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Grief and Mourning


GRIEF AND MOURNING Loss in a Paediatric Context – PowerPoint PPT presentation

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Title: Grief and Mourning

Grief and Mourning
  • Loss in a Paediatric Context

Who grieves?
  • Parents
  • Siblings
  • Grandparents
  • Significant others
  • School and activities friends
  • A large community
  • Care providers

A Parents Loss
  • part of own sense of self
  • connection to the future
  • unfulfilled expectations ambitions
  • some of own treasured qualities/ abilities
  • source of love and acceptance
  • sense of power and control over what happens to
  • social status and contacts
  • Celia Hindmarch

  • She was my child and she still is
  • Dont keep telling me what you think I am doing
  • Im doing it my way.
  • Its the only way I know how
  • Beyond Words, Skylight, 2012

Anticipatory Grief
  • Normal mourning when facing a death
  • Can be as intense as grief after the death
  • Varies in intensity
  • May not occur especially in strong denial

Stages of Anticipatory Grief
  • 1. realise death is eminent- sadness depression
  • 2. concern for dying child- regrets, anxieties
  • 3. rehearse death-concerns, fears, planning
  • 4. imagine life afterwards anniversary, stuff,

Manifestations of Grief
Manifestations of Grief
  • Physical
  • Emotional
  • Crying, moaning, agitated, exhausted, sleeping
    changes, central constriction dry mouth, tight
    chest, stomach ache, digestive issues, nausea,
    nervous laughter, more illness and accidents,
    sensory sensitivity Skylight2012
  • Shocked, stunned, sad, desolate, afraid, lonely,
    let down, overwhelmed, helpless, regretful,
    angry, guilty, relieved, sense of injustice,
    numb, empty, drained

Manifestations of Grief
  • Mental
  • Social
  • Blank, confused, forgetful, distracted, slow
    responses, difficult to make decisions,
    replaying, preoccupation, difficulty switching
    off, blaming, different world view, overwhelmed
    too hard
  • Needing to talk over, avoiding talk, wanting
    people or not, difficulty with commitments,
    changed reactions to touch, hurting others,
    differing family relations, risk taking
  • Skylight2012

Manifestations of Grief
  • Spiritual
  • Sensing the presence of the child who has died,
    asking why, seeking beliefs or turning away from
    them, praying or abandoning prayer, seeking
    nature, looking for meaning
  • Skylight2012

Inside this Shell of Mine Nancy Bright
  • Aside from offers of absorbent products, what do
    we have to offer each other?  My mother was a
    pragmatic girl who finally told me a safe place
    to grieve was lying on the floor.  She said that
    on the floor, theres no place to fall.   She
    was right.  My body would collapse from the
    howling and it would curl itself up on its side
    on the wood floor like a salted slug, and the
    floor would not drop me.  I still feel the smooth
    wide boards of the kitchen floor against my
    cheek its cool bones against my heated ones.

Words of Loss
  • Bereavement is what happens to you
  • Grief is what you feel
  • Mourning is what you do
  • Celia Hindmarch

  • culture
  • community
  • religion, spirituality
  • male/ female
  • environment
  • concurrent stresses
  • history
  • society

And then there is Media
Tasks of Grieving
  • William Worden
  • Alan Wolfelt
  • to accept the reality of the loss
  • to work through the to the pain of grief
  • to adjust to an environment in which the deceased
    is missing
  • to emotionally relocate the deceased and move on
    with life
  • Acknowledging reality of the loss
  • Embracing the pain of the loss
  • Remembering the person who died
  • Developing a new sense of identity
  • Searching for meaning
  • Receiving ongoing support from others

Practical Advice for Mourners
  • Eat healthy, drink water, rest and sleep and
  • Talk to a trusted person, be with good people who
    care about you, be by yourself
  • Ask for what you need, be honest
  • Its ok to grieve, cry, not cry, feel what you
  • Talk with people who have been there, dont cut
    off permanently
  • Listen to music, go to nature, get creative
  • Have massage, hugs, treats
  • Keep safe, get help, forgive self, be patient
  • Skylight2012

