prematurely separate from the family to avoid facing the pain and sorrow that permeates the home. It is important that adults remain emotionally available, while also permitting the adolescent to regulate how close and intimate he or she wishes to become during this difficult period.

It is normal and understandable that adults wish to protect children from the emotional pain stemming from the death of a parent or loved one. Practically speaking, however, this is not possible. Adults can help children cope with death and loss by encouraging them to express their feelings and concerns and providing accurate information and honest answers to questions. Depending on the age and temperament of a child, some may find it comforting to attend memorial and funeral services, or to participate in the planning of these events. Other children may find it reassuring to draw a picture or write a note that is placed in the casket, or to plant a tree in the deceased's honor. Children who have never attended a funeral service may be reassured by a step-by-step description in advance of what will transpire, what the body will look like, how people will act, and what to say when people express condolences.

Like adults, children respond in different ways to the death of a loved one. Some children show very little emotion, some become intensely angry, some seek constant reassurance, and some withdraw. Common emotional reactions include denial, anger, guilt, depression, anxiety, and fear. A child may show only one or two emotions, or may display a broad range of reactions.

It is expected that most children will substantially recover from the death of a parent or loved one within a 6 to 12 month period. Children who do not adequately recover and who display excessive sadness or guilt or exhibit abnormal behavior may require professional help to effectively resolve their feelings. A psychologist who is familiar with child development and grief reactions can assist a child, and his or her parents, to cope with and work through unresolved feelings related to the death of a loved one.

Reference: http://drswerdlow-freed.com/therapyarticle5.html