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Grief and Loss for Children


Mary Hildreth and Melanie Hickey Bereavement Coordinators Iowa Hospice Do this Do not do this Know your own beliefs Praise stoicism Begin where the child is Use ... – PowerPoint PPT presentation

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Title: Grief and Loss for Children

Grief and Loss for Children
  • Mary Hildreth and Melanie Hickey
  • Bereavement Coordinators
  • Iowa Hospice

  • Define loss, mourning, grief and bereavement.
  • Distinguish between anticipatory grief, normal
    grief, complicated grief and disenfranchised
    grief and how it can be different for children.
  • Learn about treatment interventions to use with
    children to teach coping strategies for their

What does grief look like?
Is this what grief should look like?
What about this child?
Are they grieving?
What about this boy?
The Grief Process
  • There are no mistakes, no coincidences. All
    events are blessings given to us to learn from.
  • Elisabeth Kubler Ross

  • Grief is a multi-faceted response to loss,
    particularly to the loss of someone or something
    to which a bond was formed. Although
    conventionally focused on the emotional response
    to loss, it also has physical, cognitive,
    behavioral, social, and philosophical dimensions.
  • The loss may be a person, thing, relationship,
    or situation.
  • Bereavement is the reaction of the survivor to
    the death of a family member or close friend.

  • Children and adolescents may experience grief
    differently from adults
  • They may react differently to the death of
    someone close to them or even when experiencing a
    loss just from being apart from their family,
    whether in a group home or in foster care.
  • When working with children who have experienced
    any type of loss, it is important to be aware of
    their developmental stage and any cultural

Normal Grief (Uncomplicated)
  • Normal feelings, behaviors and reactions to loss
  • Physical, emotional, cognitive and behavioral

Types of Grief
  • Anticipatory Grief
  • Normal Grief (Uncomplicated)
  • Complicated Grief
  • Disenfranchised Grief
  • Childrens Grief

Anticipatory Grief
  • Grief before loss
  • Actual or fear of potential losses
  • Experienced by patient, family, and professionals
  • Children have unique needs

Complicated Grief
  • Chronic grief
  • Delayed grief
  • Exaggerated grief
  • Masked grief

Complicated Grief Risk Factors
  • Sudden or traumatic death
  • Suicide, homicide
  • Death of a child
  • Multiple losses

Disenfranchised Grief
  • When loss cannot be openly acknowledged or
    socially sanctioned
  • At risk AIDS partners, ex-spouse,
    step-parent/child, terminated pregnancy

Childrens Grief
  • Based on developmental stages
  • Can be normal or complicated
  • Symptoms unique to children

Factors Influencing the Grief Process
  • Survivor personality
  • Coping skills, patterns
  • History of substance abuse
  • Relationship to deceased
  • Spiritual beliefs
  • Type of death
  • Survivor ethnicity and culture

5 Stages of Grief
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

  • No not me
  • When a person receives news of a loss be it death
    or another kind of loss they may be in denial
    that the loss actually happened.
  • We may tend to deny the loss has taken place and
    may withdraw from our usual social contact. This
    stage may last a few moments to a few months.
  • In residential care it may look like, My family
    will be here soon to pick me up. The child
    stands by the door and waits.

  • Why me?
  • May be furious at the person who inflicted the
    hurt (even if they are the one who died), or at
    the world, for letting it happen
  • May be angry with himself for letting the event
    take place, even if, realistically, nothing could
    have stopped it (magical thinking).
  • In residential care, I hate Social Workers. They
    dont understand me or my family. They lied about
    my family, my dad would not have done that! May
    cry uncontrollably or become angry when asked to
    do simple requests.

  • A person can bargain with God, others, or
    themselves to alleviate grief.
  • In residential care, the child may now realize
    they they will be in their placement for an
    extended period of time. They may say, If Im
    allowed to go home, I promise to be good and do
    what I am told.

