Helping ChildrenHelping Children

Cope with Grief Cope with Grief

and Lossand LossPresented by Presented by

Christy Harpold, LSWChristy Harpold, LSW

Susan Nichter, LSWSusan Nichter, LSW

February 8 and 9, 2007February 8 and 9, 2007

What we hope you will learn! What is grief Common behaviors of a

grieving child including the physical, behavioral, emotional, academic, social, and spiritual responses

Interventions for adults and children

When is it time to get help

Grief is the intense emotional reaction to a loss

Feelings of grief can occur when Feelings of grief can occur when there is a:there is a:

Loss in the environmentLoss in the environment Loss related to skills and Loss related to skills and

abilitiesabilities Loss of external objectsLoss of external objects Loss of relationshipsLoss of relationships Loss of selfLoss of self

Common Responses PhysicalPhysical

BehavioralBehavioral EmotionalEmotional Academic Academic Social Social Spiritual Spiritual

Common Physical Responses Stomachaches, Stomachaches,

headaches, headaches, heartachesheartaches

Frequent accidents Frequent accidents or injuriesor injuries

Sleep disturbancesSleep disturbances Loss of appetite or Loss of appetite or

increased eatingincreased eating Low energy, Low energy,

weaknessweakness

Increased illnesses Increased illnesses and infectionsand infections

Rapid heart beatRapid heart beat AcneAcne New habits or New habits or

regression in regression in behaviorbehavior

Increased Increased psychosomatic psychosomatic complaintscomplaints

Common Behavioral Responses

Disruptive behaviorsDisruptive behaviors Aggressive behaviorsAggressive behaviors Non-complianceNon-compliance Increase in risk takingIncrease in risk taking ““Hyperactive – like” Hyperactive – like”

behaviorbehavior WithdrawalWithdrawal Regressive behaviorsRegressive behaviors

LyingLying Separation anxietySeparation anxiety Refusal to return to Refusal to return to

school or daycareschool or daycare Rage and angerRage and anger High need for High need for

attentionattention A need to check in A need to check in

on other loved ones on other loved ones

Common Emotional Responses

Insecurity Insecurity Concern about being Concern about being

treated differentlytreated differently ““I don’t care” attitudeI don’t care” attitude DepressionDepression Overly sensitive, Overly sensitive,

frequently tearfulfrequently tearful Mood swingsMood swings Trouble concentratingTrouble concentrating NightmaresNightmares

IrritableIrritable Appears unaffected by Appears unaffected by

the lossthe loss Suicidal thoughts or Suicidal thoughts or

ideationsideations Increase in fearsIncrease in fears Guilt, confusion, Guilt, confusion,

regret, angerregret, anger Withdrawn or spending Withdrawn or spending

a lot of time alonea lot of time alone

Common Academic Responses

Inability to focus Inability to focus Decline in gradesDecline in grades Incomplete work, Incomplete work,

or poor quality or poor quality Increase in Increase in

absencesabsences Over achievement, Over achievement,

trying to be perfecttrying to be perfect

InattentivenessInattentiveness DaydreamingDaydreaming Increase in Increase in

behavior problems behavior problems at schoolat school

Lack of interestLack of interest

Common Social Responses

Withdrawal from Withdrawal from friendsfriends

Withdrawal from Withdrawal from activities and sportsactivities and sports

Use of drugs or Use of drugs or alcoholalcohol

Changes in Changes in relationships with relationships with peerspeers

Change in family Change in family rolesroles

Stealing, shopliftingStealing, shoplifting Difficulty being in Difficulty being in

social situations that social situations that were once were once comfortablecomfortable

Wanting to be Wanting to be physically close to physically close to safe adultssafe adults

Common Spiritual Responses

Anger at GodAnger at God Questions of “Why Questions of “Why

me?” or “Why me?” or “Why now?”now?”

Questions of the Questions of the meaning of lifemeaning of life

Confusion about Confusion about what happens after what happens after deathdeath

Doubting or Doubting or questioning questioning previous beliefsprevious beliefs

Sense of despair Sense of despair about the futureabout the future

Change in values, Change in values, questioning of what questioning of what is importantis important

Developmental Understandings of Grief and

LossAgAgee

UnderstandingUnderstanding Common Common BehaviorsBehaviors

0-20-2 Cannot understand death/loss. All he/she Cannot understand death/loss. All he/she knows is that someone who cared for knows is that someone who cared for him/her is no longer presenthim/her is no longer present

Needing to be held, sleep Needing to be held, sleep problems, stomach problems, stomach problems, separation problems, separation anxiety, cryinganxiety, crying

