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 Talking to Children about Death
 
 
Children need and deserve to know the truth about illness and death. If we don't tell them the truth, what they imagine will always be far worse. White lies and euphemisms create problems. These statements can leave them more frightened and confused.  If we tell them that their mom is in heaven and talk about what a great place heaven is and then we are sobbing, they become confused. Instead tell a child," Mommy died and we believe that she is in heaven. It is a wonderful place, but I will miss her very much. I am glad that she got to go to heaven, but I do wish she was here with us longer. She also wishes that she could have stayed longer as well."
*  if we simply tell them that they were so good that God wanted them with Him, they may fear being good.
* if we tell them that their grandma has gone to sleep, they may fear going to bed.
* if we tell them that Daddy went on a long trip, they may believe that Daddy has abandoned them.
* if we tell them that death is darkness and nothingness, they may become afraid of the dark.

4 Important Concepts About Death When Supporting Children  


Children as well as adults need to understand these concepts when faced with death in order to fully grieve.  Like young children, teenagers and adults often struggle with accepting the reality of a death. Intellectually, they may have a rational understanding, but emotionally they may find it difficult to accept what they know to be true. I have heard it said that the longest distance in the world is the head to the heart. So it is not only children who struggle with death, but adults too. However, children who do not yet understand these basic concepts about death may have even more difficulty in coping than those who do. Understanding helps with acceptance. 

It is best not to assume that children know certain things about death based on their age. Instead, adults need to ask them to talk about their ideas, thoughts, and feelings. As we allow children to shaire their understanding about death with us, we will know what concepts that they may need help in understanding. Listening to children is vital especially around death. 

Concept 1: Death Is Irreversible
When children watch cartoons, television shows, video games and movies, children may see characters "die" and then come back to life. In real life, we know that this is not going to happen. Children who do not fully understand this concept of death being irreversible may view death as a kind of temporary separation. They often think of people who have died as being far away, perhaps on a trip. Sometimes adults reinforce this misunderstanding by talking about the person who died as having "gone on a long journey."  Some adults today will share how they were told years ago as children that an aunt or grandparent suddenly went on a trip or went to the hospital and never returned and so they never saw them again. These adults shared that as time went on they often felt scared, confused and angry when they eventually learned their loved one had died and no one told them the truth. They grew to not trust the adults to share truth with them. Children who have had a family member or friend die may feel angry when the person does not call or return for important occasions.

If children do not think of a death as permanent, they have little reason to begin to mourn. Mourning is a process that requires people to adjust their ties to the person who has died. An essential first step in this process is understanding and, at some level, accepting that the loss is permanent.

Concept 2: The body and all of its functions stop working at death. 
Very young children view all things as living- their brother, a toy car, a sticker bush that scratched them.  In daily conversations, adults may inadvertently play into this confusion by talking about the child's doll being lonely or cold or saying they got home late because the car "died" and couldn't call as their iphone "died".  Yet, whereas adults understand that there is a difference between pretending a doll is lonely or cold and believing that to be a fact,  this difference may not be clear to a young child.

Young children are sometimes encouraged to talk to a family member who has died. They may be told that their loved one is "watching over them" from heaven. Sometimes children are asked to draw a picture or write a note to the person who died so that it can be placed in the coffin. These requests and comments can be confusing and even frightening to some children who do not yet understand the finality of death. In a young child's mind, if the person who has died could read a note, does it mean he or she will be aware of being in the coffin? Will the person realize he or she has been buried?

Children may know that people cannot move after they have died, but may believe this is because the coffin is too small.Theymay know people cannot see after death, but may believe this is because it is dark underground. These children may become preoccupied with what they perceive as the physical suffering of the deceased.

When children can correctly identify what living functions are, they can also understand that these functions end completely at the time of death. For example, only the living can think, be afraid, feel hunger, or feel pain. Only the living have a beating heart or need air to breathe. 

Concept 3: Everything That Is Alive Eventually Dies
Children may believe that they and others close to them will never die. Parents often reassure children that they will always be there to take care of them. They tell them not to worry about dying themselves. This wish to shield children from death is understandable, but when a death directly affects a child, this reality can no longer be hidden. When a parent or other significant person dies, children usually fear that others close to them-perhaps everyone they care about-will also die.