  • The person first mourns past losses, things not
    done, and wrongs committed.
  • They may feel numb, although anger and sadness
    may remain underneath.
  • In residential care, Who is going to take care
    of me? Did I make this happen? I give up. Why me?
    Im so alone.

  • The person has accepted the loss or the reason
    why the loss happened. They have accepted the
  • Im here in this home, but Im safe. This is not
    my fault. I did not make this happen. Adults make
    choices for me. I need to do my best to share my
    feelings with adults around me that I trust. I
    will get through this and be OK.

Dynamic not Static
  • Processing grief is not a linear process and is
    not neat and tidy.
  • It is not necessary to go through all stages.
  • Be prepared to go back and forth between stages
    as needed to process the situation.
  • Watch for signs that someone may be stuck in one
    stage. They may need additional support.

Long term effects of bereavementon children
  • Up to 40 of bereaved children show disturbance
    after one year
  • 37 of prepubertal children in a recent study had
    a major depressive disorder within one year of
    the death.
  • Longing for reunion is common and may lead to
    suicidal thinking in children but not usually
    acted on.
  • Bereaved children are 5 times more likely to
    develop a psychiatric disorder.
  • Coping with Loss Bereavement in Childhood. By
    Dora Black

Age Groups
  • We will look at the differences in grief
    reactions according to developmental stages
  • Birth to age 2
  • Ages 2 to 5
  • Ages 6 to 9
  • Ages 9 to 12
  • Ages 13 to 19
  • https//

Birth to 2 years
  • Types of loss would be the death of the primary
    caregiver, loss of primary caregiver because of
    the birth of a sibling, or removal from primary
  • Sense of security and well being is challenged
  • Surroundings are no longer familiar
  • Child may display excessive crying, rocking,
    whining, biting, and/or other anxiety related
  • Child may not be able to process death as
    anything other that separation anxiety.

Ages 2 to 5
  • May have feelings of sadness, anxiety,
    insecurity, irritability and anger.
  • Tend to believe that death is a temporary state
    that can be reversed.
  • May equate death with sleeping or being gone on a
  • Magical thinking may occur.
  • Some children will act as if nothing has happened
    while others may regress in areas such as
    toileting or wanting a bottle.

Ages 6 to 9
  • Are able to understand the biology of death and
    comprehend the finality of it.
  • May develop fears associated with their own death
    or the death of a surviving parent
  • Feelings of insecurity may be expressed in a
    reluctance to separate from caregivers.
  • Some may be hyperactive, aggressive and
    disruptive, while others are withdrawn and sad.
  • May have nightmares, difficulty sleeping, or
    display regressive behaviors.

Ages 9 to 12
  • Understand that death is final and that it
    happens to everyone.
  • Continuity is important at this age. They may
    want to go out and play instead of talking.
  • They may have a strong need to control their
    feelings while at the same time they have great
    difficulty doing so.

Ages 13 to 19
  • Adolescents may have difficulty coping with the
    loss for months or years
  • Want to be in control of their emotions so may
    isolate from others.
  • May engage in risk taking behaviors such as
    reckless driving, drug/alcohol use, sexual
    promiscuity, cutting, and/or defiance of
  • May become more easily distracted, experience
    sleeping and eating disturbances, perform better
    or worse in school, and display strong emotional
    mood changes.

