How to Respond to Grieving Children

I'm concluding a mini-series on children and death today. if you missed earlier posts, you can click here for the introductory article on what children understand about grief, and here for the post on what common grief reactions are for the each age group.

Today, I'll wrap it up with how adults are supposed to intervene and respond to children in the various age ranges.

0-2

Infants basically need consistent care, which includes physical contact that is both nurturing and loving, as well as a secure routine. Patience is a huge asset to have when they are upset. Your presence does more than anything else. Watch your tone and take care to breathe deeply, as infants absorb your mood almost by osmosis. They sense when adults around them are upset. Older children in this age range will respond to simple, honest explanations. If they attend a funeral, they need individual attention directed to them, so that they can ask questions and receive support.

2-4

Older children also need simple and honest explanations, but they really need adults who are patient with their questions and thoughts. Responding appropriately to their innocent questions will go a long way toward reassuring them that the world is still aright. When adults are crying, telling a child that the adult is sad or missing/thinking about so-and-so will help normalize the child's similar reaction. One of the worst things you can do is skirt around the words "dead" and "death." To tell a child that someone is simply "sleeping," or "gone away," or "resting," or "passed away" doesn't illuminate the situation, and often cause confusion. This age also needs steady routines, and might need additional help and prompting through transition times. Adults can read books that explain death (there are many good ones on the market that I like to use in sessions), and can involve the child in methods to help them find closure (drawing a picture, writing a letter, etc.) with the deceased.               

5-8

The same basic interventions apply as for the age group above, but perhaps with more emphasis on rituals and closures. Allowing the child to talk about the death over and over is important, as each time the child is working something else out emotionally. Education about death and what it means is appropriate, using words they will understand. Books with this age group are very helpful, as well, and I find that artistic means of expressing themselves are great. Not only does art occupy their hands with something, but it frees their minds to be able to talk more stream of conscious. Many times, children this age will free associate almost, with memories of the person they lost. Acknowledging their pain and tears, as well as the adult's pain and tears, is an important step to remember, so as to normalize their emotional experiences.

9-12+

Older children need someone to listen to them...when/if they are ready to talk. Do not force the issue. Mandatory counseling is often counter-indicated, because teens will talk when they're good and ready to do so. Of course, encourage communication, but just being available is sometimes enough. Helping them understand that they might have more intense reactions on the deceased's birthday or anniversary is good psychoeducational information to give them. They might want to make use of a journal or a particular playlist on their phone or iPod that helps them cope better.

Let's Analyze

Have I missed anything on grief and children that you wanted me to cover? If so, drop me a comment below and I'll try to address it next week.

How Do Children React to Death?

Continuing my series today with how different age groups might realistically react to death. You can read up here for last week's post on what children intellectually understand about death. But I get a lot of questions about the feasibility of reactions of young children, so I'm trying to clear that up here.

0-2

Children this age most often cry when in any kind of distress. That's how they let you know, without words, that they are cold, hot, wet, gassy, hungry, etc. In a child who experiences a grief reaction (and yes, in the field we'd call it that....it's traumatic to lose anyone at any age), you'd see crying and general crankiness, but you'd also see a fussiness to get more attention. This could turn into temper tantrums or extreme bouts of crying (lasting anywhere from an hour to three) where they are inconsolable. Small infants and toddlers will also show variance in their eating and sleeping patterns, perhaps being more picky, have trouble latching on, or frequent night wakings. Toward the end of this age range, children will show regression in behaviors and skills they have already learned, like toilet training, walking, and language.

2-4

Preschool-aged children will also show regressive behavior, just like the above age range. They could be completely potty trained, but regress back to using pull-ups when faced with a traumatic grief situation. These children could show anxiety, specifically when having to be separated from a parent or caregiver. They might be clingy, grabbing on to the legs of their safe person, when faced with being separated. Crying is also common. Children this age might be aggressive, when they weren't so much before. This is an adjustment reaction to the trauma, and with appropriate intervention, as we'll discuss next week, should eventually dissipate. This age range obviously has more language skills, and as such will openly talk about death and try to make sense of it.

5-8

School-aged children could develop school phobias, withdrawal from friends, or learning problems they didn't have before. They might also exhibit aggressive behaviors, especially boys, who tend to show an increase in destructive behaviors. Children this age might be more prone to stuffing their emotions so that they appear to be okay to peers. They might be more clingy to caregivers, though. The emotions they do have might be excessive guilt or denial, both of which are common. Children are ego-centric beings, thinking the world revolves around them, so they take undue weight upon their shoulders. It's also at this age that psychological symptoms might manifest more as physical symptoms, such as hurting tummies, headaches, etc.