Children, just like adults, struggle to make sense of a death. If they do not understand that death is an inevitable part of life, they will have misunderstandings while trying to figure out why this particular death occurred. They may assume it happened because of something bad they did or something they failed to do. They may think it happened because of bad thoughts they had. This leads to guilt. Children may also assume the person who died did or thought bad things or did not do something that should have been done. This leads to shame. These reactions make it difficult for children to adjust to a loss. Many children do not want to talk about the death because it will expose these terrible feelings of guilt and shame.

When teachers talk to children about how everyone eventually dies, children may raise concerns about the health and safety of their own family members. If individual children are particularly concerned about the well being of their parents, teachers can ask students if they can talk with their parents. They can suggest that parents reassure their children that they are doing everything they can to stay healthy, and that they hope and expect to live a long life. For example, if a child's father died of a heart attack, the child may benefit from knowing that his or her mother has seen her doctor and had a physical exam. This shows the child that family members are taking steps to stay healthy and safe. This is different from telling children that they or their parents will never die.

Concept 4: Death Is Caused by Physical Reasons
When children experience the death of a family member or friend, they must understand why the person died. If children do not understand the real reason their family member has died, they are more likely to come up with explanations that cause guilt or shame.

The goal is to help children understand what has happened. When explaining a death to children, teachers should aim for a brief explanation that uses simple and direct language. They can watch for cues from the children and allow them to ask for further explanations. Graphic details are not necessary and should be avoided, especially if the death was violent.

Although it would be unusual for a teacher to be the first to tell an individual child of the death of a family member, teachers may need to make a class announcement about someone in the school or community who has died, a classmate who has lost a parent or other family member, or another death that affects students in a classroom or school. Parents may also ask teachers for guidance about how to tell their child about death. 

Help children to grieve and express their emotional responses about the loss. A loss can be anticipated as well.  Children need to be validated. "I understand that you are angry that dad died. It makes me pretty angry too sometimes."  Teach your children to cry by letting them see you cry. Let them know that anger is okay. Also some children don't feel upset and then feel guilty for not feeling much. They do not need to pretend to be upset.  Often the child wasn't even that close to the person who has died.

Help children to make sense out of what has happened.  Tell the truth. Name the disease and let them know that not all diseases are as serious as this one. Children feel less confused and scared when we tell them what to expect in the course of treatment of a disease. If there was an accident also please let them know what has happened and what will happen next. The more prepared they are the less out of control they feel.

Help children commemorate the loss.  Light a candle together. Take time to tell stories and share memories. Say a prayer or put up favorite photos. Make a memory box with special tokens and letters from the person. Allow the child to make a donation with the child's allowance to an organization related to the death.On the first anniversary of a death, look through scrap books, bake a cake, play the person's favorite music and eat their favorite meal. These actions help to keep memories alive of the person as well as encourage expression of feelings.
Developmental Issues of Grieving Children and Teens:
Pre-school children:  This is an egocentric age. They believe the world revolves around them and often think that they cause things to happen. They often experience a death as abandonment. Their "magical thinking" causes them to think it is their fault, or that they have the power to bring the deceased back. Some children who have lost the disciplinarian parent, have been known to act out a lot, thinking that the parent will have to come back to discipline the child. Their grief responses are short in duration but often intense and often at specific times. This may happen at dinner time or bed time or getting to school time. Children this age tend to ask the same questions over and over again. They don't understand the finality or universality of death yet. Often a child this age may say, " I know daddy died, but will he come to my party?"  Be patient and keep answering the questions. Many children of this age will "regress" back to an earlier time of mastery.  They may suddenly wet the bed, want to sleep in the parent's bed, want to be fed or dressed, stop going on the potty, stop sleeping or napping, thumb sucking or other self soothing, baby talk, irritability or become very clingy or worried about safety.
  • Use simple and honest answers
  • Be patient
  • Include the child in rituals
  • Support the child in play
  • Allow for anger and physical expression
  • Maintain consistent structure and routines
  • Allow the child to regress
  • Hold the child and give him/her extra attention and care
  • Encourage and allow for fun and happy times
  • Have books on death and grief
  • Have toys and dress up, art supplies, play Doh which help facilitate grief expression
  • Address grief issues in a group setting without the focus on the grieving child.
  • Model by sharing own grief stories

Helpful books:  The Goldfish Went on Vacation: A Memoir of Loss (and Learning to Tell the Truth about it)by Patty Dann(2007) A woman tells the true story of her husbands diagnosis of a brain tumor, who was once fluent in multiple languages changes in front of her and her little 4 year old son into a mane whose brain can't remember the purpose of a paper-clip. Out of a family tragedy Dann has created a book that will surely help many others with young children.