3-53-5 ““Magical thinking” leads them to believe that Magical thinking” leads them to believe that they somehow caused the loss, or somehow they somehow caused the loss, or somehow can bring the person back. They will can bring the person back. They will repeatedly ask questions about the lossrepeatedly ask questions about the loss

Regression in behavior, Regression in behavior, confusion, concerns about confusion, concerns about their own safetytheir own safety

6-106-10 If loss is due to a death, they begin to If loss is due to a death, they begin to suspect that they might die. Develop suspect that they might die. Develop interest in causes of the loss. Loss is viewed interest in causes of the loss. Loss is viewed as final and inevitable. Start asking for as final and inevitable. Start asking for reasons and connect what is happening to reasons and connect what is happening to others may happen to themothers may happen to them

Anger, difficulty in paying Anger, difficulty in paying attention and attention and concentrating, not concentrating, not completing schoolwork, completing schoolwork, withdrawalwithdrawal

11-1411-14 Comprehend loss as final and unavoidable. Comprehend loss as final and unavoidable. May start to show concern for future and May start to show concern for future and impact on othersimpact on others

Anger, risk-taking, lack of Anger, risk-taking, lack of concentration, concentration, unpredictable ups and unpredictable ups and downs or moodinessdowns or moodiness

15-1815-18 Essentially adult views of loss. Essentially adult views of loss. Withdrawal for parents, Withdrawal for parents, pushing limits or rules, pushing limits or rules, inability to focus, increased inability to focus, increased risk-taking, wanting to risk-taking, wanting to spend lots of time with spend lots of time with friendsfriends

Important things to remember: Children feel the pain of loss—but do not have

the coping skills that adults have developed

Children often express their feelings of grief through behavior

Grieving may not “show” on the outside—the child may hide his/her sadness, deny the reality or seem unaffected

Children’s grief can be cyclical. They can not tolerate long periods of sadness.

Each child’s grief experience is unique

Many factors can affect the grief response of the child, including:

•Gender•Age—Emotional and developmental•Religious and ethnic customs•Relationship with the person that

died or involved with the loss•Prior grief experiences•Circumstances of the loss•Support available•Status of “unfinished business”•Physical and mental health•Personal resilience•Ability to cope with the stress

Children experience many different thoughts and feelings when they are grieving, including:• Shock and denial• Disorganization and panic feelings

such as scared, insecure, confused or overwhelmed

• Explosive emotions, such as rage, blame, terror, and jealousy

• Guilt• Sadness• Acceptance

Grieving children must complete four tasks for recovery. The tasks are: Acknowledging the reality of loss; Experiencing the feelings of grief

and confronting the pain of loss; Adjusting to a way of life without

the person who died, the lost object or the change in the family

Re-entering life and becoming involved with others

Grief is a natural process occurring for an unspecified period of time.

Words and Actions to Avoid

DO NOT suggest that the child has grieved DO NOT suggest that the child has grieved long enough or indicate that the child should get long enough or indicate that the child should get

over itover it

DO NOT act as if nothing happenedDO NOT act as if nothing happened

DO NOT tell a child things that she /he will later need to DO NOT tell a child things that she /he will later need to unlearnunlearn

DO NOT force them to go to the funeral if they adamantly DO NOT force them to go to the funeral if they adamantly refuse to go or deny them the opportunity to go to refuse to go or deny them the opportunity to go to

the the funeral home for the visitation or funeralfuneral home for the visitation or funeral

DO NOT rely on your child for your own emotional DO NOT rely on your child for your own emotional supportsupport

DO NOT burden your child with adult responsibilitiesDO NOT burden your child with adult responsibilities

DO NOT try to protect your child from your own DO NOT try to protect your child from your own sad feelingssad feelings

DO NOT say things like:DO NOT say things like:““I know how you feel.” I know how you feel.” ““You’ll be stronger because of this.”You’ll be stronger because of this.”““It could be worse you still have…” It could be worse you still have…”

Helpful Strategies

It is better for the child to learn about the loss from a parent or family member

Answer questions with honesty and provide factual information

Use accurate words such as died or divorced

Give developmentally appropriate definitions of words

Reassure that death is not “contagious”

Talk about and encourage discussion of the person, or pet, using names and memories

Involve child in decision about attending the funeral or memorial service

Prepare child for what will happen, what they will see, and how people will behave at the funeral or memorial service

Model appropriate responses to loss

Provide lots of hugs, holding, physical contact, and nurturing

Encourage and allow fun and happy times

Ask and discuss “What do you need to comfort yourself?” Create with your child a list of comfort strategies

Listen much and say little… Listen quietly and attentively

Acknowledge their feelings with a word. “Oh…I see…Mmmmm….”

