What About the Kids?
WHY DO KIDS SCARE US?
What scares us about kids in difficult situations such as a terminal illness or the death of a loved one is, in fact, our own feelings of helplessness and inadequacy. This is a hurt we cannot take away. As parents and grandparents it is our job to shield our children from harm. We bandage the scraped knee and fix the broken bicycle, but we cannot shield children from grief and loss. Nor should we. Doing so, no matter how well intentioned, will cause children to feel isolated, overlooked, and excluded. Children of all ages, even the very young, are remarkably wise and resilient and possess a degree of understanding far beyond their verbal capacity. Children know what they can handle. They can set their own pace and chose their own level of contact and involvement so long as they have loving adults willing to share their own tears, be honest, and be there. Trust and respect the wisdom of the children.
CHILDREN AND DEATH.
Many factors play a role in how a child perceives death and responds to the loss of a loved one.
1. Family attitude: Is death acknowledged as a natural part of life? Or is it "something we don't talk about"?
2. Past history: Is this the first loss this child has experienced? If not, have prior experiences been traumatic; expected; about someone very significant; or a distant relative?
3. Age of the child: Whereas age is a significant determinant, I have found great variability within age groups. Therefore I try to avoid making assumptions about a child's understanding of death based solely on his or her chronological age.
CHILDHOOD PERCEPTONS OF DEATH
Early perception of death from a child's perspective is that death is a condition different from being alive. In early stages of development, children see death as a temporary and reversible condition much like going to sleep (which is one very good reason not to use "gone to sleep" as a euphemism for death). "Yes, I know grandma is dead but when can we go see her?"
The understanding of death as final is often, in the early years, accompanied by the belief that death is violent (possibly a fall-out from cartoons and movies) or contagious. Later, the concept of responsibility takes hold. It is not unusual for a child to wonder if it was anything he or she did that might have caused the death. This is especially true if the child, in a fit of rage, might have yelled "I hate you" or silently wished an "offending" parent, teacher, or sibling would drop dead.
As children mature they will begin to realize that death is universal; all living creatures will die, themselves included. As that understanding takes hold, many will be curious about the physiology of death as well as expressing concerns about the practical aspects of how life in the family will change from now on. How will responsibilities shift? In addition to the loss of a family member, other losses or significant changes may follow in its wake.
HOW TO TALK WITH CHILDREN ABOUT ILLNESS AND DEATH
1. Do not delay. Inform the children as soon as possible. Delaying this will leave them wondering why everyone is upset and pretending not to be. A child's imagination will fill in the unspoken blank with fearful images.
2. Be direct. It is best to avoid using euphemisms like "passed away", "gone to sleep", or other common phrases. Children are quite literal and such "avoidance terminology" can lead to confusion and anxiety in a child.
3. Be honest. Express yourself in simple terms, especially when dealing with younger children. Avoid elaborate explanations or unnecessary detail. Answer questions honestly. Younger children will ask the same question over and over. It is important that you give the answer the same way, using the same words every time. It helps the child feel more secure and minimized confusion.
4. Initiate contact. It is never easy to talk about death to a child who will be profoundly affected by it. Do not wait for children to come to you. You are their role model and if you do not initiate, neither will they. Opening the door for communication is the responsibility of the adult.
5. Provide structure and routine. Having your world shaken by a death will make a child feel vulnerable. The comfort of daily routine and familiar structure, whenever possible, provides the child with a greater sense security.
GRIEF IS A NORMAL HUMAN RESPONSE TO LOSS.
Grief is a universal human experience breaching all nationalities, faiths, and age differences. Even though grief is not commonly associated with death, it the companion of anyone undergoing life changing experiences of all types.
Elizabeth Kubler-Ross, a German physician studied the emotional responses of persons who had been diagnosed with a terminal condition. Her work has come to be understood to apply also to people surviving a loss as well as those facing their own death. She identified five emotional responses which she called "the stages of Grief":
- Denial. A sense of unreality and shock, often with numbness. "This just cannot be true!" Denial is a wonderful built in protective mechanism that keeps us from being overwhelmed.
- Anger. This can be expressed in many ways. People mostly respond to the "unfairness" of their situation; their anger mostly directed toward "safe" targets. The adrenalin generated by anger may give some energy and impetus to make productive changes and decisions.
- Bargaining. This coping mechanism helps people hold on to a sense of control. This is looking for second opinions, setting goals, writing the "bucket list" and taking action.
- Depression. This part of the grieving process takes a tremendous amount of energy, both physical and emotional. It is a time of turning inward and is a part of the journey through grief that is the most solitary.
- Acceptance. Coming to terms with loss does not mean getting over it. It means that the intensity of the grief has lessened and that a new "normal" is being established.
The stages of grief are not rigid and not always sequential. They often overlap, and most people move through them multiple times. The journey through grief is highly individual; coping strategies that work for one member of a family may be the polar opposite of what is helpful to someone else.
Grief takes time and each person grieves in their own time and on their own schedule. Give yourself and the people around you permission to grieve. Our culture has no patience with grief; we are expected to "get over it" and get "back to normal" as soon as possible. Remember: wherever you are in your journey you are "right on schedule."
No, they are not too young! Dr. Alan Wolfelt states that "any child old enough to love is old enough to grieve". Even an orphaned newborn misses the comforting rhythm of the mother’s heartbeat, the familiar rocking motion of her walk, the whoosh of her breath, and the timbre of her voice. Children may be too young to identify, let alone verbalize their feelings; however, they will find a way of expressing their grief when they feel it is safe for them to do so.
Childhood grief is as intense as the grief of an adult. Adults, however, have over the years developed defense mechanisms and coping skills to help them in this time of emotional turmoil. Children are new at this! They do not recognize this intense distress and do not always realize that it is related to their recent loss. Adults go about their day, getting the laundry done, groceries in the house, and the bills paid; appearing to most of the world as if nothing is different. Children do the same: they play, go to school, and fight with their siblings. It is important to recognize that, for adults and children alike, the grief is always right under the surface no matter how "normal" they may seem.
When children are not expressing their grief verbally, the intense emotions manifest through behavior and through physical symptoms. The death of a loved one shakes the world of a child. Feeling extremely vulnerable, a child often fears other losses and will cling to other adults in the family. A grieving child may also become more dependent and behave more like a much younger child. This behavior is called regression and may result in baby talk, bed wetting, and inability to perform previously mastered tasks. Regression is usually self limiting and will resolve on its own as the child adapts to the loss and starts to feel more secure again.
Physical symptoms most often present as headaches or stomach aches. Intense emotional stress affects the immune system and grieving children (as well as adults) will be more prone to colds, flu, and other opportunistic infections. Symptoms not always recognized as being related to grief include fatigue, forgetfulness, and inability to concentrate. This may cause changes in scholastic performance and require extra support and understanding from adults in the home as well as at school. If the death was caused by a terminal illness, some children may manifest symptoms mimicking the symptoms of the disease.
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Several years ago I sent a questionnaire to the children who had just completed one of my grief support groups. One ten year old girl answered the question: "What was the most important thing you learned" with the profound statement: "I learned that it is okay to be happy". That indeed is a very important thing to keep in mind.