9-12+

It's very common for emotional reactions to be kept silent at this age. If the youth as an outlet (counselor, church group, sports) they might find their emotional needs met. If they don't, then unresolved grief can lead to "acting out" behavior, such as drugs, criminal activity, and risk-taking (pushing their body to its physical limit). Two common polar opposite reactions I've heard from teens: "I just want to feel something" or "I just want to numb out." For those teens who are more likely to be emotional, there can be overt depression, withdrawal, guilt, anger, and denial. They might lack motivation to do anything, grades could drop at school, or things they once found pleasurable don't appeal to them anymore.



Hopefully this has helped flesh out some common reactions. There are other behaviors that might exist that haven't been explicitly listed, and each child's grief is unique. Environmental factors like previous exposure to trauma, responsiveness of caregivers, and internal resiliency of the child can make reactions more or less intense and/or severe. Be sure to write-in with any specific questions, using Friday's Dear Jeannie column.

Let's Analyze

Are any of the above behaviors baffling? What else would you like to see added?

What Do Children Understand about Death?

I get a lot of questions about what children understand or don't understand about death, so I thought a series of posts about children and death would be helpful. Today I'll start with outlining the developmental stages and concepts of death for children. Next Monday I'll move into realistic reactions for each age group, followed by helpful approaches for adults to use with children to intervene and comfort them, such as examples of how to convey and verbalize the harsh truths of death.

First there are three concepts that we refer to when we discuss death:

Universality = all alive things will eventually die
Irreversibility = things that have died cannot come back to life
Nonfunctionality = once something dies, it ceases all physical functioning

All children vary in their understanding, of course, and there are no hard and fast rules, which I know writers would love to get. But here are some basic guidelines as to what children generally understand at what age.

0-2

These children can't understand any of the components of death, and they don't have much or any language to attach to any thoughts about death that they might have. They sense loss through reacting to the emotions of others. They are observant of adults and know something is wrong, which upsets the security of their world. If a pet dies, a child this young probably wouldn't understand that the pet has ceased to function. Even if you included them in the burial in the backyard, the child might think of the pet as romping around under the ground.

2-4

Children this age tend to think that if something dies, it can come back to life. They might think the dead person/thing is simply sleeping. They watch cartoons and movies that reinforce this idea (i.e., Rapunzel's tears bring back Flynn Rider in Tangled; Aslan comes back to life in Narnia..you get the idea). They don't think it's possible for them to die. This usually doesn't enter their mind, unless they've had a traumatic experience of losing someone close to them during this time. They also have what is called magical thinking at this age, and can believe that someone died because of a death wish they made or because of some magical spell.

5-8

Children begin to understand the nonfunctionality of something that has died. They also begin to understand that death is irreversible, especially for plants and animals. Even though they get the physical component of death, they still have a lot of questions about the biological aspect of death. They might get fixated on death, or even get sad anticipating a death that's not rationally imminent. (For example, my little girl, who turned 6 TODAY---!!!---will have real tears thinking about my death.) However, they don't really think of death as universal, but as something that only happens to people who are old or sick. (Note: if the child has been exposed to situations, like sudden infant death syndrome of a younger sibling, or losing a same-aged peer to a car accident, this lack of universality would change.)

9-12+

Children begin to have an understanding of all three concepts of death. They really start to fear death, and even think of it as sudden and unpredictable. They get scared thinking about painful forms of death, and feat the void of inanimate suspension that follows death. These children and teens are more likely to have emotional, rather than cognitive, difficulties processing death.

Let's Analyze

You probably have stories, similar to the one I told about my daughter, that convey these concepts using real narratives. Feel free to share any below.

Dear Jeannie: Stages of Development and Bibliomania

Dear Jeannie,

My character, Tanya, is a six-year-old in a fantasy setting. She becomes pair-bonded with a Genki (speak with him telepathically and be aware of each other's presence and state). Her village believes the Genki are monsters, and exile Tanya, along with her family, when this is found out. She is allowed to set up outside the Genki village (who are also mistrusting of humans) of her pair-bond. I imagine Tanya would have some guilt from her family going into exile with her, and causing grief for her pair-bond. Also maybe some anger towards her village and confusion about the recent events. Fear of other humans is probably another outcome. Though, I believe, there would also be a stabilizing effect from her pair-bond. What else would be realistic for a six-year-old in this situation? And, as she grows into a young teen, how might these events affect her emotional and mental development, as well as that of her pair-bond?

