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Death, Dying and the Child

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Displays distress from loss by changing sleeping and eating habits ... children who are told that death is like sleeping may develop fears about falling asleep. ... – PowerPoint PPT presentation

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Title: Death, Dying and the Child


1
Death, Dying and the Child
  • 2007 Psyc 456
  • Dusana Rybarova

2
Childs reactions to loss of a parent Elisabeth
Kubler-Ross On Children and Death
  • 0-6 months
  • Displays distress from loss by changing sleeping
    and eating habits
  • Reacts to grief reactions of others
  • Needs continuous loving care
  • 6 months to 2 years
  • Doesnt understand the permanence of the loss,
    will ask for the missing parent
  • May become angry because parent doesnt come
    back, disinterest in play and food
  • Clinging to caregivers and refusal to let them
    out of sight
  • Constant loving care is the key

3
Childs reactions to loss of a parent Elisabeth
Kubler-Ross On Children and Death
  • 3 to 5 years
  • Asks questions concerning absence of the parent
  • Anger reaction to unfulfilled wish of parents
    return
  • Magical thinking, thoughts about life in the
    cemetery
  • Clinging to favorite toys
  • Importance of talking to the child and giving
    her/him loving attention
  • 5-9 years
  • Beginnings of understanding of the finality of
    death
  • Grieving manifest in changes in behavior, school
    performance, anger reactions
  • Important to have trusting relationship which
    allows the child to talk about their grief and
    distress
  • At age 9, with maturation of abstract thinking
    processes, most children have mature
    understanding of the concept of death

4
How to react http//www.med.umich.edu/1libr/aha/um
grief.pdf
  • Is death like sleeping?
  • Death is different from sleeping. When a person
    is dead, his or her body doesn't work anymore.
  • children who are told that death is like sleeping
    may develop fears about falling asleep.
  • Why did they die?
  • the person's body couldn't fight the sickness any
    more. It stopped working.
  • Explain that when most people get hurt they can
    get better and live a long, long time.
  • Will you die? Will I die?
  • Let your child know that most people live for a
    very long time.
  • Children also need to know who will take care of
    them if a parent or guardian dies.
  • Did I do or think something bad to cause the
    death?
  • Reassure your children that saying and wishing
    things do not cause a death to happen.

5
How to react http//www.med.umich.edu/1libr/aha/um
grief.pdf
  • Will they come back?
  • "Forever" is a hard concept for young children to
    understand.
  • Young children may need to be told several times
    that the person won't be back ever.
  • Is she cold? What will he eat?
  • Young children may think the dead body still has
    feelings and walks and talks under the ground.
  • explain that the body doesn't work anymore. It
    can't breathe, walk, talk or eat anymore.
  • Why did God let this happen?
  • Answer questions related to God and your faith
    according to your own beliefs.
  • It is best to avoid suggesting God "took" someone
    to be with him, or that "only the good die
    young".
  • Some children may fear that God will take them
    away too. They may try to be "bad" so that they
    won't die, also.

6
Child Suicide
  • Increase in suicide in children between 5 and 14
    years of age
  • Child suicide is influenced by immature
    understanding of death
  • Death understood as a transient and reversible
    state
  • Death as a vehicle to a happy reunion with the
    deceased or as a gateway to a happier situation
  • Inability to understand multiple dimensions of a
    situation

7
Erik Eriksons model of life-span development
  • Stage 1 Trust vs Mistrust
  • Infancy
  • Counts on caretakers to meet her/his basic
    physiological, social and belonging needs
  • Based on that experience develops understanding
    of the world as a predictable place
  • Long-term unpredictable separation may lead to
    anxious, emotionally defensive reactions
  • Stage 2 Autonomy vs Shame
  • Toddler
  • Learns what he/she can control (preference of
    food, preference of toys, excretory functions)
  • Belittling a childs efforts can lead to feelings
    of shame, self-doubt and a lasting sense of
    inferiority

8
Erik Eriksons model of life-span development
  • Stage 3 Initiative vs Guilt
  • Early childhood 3-6 years
  • Explores environment, initiates new activities,
    takes on new challenges
  • Lack of encouragement may lead to self-negation,
    guilt, resentment and unworthiness
  • Stage 4 Industry vs Inferiority
  • 6 years to adolescence
  • Learns to function in adult-like world, compares
    itself to the standard or others
  • If the child does not learn strategies to
    overcome lifes challenges and crises, it can in
    most extreme cases result in self-destructive,
    suicidal behavior

9
Humanistic perspective
  • Each human being is unique and childs reaction
    to loss depends on their unique personal
    experience, which goes beyond the child/parent
    bond and stages of cognitive development
  • To understand childs grief their individual
    experience, environmental, familial and cultural
    background needs to be taken into account
  • Questioning of stage theories of development as a
    key to understanding childrens concepts of death
    and grief reactions

