Grief and Grieving of Children

2. Grief and Grieving of Children By: Cathy B.Herbert, MSN,RN

3. Objectives By the end of this module students should be able to: 1. Describe the child’s concept of death according to their developmental stage. 2. Describe the child’s responses to death and loss. 3. Identify strategies to assist the child in coping with loss or death.

4. Children’s Understanding And Response To Death According to Their Stage of Development

5. Infants • Erikson Stage: Trust v. Mistrust • Cognitive Stage: Sensorimotor • Lacks understanding of death • May sense caregivers stress, anxiety and sadness • May sense separation • Responds to altered routines

6. Infant (cont.) • Infants may be fussy, cry excessively • May sleep more than normal • May eat less and resist cuddling • May regress

7. Toddler • Erikson Stage: Autonomy v. Shame and Doubt • Cognitive Stage: Preoperational • No understanding of true concept of death and its finality • Unable to distinguish fact from fantasy • Fears separation (separation anxiety)

8. Toddler (cont.) • Fearful, shows distress by hitting, crying, biting • Problems sleeping and eating • Clingy, refuses to let caregiver out of sight • Regression in toilet training, weaning from bottle, talking, etc. • Reacts to others around them ie. their stress, sadness

9. Preschool • Erikson Stage: Initiative v. Guilt • Cognitive Stage: Preoperational • Believes death is temporary and dead person will return • Magical thinking (dead person can be brought back to life) • Believes bad thoughts can cause death

10. Preschool (cont.) • May have beginning experience with death of animal, plant • May fear going to sleep, fear of dark • May have nightmares, temper tantrums, acting out behavior, crying spells • Asks a lot of questions, morbid fascination with death • Displays anger at failure to keep person “alive” • Regression, complaints of abdominal pain

11. School Age • Erikson Stage: Industry v. inferiority • Cognitive Stage: Concrete Operations • Acquires more realistic understanding of death- by 8-10 years understands death is permanent and irreversible • Still associates bad thoughts or misdeeds with causing death and feels guilt • Believes death is universal but happens to adults

12. School Age (cont.) • May have fear of own death, death of loved one; fear of going to sleep

13. Adolescent • Erikson Stage: Identity v. role confusion • Cognitive Stage: Formal Operations • Intellectually capable of understanding death; better understanding of association between illness and death • Has a sense of invincibility therefore does not really believe anything bad will happen to them

14. Adolescent (cont.) • Able to recognize effect of death on others • May suffer from severe depression • May feel angry or guilty • May have acting-out behavior ie. risk-taking, appear indifferent • May have difficulty sleeping and eating

15. Coping Strategies for Infant and Toddler • Try to maintain usual routines • Hold and cuddle infant to provide sense of security • Talk with child and answer questions • Consistent caregiver

16. Coping Strategies for Preschool Children • Listen to child and answer questions honestly • Use correct terms like death and dying; terms like sleep, gone away only cause confusion • Consistent caregiver • Encourage parents to stay as close to child as possible • Be tolerant of regressive behaviors

17. Coping Strategies for Preschool Children (cont.) • Provide play activities • Participate in rituals like visiting cemetery, planting tree or flowers • Provide pictures, personal items to remind child of loved one • May have to repeat information and answer same questions more than once

18. Coping Strategies for School Age Child • Encourage child to talk about their feelings, or have them draw pictures about how they feel • Listen to the child and answer questions honestly using proper terms • Help keep memories alive with memory book, pictures, participating in rituals like planting tree or flowers, releasing balloons.

19. Coping Strategies for School Age Child (cont.) • Return to normal routines as soon as possible • Use support groups

20. Coping Strategies for Adolescent • Share personal grief with adolescent • May be confused, frightened, or angry • Be available to answer questions honestly, but respect privacy and personal expressions of grief. • Share internet resources • Access support groups • Help keep memories alive with things like memory books, pictures, special memorial events

21. Effect of Child’s Death on Parents/Family • Death of a child is very stressful for entire family • Family members may grieve in different ways and for different lengths of time causing stress on other family members • Extreme sadness may not allow parents to talk about the child who died or answer questions • Family members may have somatic symptoms such as insomnia in response to grief

22. Review Questions • 1.The mother of a 4-year-old expresses concern about her child who believes that her grandmother is still alive 3 months after the grandmother’s death. Which explanation by the nurse is most appropriate? a. The child is in denial regarding her grandmother’s death b. This is a form of regression exhibited by the preschooler c. This is an example of the magical thinking typical of preschoolers d. There is a need for psychological counseling for the child

23. 2. An adolescent appears indifferent to his best friend’s death in an auto accident. How does the nurse interpret this reaction? a. This is within the normal range of behaviors adolescents exhibit in response to death. b. This behavior is a cry for help by an adolescent planning to commit suicide. c. This behavior is indicative of a serious psychological problem requiring immediate intervention. d. This is evidence that the adolescent is in a stage of denial. .

24. 3. The parents of a 6-year-old boy whose infant sister has recently died of Sudden infant death syndrome (SIDS) ask the nurse how they can help their son cope with his sister’s death. Which response by the nurse would not be appropriate? a. “Listen to your child and answer his question s honestly.” b. “Encourage your son to draw pictures about how he is feeling.” c. “Do not share your feelings with your son to protect him from your sorrow.” d. “Return to your son’s normal routines as soon as possible.”

25. Answers • 1. “C” • 2. “A” • 3. “C”