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					Helping Children
Cope with Grief
   and Loss
        Presented by
    Christy Harpold, LSW
     Susan Nichter, LSW
   February 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
 there is a:

   Loss   in the environment
   Loss   related to skills and abilities
   Loss   of external objects
   Loss   of relationships
   Loss   of self
Common Responses
         Physical
         Behavioral
         Emotional
         Academic
         Social
         Spiritual
Common Physical Responses
   Stomachaches,              Increased illnesses
    headaches, heartaches       and infections
   Frequent accidents or      Rapid heart beat
    injuries                   Acne
   Sleep disturbances         New habits or
   Loss of appetite or         regression in behavior
    increased eating           Increased
   Low energy, weakness        psychosomatic
                                complaints
    Common Behavioral Responses

   Disruptive behaviors         Lying
   Aggressive behaviors         Separation anxiety
   Non-compliance               Refusal to return
   Increase in risk taking       to school or
   ―Hyperactive – like‖          daycare
    behavior                     Rage and anger
   Withdrawal                   High need for
   Regressive behaviors          attention
                                 A need to check in
                                  on other loved ones
    Common Emotional Responses
   Insecurity                   Irritable
   Concern about being          Appears unaffected by
    treated differently           the loss
   ―I don’t care‖ attitude      Suicidal thoughts or
   Depression                    ideations
   Overly sensitive,            Increase in fears
    frequently tearful           Guilt, confusion, regret,
   Mood swings                   anger
   Trouble concentrating        Withdrawn or spending
                                  a lot of time alone
   Nightmares
    Common Academic Responses
   Inability to focus        Inattentiveness
   Decline in grades         Daydreaming
   Incomplete work, or       Increase in behavior
    poor quality               problems at school
   Increase in absences      Lack of interest
   Over achievement,
    trying to be perfect
    Common Social Responses
   Withdrawal from            Change in family roles
    friends                    Stealing, shoplifting
   Withdrawal from            Difficulty being in
    activities and sports       social situations that
   Use of drugs or             were once comfortable
    alcohol                    Wanting to be
   Changes in                  physically close to safe
    relationships with          adults
    peers
    Common Spiritual Responses
   Anger at God              Doubting or
   Questions of ―Why          questioning previous
    me?‖ or ―Why now?‖         beliefs
   Questions of the          Sense of despair
    meaning of life            about the future
   Confusion about what      Change in values,
    happens after death        questioning of what
                               is important
   Developmental Understandings of
           Grief and Loss
Age Understanding                                              Common
                                                               Behaviors
0-2     Cannot understand death/loss. All he/she knows         Needing to be held, sleep
        is that someone who cared for him/her is no            problems, stomach problems,
        longer present                                         separation anxiety, crying
3-5     ―Magical thinking‖ leads them to believe that          Regression in behavior,
        they somehow caused the loss, or somehow can           confusion, concerns about
        bring the person back. They will repeatedly ask        their own safety
        questions about the loss
6-10    If loss is due to a death, they begin to suspect       Anger, difficulty in paying
        that they might die. Develop interest in causes        attention and concentrating,
        of the loss. Loss is viewed as final and inevitable.   not completing schoolwork,
        Start asking for reasons and connect what is           withdrawal
        happening to others may happen to them
11-14   Comprehend loss as final and unavoidable. May          Anger, risk-taking, lack of
        start to show concern for future and impact on         concentration, unpredictable
        others                                                 ups and downs or moodiness
15-18   Essentially adult views of loss.                       Withdrawal for parents,
                                                               pushing limits or rules,
                                                               inability to focus, increased
                                                               risk-taking, wanting to spend
                                                               lots of time with friends
    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
        long enough or indicate that the child should get
        over it
   DO NOT act as if nothing happened
   DO NOT tell a child things that she /he will later need to
        unlearn
   DO NOT force them to go to the funeral if they adamantly
        refuse to go or deny them the opportunity to go to the
        funeral home for the visitation or funeral
   DO NOT rely on your child for your own emotional
        support
   DO NOT burden your child with adult responsibilities
   DO NOT try to protect your child from your own
        sad feelings
   DO NOT say things like:
        ―I know how you feel.‖
        ―You’ll be stronger because of this.‖
        ―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
  loss
 Grieving process seems to interfere
  with the child’s daily functioning
 If the expression of, or lack of,
  feelings seems too strong for what is
  happening or last too long
 Exhibits self-destructive behavior
 Trouble with the law
 Extreme belligerent, acting-out,
  destructive or impulsive behavior
 Expresses suicidal ideation
   Appetite changes that have caused major
    weight gain or loss
   Upset sleep patterns that leave you unable
    to rest or sleep excessively
   Long term withdrawal from peers or family
   Inability to experience pleasure no matter
    what
   Feeling overwhelmed by anger, fear, or
    hopelessness
   Only feeling happy with drugs and alcohol
   Sharp drop in school performance or refusal
    to attend school
   Acting much younger for an extended period
   Seek help for your child if the grief
    or loss becomes more than he or she
    can handle or if it is negatively
    impacting two or more areas of his or
    her life.
    Contact:
     A counseling or mental health center
     Your pastor, priest, rabbi or minister
     A child psychiatrist or psychologist
     Your child’s school
     Your family physician or pediatrician
     A support group
Brooke’s Place for Grieving Young People
        Suite 103
        50 East 91st Street
        Indianapolis, IN 46240
        317-705-9650
Camp Healing Tree
  A 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.org
www.tlcinstitute.org
www.aacap.org
www.mentalhealth.org
www.childgrief.org
   “Grieving is as natural
  as crying when you hurt,
sleeping when you are tired,
eating when you are hungry,
      or sneezing when
      your nose itches.
    It is nature’s way of
  healing a broken heart.”

				
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