Unhelpful Comments Helpful Comments
I know exactly how youre feeling. I am sorry that you are going through this painful process.
I can imagine how you are feeling. It must be hard to accept that this has happened.
Im always here for you call me if you need anything. I can bring dinner over either Tuesday or Friday. Which would be better for you?
You should be over it by now. It is time for you to move on. Grieving takes time. Dont feel pushed to hurry through it.
You had so many years together. You are so lucky. I did not know ____, will you tell me about him? What was your relationship like?
At least you have your children. It is not your fault. You did everything you could
Youre young, youll meet someone else. Whats the most scary part about facing the future alone without _________?
At least her pain and suffering is over. She is in a better place now. You will never forget ______ will you.
He lived a really long and full life. Its not easy for you, is it? What about your relationship will you miss the most?
How old was he? He meant a lot to you.
Do this Do not do this
Know your own beliefs Praise stoicism
Begin where the child is Use euphemisms (died in his sleep)
Be there and be truthful Be nonchalant
Confront reality and use touch to communicate Glamorize death
Allow and encourage expression of feelings Tell fairy tales and half truths
Include the child in family rituals Encourage the child to be like the deceased
Encourage remembrance Protect the child from exposure to experiences with death
Admit when you do not know the answer Encourage the child to forget and just get over it
Talk about death as it naturally occurs (change of seasons, pets, current events) Close the door to questions
Accept different reactions to death Be judgmental of feelings and behaviors
Death and Dying Simulation Activity
Grief Interventions for Survivors
  • Provide presence
  • Active listening, touch, silence, reassurance
  • Identify support systems
  • Normalize individualize the grief process
  • Actualize the loss facilitate living without
  • Use bereavement specialist and resources

How can a Bereavent Counselor help?
  • Bereavement Counselors are trained specifically
    in the area of grief and loss.
  • They understand the different ways a person
  • Access to various interventions to support the
  • Can meet the person in their own home
  • Counseling is provided at no cost to the person

  • Jungle Journey by Barbara Betker McIntyre
  • Badgers Parting Gifts by Susan Varley
  • Water Bugs and Dragonflies by Doris Stickney
  • Tear Soup by Pat Schwiebert Chuck DeKlyen

Hearts n Hooves
  • One day camp for kids ages 7 to 17 who
    experienced a death of a loved one.
  • Designed to help kids communicate sorrow, manage
    pain, and work through their grief by utilizing
    activities with crafts and horses.
  • 2 locations Timber Creek Therapies in Guthrie
    Center and Juan Diez Rancheros in Davenport.
  • Open to all children who qualify and there is no
    cost to attend.

What else can we do to help?
  • Remember to be honest and ask what the child
    wants to know.
  • Allow the child to see your emotions and tears.
  • Do not try to fix the child, they need to process
    on their own terms.
  • Allow them to experience the death if appropriate
    and warranted.
  • Maintain a regular routine.
  • Try not to expect more than they can give.

  • Allow children to mourn small losses (pets) and
    be open to discussion.
  • Give them the opportunity to say goodbye.
  • Use concrete terms and use language the child
    will understand.
  • Do not make promises that are out of your

Myths and Facts
  • I wont say or do the right thing. Just let them
    know you are there for them.
  • They wont want to talk about it. Let it be
    their choice, not yours.
  • I might upset them. They are already upset and
    that is okay.
  • They need to keep busy. Not thinking about it
    can delay their grief
  • Getting rid of reminders help. This can send
    the message that it is not okay to think about
    the person who died.

Myths and Facts, cont.
  • I wont mention unless they do. Sends the
    message that there is something bad about talking
    and they will sense your discomfort.
  • Once they have felt anger or guilt, that should
    be the end of it. Grief is circular and is life
  • It is morbid to want to touch or talk about the
    body. This is healthy and makes the death real
    but do not force it.
  • It is easier to say passed away. These
    phrases can confuse or frighten children.
  • If they are not showing emotion, they are not
    grieving. They may not know how to show emotion
    or are taking cues from the adults around them.

Completion of the Grieving Process
  • No one can predict completion
  • Grief work is never completely finished
  • Healing occurs when the pain is less
  • You do not get over it, but you can get through

  • Black, Dora. Coping with Loss Bereavement in
    Childhood. March 21, 1998. BMJ Volume 316 p
  • Center for Loss and Change http//www.centerforlo
  • The Dougy Center National Center for Grieving
    Children and Families.
  • Earl Grollman Talking About Death A Dialogue
    Between Parent and Child
  • Elisabeth Kubler-Ross Foundation
  • https//
  • http//
  • Hospice Education Institute
  • Zucker, Robert. The Journey Through Grief and
    Loss. 2009. St.Martins Press, New York