10
The Dying Child
  • Terminally ill children as young as 3 years old
    come to know that they are dying, and that death
    is a final and irreversible process
  • http//www.cancer.org/docroot/NWS/content/NWS_2_1x
    _Discussing_Death_with_a_Dying_Child.asp
  • Children may not be able to talk about death but
    express their understanding of their approaching
    death in their behavior
  • Fear of wasting time, wanting to have things done
    right away
  • Dislike of talking about the future
  • Absorption with death and disease
  • Setting up a distance from others but acts of
    anger and silence

11
The Dying Child
  • http//www.athealth.com/consumer/disorders/child_a
    rticle.html
  • Stages
  • Initial awareness of the seriousness of the
    illness
  • Learning names of various drugs and medical
    procedures, perceives that he/she is seriously
    ill but will get better
  • Learns the purpose of various medical procedures
    and perceives that she is always ill but will get
    better
  • After series of relapses he perceives that he wil
    never get better
  • After numerous relapses and remissions
    understands that he/she is dying (often
    associated with leaning about death of a peer
    with the same disease)

12
Feelings of a Dying Child
  • Fear and anxiety
  • Separation from parents and other family members
  • Increasing anxiety of medical procedures
  • Increased anxiety because of feelings of fear and
    anxiety in their family members
  • Anger
  • Loss of self-control and independence
  • Often results in developmental regress to an
    emotional level at which they are no loner
    independent
  • Some children overcompensate by refusal of help
    from family and hospital personnel
  • Sadness
  • Grieving loss of what they had before the illness
    (decline in contact with friends, absence from
    social and other activities, pain, discomfort,
    decreasing mobility, alterations in body image
    etc.)
  • Loneliness and Isolation
  • Because of mutual presence of the approaching
    death, there may be no opportunity for parents
    and the dying child to truly share their concerns
    and fears and provide comfort, security, and
    reassurance
  • Childrens feelings about death sometimes become
    masked and repressed

13
Feelings of a dying child
  • Often marked by mutual pretense of the
    approaching death
  • Children may want to maintain the pretense that
    they are feeling well because they are afraid of
    being abandoned or rejected
  • To let children talk about death, about their
    fears and feelings, their hopes and despairs,
    their certainties and uncertainties, their love,
    and hate, means we are allowing them to talk
    about life, their life, and we are providing them
    with the only possible help the presence of
    another human being until the end.
  • Spiritual needs
  • Prominent in the lives of dying children
  • A positive image of what lies beyond death
  • Reassurance that they will be remembered
  • Individual differences
  • Some children are resilient and playful even when
    their life is ending

14
Three stages of bereavement in the young child
dealing with death of a parent
  • Protest
  • Anger and fear aimed at reattachment to the lost
    parent
  • Despair
  • Sadness, distance, unresponsiveness
  • May result in psychosomatic symptoms (headaches,
    enuresis,…) or psychological problems (school
    phobia, depression, poor school performance)
  • Slowly processing the loss
  • Detachment
  • Moves from depression to increased activity and
    openness to new relationships

15
Reactions and Grief Strategies
  • Regression to an earlier developmental stage
  • If denied the opportunity to openly grieve a lost
    parent, the child is likely to remain frozen in
    the regression
  • With time and nurturance the regression will
    subside
  • Hyperactivity
  • Increased activity to get attention
  • Emotional outbursts
  • Angry outbursts and irritability as symptoms of
    grief
  • Overprotectiveness of the surviving parent
  • Preoccupation with the remaining parents
    potential death
  • Constructing the deceased parent
  • Locating, experiencing and reaching out to the
    deceased parent, waking memories of the parent,
    cherishing objects shared by the child and the
    dead parent

16
The Death of a Sibling
  • Bereaved siblings show significantly higher
    levels of behavior problems and significantly
    lower social competence than normal children
    throughout the bereavement period
  • Siblings can tolerate and accept less parental
    attention and more anxiety if they know what is
    happening with the dying sibling
  • The anxiety level of a children informed about
    terminal illness and loss was found to be
    significantly lower than that of uninformed
    children
  • Bereaved children need explanations, comfort, and
    support
  • Pretense and avoidance can be frightening to
    anyone in a stressful and painful setting,
    especially a child
  • If children are involved in grieving of the
    family, it helps them to learn coping strategies
    they can rely on in dealing with future losses

17
When a Pet Dies
  • For many children loss of a pet is their first
    experience with death
  • Reactions to death of a pet across ages
  • Preschool children appear to miss the animal more
    as a playmate
  • School-age children express profound grief over
    the death of a pet, but usually for a short-time
    and adapt quickly to the change
  • Older children and adolescents tend to have the
    most profound experiences with the loss of a pet,
    possibly because of their adult understanding of
    the death as final, permanent, inevitable, and
    irrevocable
  • Through this experience children can learn that
    death is a natural part of the life process,
    that death is permanent and painful, that the
    grieving process itself is tolerable and doesnt
    last forever, and that feelings of guilt,
    sadness, and anger following death are common and
    can be overcome. (Levinson, 1972)
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