I Know I Made it Happen: A gentle book about feelings  by Lynn Bennett Blackburn  (1991)  Wonderful book to read with children about magical thinking. Examples include divorce, illness, injury and death all raise issues for children about security.  Children have a need to find a cause for important events and often blame themselves.

When Dinosaurs Die: A Guide to Understanding Deathby Laurie Krasny Brown and Marc Brown

Help Me Say Goodbye: Activities for Helping Kids Cope When a Special Person Dies by Janis Silverman (1999)

Grieving Elementary Child:

Concrete thinkers who are beginning to develop logical thinking patterns along with increased language and cognitive ability. After a death they question how their lives will be different, what will be the same, and how one knows the person is really dead. They are involved in how the body works and ask specific questions like, "Did the blood get all over the windshield?" or " Will her hair fall out now that she is dead?" Their questions can be graphic and gory, displaying a fear of bodily harm and mutilation. Try to give simple, honest answers to their questions. 6-12 year olds want to see death as reversible but are beginning to understand the finality and permanence of death.

Common Behaviors to Expect:

  • Regression
  • Fighting, Angry outbursts
  • Difficulty in paying attention and concentrating
  • Daydreaming
  • Not completing homework or assignments
  • Sleepiness
  • Withdrawal

How to help:    Answer questions clearly and accurately. Provide art, journals, music and movement. Make time for physical outlets: sports, games, walks etc. Help the child identify their support system. Work with the child on school assignments. Encourage the child to take breaks from school work and to have some alone time when needed or time with the school nurse or school counselor. Having a safe space to go when needed is crucial.  Allow for expression of feelings. Maintain routines and structure, but allow for flexibility.  Classmates can be coached as well on how to welcome back to school a child who has been out with the death of a loved one. Treating the friend as "normal" as possible and try including him/her in activities. Do not tell children not to ask questions. Children will naturally ask questions and that helps to make things as normal as possible. Children who have had a loss, often want to talk about their loved one.

 

When families join together to face a crisis and the adults are willing and open to talk to the children and answer their questions, the crisis becomes more manageable. This is true even if the death is accompanied by stigma and sometimes guilt and shame. Research has been done on children who have lost parents to AIDS. It was found that stigma and multiple loss were factors that complicated the children's grief process. Factors that helped with the healing process were: sustained care and support for the children, open family communication, consistency and environmental stability. 

 

Other studies show that children who have lost a parent through suicide were more likely to experience anxiety, anger and shame on a greater level than by a child who lost a parent not by suicide. However these children didn't differ from the other children in terms of depression and suicidality or psychosocial functioning. ( Doka, Disenfranchised Grief).

 

Worden(1996, Harvard) found that only 1/3 of the children who were followed up after a parental death showed serious levels of emotional disturbance over time. Children actually stayed connected  to their deceased parents by talking to them, dreaming of them, keeping special linking objects and feeling watched by them. Children in this way can draw a timeless attachment to the deceased parent. Children who adjusted the best following the death of a parent were those who had experienced the fewest disruptions and changes in their lives.  

According to Worden there is a late effect for some grieving children. Some of the negative grief reactions don't show up until the second year. Don't assume that children who are grieving are okay but rather continue to monitor them. Children can be resilient and cope when provided with support and facilitation of their grief. Therefore don't assume that a parent's death, even by suicide or AIDS will always result in  trauma for a child or else this may become a self-fulfilling prophecy.  (adapted from K. Doka, Disenfranchised Grief, 2002)

 Some children fear acknowledging grief, much like some adults for fear of emotional flooding. Grief is powerful and the emotions felt can be overwhelming. Many choose to avoid thinking or talking about the loss as they worry that if they were to feel fully their grief, they may never stop crying. Children need direct encouragement to express their grief and acknowledge their pain. They need to be reassured by adults that this is a good thing to do. Some children fear disappointing their loved ones by showing their true feelings. Some fear being chastised for crying. It is important for adults in children's lives to let the children know that all of their feelings will be understood and accepted. Giving children permission to grieve as well as healthy opportunities to express that grief in safe ways is all part of helping children to cope and grow through life's losses and transitions. Children who learn that feelings are simply feelings and that they don't have to hide them or feel ashamed or embarrassed by them, are that much better at learning about the life long process of healthy mourning. 

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