Curious in Cascadia


Dear Curious,

Only a writer can ask a question like "what else would be realistic for a 6-year-old in this situation?" after having just described a scenario where The Village (Shyamalan) meets Twilight-type stuff. :) The most important part of that question is her age. The psychosocial stage she's supposed to be in is industry v. inferiority...but she's reading more like the stage for 3 to 5-year-olds, which is initiative v. guilt. She's exerted too much control over her environment by bucking the trend to not go into the forest and now is pair-bonded with a Genki. According to Erickson, she's definitely going to feel guilt. But at age 6, kids are usually entering the academic world more fully...so if, while outside the Genki village, she's engaged in some sort of industrious learning or schooling (whether traditional or about the Genki or the pair-bond or what-have-you), this will do a lot for helping move her along. You can consider the pair-bond stabilizing only as far as she doesn't blame him or their bond on what has happened to her. Moving from her village and uprooting her family is what professionals would call an adverse childhood event, which in turn, if prolonged or severe, can cause trauma and stunted development in children. If the pair-bond is a positive experience in her mind, then he will be the secure base she'll gravitate toward, and research shows just having one of these in a child's life improves outcomes for them. Hopefully this information, and the Ericksonian psychosocial stages I gave you links for, will help you out. Thanks for writing in!


Dear Jeannie,

Sylvia lost a child, aged about 6 months, in a horrific accident (the baby fell from the a mountain cliff). Sylvia was then age 32 and already had two other children. We meet her when she's 60 and suffering from bibliomania. How likely is it that the accident and the book hoarding are connected psychologically?
 
Thanks,
The Lost Girl


Dear Lost Girl,

I'd have to know a few things first, namely, when did the book-hoarding begin? Did she collect books at all prior to the accident? Bibliomania is not a disorder recognized by the DSM-V (newest edition of our "bible" of mental disorders), though it would fall under obsessive-compulsive disorders. I'd want to know if Sylvia had any other compulsions prior to collecting books, because by age 32, usually a person would already have displayed symptoms of anxiety or compulsiveness. I'd also want to know if collecting the books relieves anxiety she might have, and if so, on what doess her anxiety center? If it could talk, what would it say? It's my understanding that for the bibliomanic individual, the type of books collected doesn't matter. They will buy many copies of the same book, with no intention of reading. How severe are her compulsions? Is her house completely littered with books? or is it just her deceased baby's old nursery? Gotta say...this would be a good one to have sit on my couch. Kudos, 'cause I'm intrigued...so other readers should be as well. :)


Got questions of your own? Leave them in the comment section, using monikers like Sleepless in Seattle, and I will post my answers in next week's column.

THE Post to Read if You Write Young Adult Fiction

A while ago, I was asked what the difference is between YA character development and that of the development of characters for adult fiction. The actual writing process is much the same, yet the themes from a developmental perspective might be different...however, still universal (thus the appeal of YA books to adults).

Young Adults Are In Transition

According to Erik Erickson, the Adolescent stage of development (ages 12-19, depending on who you quote) marks the beginning of when what we do makes more of a difference than what is done to us. The YA reader is neither child nor adult, so they are grappling with who or what, exactly, they are.

They are trying to define themselves with their actions, which can be translated into behaviors that alter their appearance, such as tattoos, piercings, and dying their hair, or where they choose to spend their time (church v. mall v. the downtown "strip" where they ride in each others' cars---you know you did this). All of it is an attempt to figure out the main question children this age want answered: "Who am I and where am I going?"

This can be summed up by saying a YA will have an identity crisis (Erickson was the one who is credited with coining this term). Life gets bigger and bigger the longer they live it, and they realize they no longer are the center of the universe eventually. They grapple with social and moral issues. Teens are building up their ideals, because at this time, it's easier to think in terms of ideals than reality, because a teenager has little experience. So give them something to idealize, care about, ponder.

Bros Before Hos 'Rents

Crass, but true. The most significant relationships teens have are with their peers. They most likely aren't going to want to read about a teen hero's problems with his parents. Romance is burgeoning during this stage, so not including a romantic theme would be a mistake (according to developmental theories, anyway).

The main thing is for the reader to identify with the character, so your YA character should be struggling to find their place in the world, what they want to do with their life, who they want to be. It's cliche, but coming of age stories work for this age group.

A Warning: Don't Sell Teens Short

Teens deserve more than just fluff, and sometimes YA gets the wrong impression that it's just a "quick read" (because they are indeed oftentimes shorter books)....but that should not translate to "shallow." This age period is one where they are experimenting and need to be reminded of what all is out there, both good and bad.

Books like Twilight, Divergent, and The Hunger Games fly off the shelf because of the character development. These are teens in transition, trying to figure out life, love, and survival. (Have you walked the halls of a high school lately? Not too different from post-apocolyptic descriptions of America, folks.)

Many YA books are written in first person point of view, and I think that's by design. Teens (and adults) are literally drawn in from page one....becoming the heroine or hero, feeling their conflicts and vicariously living them out.  We can only hope that our books will give teens similar strength, commitment, drive, and integrity to jump life's hurdles.

So in closing, be real. Grapple with hard, strong emotions....because you can be sure the teens out there reading your stuff are doing the same. 

Let's Analyze: 

What are you're thoughts on the differences between character development for YA v. adult fiction? Anything you want to add?