  • A new sense of self
  • connecting to the deceased
  • inner representation
  • identification
  • incorporation
  • rituals, remembering
  • death is a transition not an illness
  • Phyllis Silverman

  • Making friends with grief
  • Carrying on without physical presence
  • New sense of meaning and purpose
  • Hope and commitment to future
  • An ongoing journey

  • Allow yourself to mourn
  • Your grief is unique
  • Allow yourself to feel numb
  • This death is out of order
  • Expect to feel a multitude of emotions
  • Be tolerant of your limits
  • Talk about your grief
  • Watch out for cliches
  • Develop a support system
  • Embrace your treasure of memories
  • Gather impt keepsakes
  • Embrace your spirituality
  • Move toward your grief and heal
  • Dr Alan Wolfelt

Risk factors
  • who the person was
  • nature of attachment
  • mode of death
  • history
  • personality
  • social context
  • concurrent stresses

Masculine Style
  • Quieter, less visible
  • Less connected with past, more with future
  • Less passive, more aligned with action
  • Not as well accepted
  • When a woman feels lost, she tends to ask for
    help. When a man feels lost, he looks for a map
    Tom Golden

  • a grandparents grief is like a fork with two
    tinesone representing the loss of a grandchild,
    the other representing the pain of your own
    childs suffering.
  • M.H.Gerner-For Bereaved Grandparents
  • Listen to your bereaved child
  • Talk about your grandchild
  • Consider your needs
  • Survivor guilt anger
  • Hope for a better day

Siblings Charter
  • We need to respect their rights to
  • Bereavement Support
  • Express feelings and thoughts
  • Remember the person who has died
  • Education information
  • Appropriate and positive response from school
  • Voice in impt decisions
  • Everyone involved
  • Meeting others
  • Established routines
  • Not to blame
  • Tell their story
  • Winstons Wish 2003

What do Children Understand?
  • age
  • environment
  • experiences
  • personality
  • family coping

Concepts of Death
  • Separation (age 5)-dead people do not co-exist
    with the living
  • Causality (age 6)-death is caused by something,
    be it trauma, disease, or old age
  • Irreversibility (age 6)-a dead person can not
    come alive again
  • Cessation of bodily functions (age 6)
  • Universality (age 7)- all living things will die
  • Insensitivity (age 8)-the dead can not feel fear
    or pain
  • RCH website

What do Children Understand?
  • Environment
  • Physical
  • Social
  • Cultural
  • Emotional

What do Children Understand?
  • Experiences
  • Personality
  • Life journey
  • Responses to stress
  • Sex
  • Capacity to adapt
  • Bonding

What do Children Understand?
  • Family Coping
  • Extent of crisis
  • Collective behaviours
  • Communication style
  • Alliances
  • Resources

Age Grief Response Companioning
Infants and Toddlers Baby-2 years Loss absence Im upset cry, thumb suck Change in normal patterns in sleeping, eating, fussing Physical comfort Accept, get routine
Preschoolers 3-6 years Death may be thought of as temporary and/or reversible May not understand new feelings, unable to verbalise Ask ? About death over and over. Reenact death in play Regress- potty, sucking, baby talk Provide terms for feelings Answer concrete lovingly. No half truths Death play ok, join in and offer guidance These are normal. Offer presence and support
Grade Schoolers 6-11 years Express grief primarily through play May hang back socially, scholastically May act out because they dont know how else to handle their grief Use older kid play therapy Permit to take time to mourn, give them time Offer venting alternatives. Support groups can be helpful.
Alan Wolfelt-Companioning the Grieving Child
Age Grief Response Companioning
Adolescent 12 years and up Understand death cognitively but are only beginning to grapple with it spiritually May protest the loss by acting out/ withdrawing May feel life has been unfair to them, act angry May act out a search for meaning, test his own mortality Tolerate if no-one is being harmed. Withdrawal is normal short term only. Normal egocentrism. After he has had time to explore this, encourage to consider the impact on his larger social group. Teens explore the why about life and death. Encourage search unless it may harm
Alan Wolfelt-Companioning the Grieving Child
When a sibling dies
  • Layers of loss
  • Survivor Feelings
  • an ally
  • a companion
  • a carer, a dependent
  • an identity
  • innocence
  • routine, normality
  • balance
  • Guilt
  • Relief
  • Fear
  • Confusion
  • Wolfelt