Keep lines of communication open

Explore your religious beliefs and explain to your child

Reassure child that all emotions (sadness, anger, relief, guilt) are normal responses to loss

If possible, teach your child about death

Give the feeling a name. “That sounds frustrating.” “You sound lonely.” “It sounds like you are worried.”

Give them their wishes in fantasy.“I wish I could make make your dog come home.”“If I had a magic wand, I would change….”“I know that you wish that dad and I were still together.”

Be gentle and patient

Allow for expression of feelings but not in a way that hurts others, property or the child““I can see how angry you are about…… Tell me with words (or draw me a picture), it is not o.k. to hit.”

Plan a concrete activity such as plant a tree, create a memory book, or participate in the funeral

Reassure child of your love and support

Address child’s unspoken feelings

Help your child to use their grief in a positive way. For example, help others in similar situation, contribute or raise funds for a memorial scholarship, make ribbons, etc

Provide structure and routine with flexibility as needed

Reassure child that he or she did not cause breakup, death, etc. Be cautious about false assurance

Include your child in the process of acceptance and healing

Encourage drawing, reading, playing, art, music, dance, acting and/or sports

Work with school to tailor workload

Allow for some regressive behavior and offer comfort

Expect and accept mood swings

Teach your how to change their physical response. For example, deep breathing, imagery, muscle relaxation

Recognize and praise your child when he or she is using positive comfort strategies

Books can be helpful

Be proactive and inform children about changes in the routine, expectations, etc. Consistency and predictability is important whenever possible

Try to ensure plenty of sleep, proper nutrition, exercise, and quiet time

Provide or replace items that provide security

Holidays and anniversaries can be especially painful

When is it time to get help?

Extreme changes in behavior after Extreme changes in behavior after lossloss

Grieving process seems to interfere Grieving process seems to interfere with the child’s daily functioningwith the child’s daily functioning

If the expression of, or lack of, If the expression of, or lack of, feelings seems too strong for what feelings seems too strong for what is happening or last too longis happening or last too long

Exhibits self-destructive behaviorExhibits self-destructive behavior Trouble with the lawTrouble with the law Extreme belligerent, acting-out, Extreme belligerent, acting-out,

destructive or impulsive behaviordestructive or impulsive behavior Expresses suicidal ideationExpresses suicidal ideation

Appetite changes that have caused major Appetite changes that have caused major weight gain or lossweight gain or loss

Upset sleep patterns that leave you Upset sleep patterns that leave you unable to rest or sleep excessivelyunable to rest or sleep excessively

Long term withdrawal from peers or familyLong term withdrawal from peers or family Inability to experience pleasure no matter Inability to experience pleasure no matter

whatwhat Feeling overwhelmed by anger, fear, or Feeling overwhelmed by anger, fear, or

hopelessnesshopelessness Only feeling happy with drugs and alcoholOnly feeling happy with drugs and alcohol Sharp drop in school performance or Sharp drop in school performance or

refusal to attend schoolrefusal to attend school Acting much younger for an extended Acting much younger for an extended

periodperiod

Seek help for your child if the grief or Seek help for your child if the grief or loss becomes more than he or she can loss becomes more than he or she can handle or if it is negatively impacting handle or if it is negatively impacting two or more areas of his or her life.two or more areas of his or her life.

Contact:Contact: A counseling or mental health centerA counseling or mental health center Your pastor, priest, rabbi or ministerYour pastor, priest, rabbi or minister A child psychiatrist or psychologistA child psychiatrist or psychologist Your child’s schoolYour child’s school Your family physician or pediatricianYour family physician or pediatrician A support groupA support group

Brooke’s Place for Grieving Young PeopleSuite 10350 East 91st StreetIndianapolis, IN 46240317-705-9650

Camp Healing TreeA Special Weekend Camp for grieving children and teens, ages 7 – 17 will be held August 24-26.

Camp Healing Tree is FREE but space is limited. If you would like more information, or to register a young person, call 317-388-CAMP beginning April 3 or call any area hospice.

Websites and Resources

www.dougy.orgwww.tlcinstitute.orgwww.aacap.orgwww.mentalhealth.orgwww.childgrief.org

““Grieving is as natural Grieving is as natural as crying when you hurt,as crying when you hurt,

sleeping when you are tired,sleeping when you are tired,eating when you are hungry,eating when you are hungry,

or sneezing when or sneezing when your nose itches.your nose itches.

It is nature’s way of It is nature’s way of healing a broken heart.”healing a broken heart.”