Helping children cope with loss

Melanie Barwick is a registered psychologist with a primary role as a health systems scientist in the Community Health Systems Resource Group at the Hospital for Sick Children in Toronto.

My mother would have been 76 years old this year, had she lived past her 36th birthday.

I was only six years old when she died unexpectedly, and I vividly remember the day and the feelings I experienced throughout my childhood. I can't help but think our approach to helping children deal with loss through death has changed over time, and hopefully it has improved.

My loss occurred during a time when people had a poorer understanding of the grieving process, particularly where children were concerned. It was felt best to not dwell on memories or talk about the deceased, as this was just too painful. That was my experience and it left a void, creating a "motherless daughter" whose loss echoed through life experiences and milestones for decades.

We know a great deal more about grief and mourning today. What we have learned about the grieving process in adults has merged with increasing knowledge of child development to deepen our understanding of grief and mourning throughout childhood, and how to help children through this extremely difficult life event.

Children express their experience of loss differently from adults. And children of different ages differ from each other in this regard as well. Understanding these subtleties and providing support to children of different ages is essential for mental health and resilience.

Helping the grieving preschooler

Preschoolers have difficulty understanding the permanence of death. They may express their grief in a variety of ways, including regression to earlier behaviours, temper tantrums, excessive crying, fearfulness, clinginess and bedwetting.

For children in this developmental stage, it is important to be open and honest about the loss, and to use language that is direct and unambiguous. In other words, talk about a "death" rather than "going away." Allow them to talk about the loss and to share their feelings and worries. This is a good time to be especially nurturing and affectionate.

Since young children express themselves through play, provide more opportunities for them to play out their feelings. You could simply sit with them and observe their play without being directive. Ask them questions and help them process their feelings as they emerge. Since some preschoolers may regress during mourning, be patient. Providing a nurturing and supportive environment will help them get back to their previous level over time.

The grieving elementary-school child

Elementary-school children can express their grief in a variety of ways as well, including school and learning problems, bedwetting, regression or other developmental delays, and problems such as overeating or refusing to eat, nightmares, and excessive sleepiness. At this age, children may become preoccupied with the loss and have related worries: Who might die next and when? This could give rise to heightened anxiety, daydreaming and trouble paying attention.

Parents, teachers and others can help school-age children through their grieving in several ways. Keep tasks and requests simple; this is not a time to overload on demands or new routines. If there are changes due to the loss, such as a new neighborhood, school or new family routines, explain them beforehand to help kids visualize how they will cope with the changes. Provide structured environments, at home and at school, that are predictable and consistent.

Children of this age may still play out their feelings through their leisure and social activities. As long as these play behaviours are not hurtful, they should be encouraged. Watch for acting-out behavior and encourage them to tell you when they feel worried or are having a hard time coping with their daily routine.

Grieving pre-teens and early adolescents

By the pre-teen years and early adolescence, kids are much better able to express themselves verbally but they may experience symptoms nonetheless. At this age, they can exhibit physical grief symptoms such as headaches, stomach aches, sleeping and eating disorders, and hypochondria. They may also exhibit wide mood swings - an exaggeration of the typical mood swings we tend to see in adolescence.

While they can express their feelings verbally, pre-teens and teenagers may still experience feelings of helplessness and hopelessness, which could lead to increased risk-taking or self-destructive behaviours.

Teens are trying to grapple with many things at this stage, and death can certainly magnify their sense of uncertainty with the world, making their struggle to conquer emotions and life in general more challenging. You might see more limit-testing as a result, or feelings of insecurity. As with little kids, be truthful about the facts and events related to the death, and reassure them where needed.

Some may experience anger as they cope with a death, and show increased fighting or oppositional behavior. They may withdraw from their usual routines and those around them, experiencing depression or sadness for a time. As with all stressors, concentration and attention may be negatively affected.

As best as you can, try to accept the mood swings and provide comfort for the physical symptoms. By all means acknowledge them rather than dismissing them, which could make things worse. Encourage the adolescents to identify their painful feelings and to find positive outlets through sports, leisure and creative activities. Play is a good outlet for everyone, not just little kids.

Adults can help in spite of their own loss

Loss through death of a loved one is one of life's most stressful and challenging experiences. Parents and other adults have a role to play in helping children and teens negotiate this life event, and develop resiliency as a result.

That said, adults will also have to deal with their own loss and it will be difficult in the best of times to maintain routines and emotional availability for the children. Use your support systems and recognize that mourning is a process that takes time.

With the passage of time, together, you can work on finding ways to remember the person you lost and to keep them ever present in your life in special ways. Know that while we can learn to cope and move past the pain of loss, the experience will shape you and stay with you for years to come.