  • acting out
  • withdrawal
  • disobedience
  • insecurity
  • inattention
  • sleep disturbance
  • appetite changes
  • sensitivity, fears

What helps?
  • Information, answer questions
  • involvement, funeral etc
  • discussion about loss
  • normality, play
  • special time,
  • meaningful memory making and rituals
  • peer and school support
  • external support
  • working with the parents/carers

Memory making and rituals
  • Treasure box
  • Plant tree, garden
  • Christmas decoration
  • Drawing
  • Photo collection
  • Touchstones
  • Poetry, music
  • Star naming
  • Conversation
  • Ongoing activities
  • Anniversary actions
  • Special places
  • Mealtimes
  • Sad, mad, glad space
  • activities

Talking with Children
  • our own anxieties, helplessness
  • talking to becomes with
  • repeat information
  • reassurance, trust, security
  • right place, right time, right person
  • not what you say but how you say it!

How you say it
  • talk at eye level
  • speak directly to and with the child
  • avoid confusing language and double meanings
  • avoid cliches, platitudes
  • keep it short and simple- repeat
  • check the childs understanding
  • be truthful honest- share your feelings
  • keep them informed talk open
  • - Earl Grollman 1990

Carpe Diem Alan Wolfelt
  • Talk about the physical reality of death- may
    sure they understand how and why the person died
  • Next time they cry, hold gently and let then cry
    as long and hard and often as they want to
  • Invite to share a memory, or ask to show photo of
    who died then tell you what was going on when pic
    was taken
  • Acknowledge the reality of the loss
  • Feel the pain of the loss
  • Remember the person who died

Carpe Diem Alan Wolfelt
  • Develop a new self-identity
  • Search for Meaning
  • Receive ongoing support from caring adults
  • Include Child in Funeral
  • Ask child to draw 2 pictures of his life before
    and after the death, talk about differences.
  • Share your beliefs without pressure for child to
    believe what you do.
  • Create a plan to help, mark dates to contact and
    spend time, mark important dates
  • If funeral done, talk about ceremony answer ?,
    discuss ongoing way to honour who died.

Carpe Diem Alan Wolfelt
  • Help child choose a keepsake
  • Give permission to find comfort in linking
  • Consider childs relationship to the person who
  • Talk about keepsakes, ask about a chosen ones
    significance or help plan to chose/ procure one
  • Do they have one? Talk about this, affirm need to
    have and hold this.
  • Think about this from her point of view. Set
    aside your thoughts and feelings and enter her
    world as you consider this point.

  • inform of childs loss
  • identify others at risk
  • provide simple information with permission
  • support staff
  • written resources online
  • develop memorial/ritual
  • set up liaison with education department supports

  • Extended Family, friends
  • Facebook contacts
  • Neighbours
  • Community groups
  • Sometimes need some help here

Risk Factors
  • Nature of the Loss
  • traumatic,
  • Unexpected
  • Features of Child
  • Psyche disorder, multiple losses,
  • Nature of Relationships
  • Ambivalent, low family support, father of teen
    boy, mother of young child
  • Aranda.S, Milne,D,

  • NALAG, Grieflink
  • Child and Youth Health website
  • SIDS and Kids, SANDS
  • RCH Palliative Care website
  • Compassionate Friends
  • Skylight, NZ
  • Starbear (S.A.), Anglicare Loss and Grief Centre
  • Journeys folder- PallCareAus website
  • Disease base associations

  • If ever there is tomorrow
  • when were not together
  • There is something you must
  • always remember.
  • You are braver than you believe,
  • stronger than you seem,
  • and smarter than you think,
  • but the most important thing is,
  • even if we are apart
  • Ill always be with you.
  • A.A.Milne