Part A: Section A.2

1Part A: Understanding Grief and Loss in Children and Their Families

Understanding Grief and Loss in Children

Objectives

1.1 Describe the overarching process of grief and loss,

including:

a. ranges of grief reactions: denial, anger, bargaining, depression,

acceptance

b. difference between “normal” and “complicated” grief

1.2. Explain how the child’s concept of death develops

from toddlerhood through adolescence

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Objectives (continued)

1.3. Demonstrate knowledge of the stages of acquisition of

information that occur in children with life threatening

illnesses, including:

a. What children understand and know as their disease

progresses.

b. How to assist children’s understanding in discussions of

medical information.

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Term Definitions

o Grief: a normal process in response to loss

o Bereavement: the state of having suffered a loss

o Mourning: the public expression of grief

o Complicated grief: persistent separation distress lasting

more than 6 months and interfering with daily functioning

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Components of Grief

o Denial: “This isn’t happening.”

o Anger: “It’s not fair!”

o Bargaining: “If I just behave better, things will be

different.”

o Depression: “Everything sucks, what’s the point?”

o Acceptance: “I miss Shaggy, but things will be okay.”

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Activity: Loss Exercise

Each participant takes 5 pieces of paper and writes down

something of personal value on each piece. (Can be a

person, pet, object, skill, opportunity, etc.) Then each

participant finds a partner. They then each take three pieces

of paper away from their partner.

Expressions of Childhood Grief

o Sadness

o Guilt

o Fear

o Numbness

o Withdrawal

o Disbelief

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o Explosive emotions

o Regression

o Acting out behavior

o "Big Man” or "Big

Woman" Syndrome

o Physical symptom

Grief in Children

o How a child experiences grief will depend on their

developmental stage and personality

o Context of the relationship is also a key element

o Other important elements are

o Nature of the death

o Prior experiences with death or loss

o Availability of family/social support

o Behavior, attitudes and responsiveness of parents and other

support individuals in their environment

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Pediatric Bereavement

o Children have several “tasks” to accomplish during

bereavement:

o Accepting the loss

o Experiencing the pain and other emotions associated with loss

o Adjusting to a new situation/environment

o Finding ways to memorialize/remember the individual

who is gone

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Complicated Grief

o Invasive and debilitating grief symptoms lasting more

than 6-12 months

o Can include:

o Yearning for deceased

o Difficulty accepting death

o Inability to trust

o Excessive anger

o Intense loneliness

o Frequent pre-occupying thoughts about deceased

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Complicated Grief Risk Factors

o Deep attachment to deceased person

o Child, spouse, parent, sibling

o Unexpected death

o Traumatic death

o Prior experience with traumatic loss

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Reflection

PBS “It’s my life” on “Dealing with Death” (6:39)

http://www.youtube.com/watch?v=WHUewQtLgNs&feature=r

elated

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Reflection

o What grief responses do the children identify in the video?

o What additional losses to the children identify?

o What coping mechanisms do the children identify?

Changing Face of Death

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Before 1900s

• Intergenerational family units

• Limited effective medical interventions

• Common to experience births and deaths in the home

20th

Century

• Hospitals and medical technology advance

• Resuscitation (CPR) developed in 1960

2000s

• Emphasis on youth and health

• Death as a medical failure

• Death occurring in medical facilities > home

Adult Understanding of Death

o Irreversibility

o Death is permanent.

o Nonfunctionality

o All life-defining functions cease at the time of death.

o Universality

o All living things die, including self.

o Causality

o There are physical reasons someone dies.

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Understanding of Death

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Age Developmental Stage (Piaget)

Perception or Concern

Anticipated Response

< 2 years Sensorimotor Sense separation and the emotions of others

Withdrawal Irritability

2 – 6 years Preoperational Dead = “Not Alive” Death as Temporary

Wonder about what the dead “do” Magical thinking (I am the cause)

6 – 10 years Concrete operational

Morbid interest in death Others die  I die

Exaggerated behavioral reactions to the idea of death and dead things

Adolescence Formal operational

Adult concepts Existential implications

“But not me” Death as an adversary

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Reflection

PBS “Sesame Street” Big Bird learns about death

(Mr. Hooper dies) (4:33)

http://www.youtube.com/watch?v=9NjFbz6vGU8&feature=rel

ated

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Reflection

o Where is Big Bird in his developmental understanding

of death?

o How do the adults help support his understanding?

o How could you use this with parents or patients?

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Reflection

GENERATIONS; The Final Farewell, in a Child’s Eyes, in

New York Times October 29, 2006

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Reflection

o What are your personal experiences with talking about

death?

o What are your personal experiences being told about a

death?

o What are your fears around talking about death with

children?

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Activity

Role play explaining the death of a grandparent to a child

aged 3, 8, and 14 years old.

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Understanding of Death –

Impact of Experience

Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 1

o Child’s Information

o “It” is a serious illness

o Not all children will know the name of the disease

o Experience Required for Passage to This Stage

o Parents informed of the diagnosis

o Child’s Self-Concept at This Stage

o I was previously well but now I am seriously ill

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Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 2

o Child’s Information

o The names of the drugs used in treatment, how they are given and

their side effects

o Experience Required for Passage to This Stage

o Parents informed the child is in remission

o Child is speaking to other children at clinic

o Child’s Self-Concept at This Stage

o I am seriously ill but I will get better

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Stages in a Sick Child’s Acquisition of

Information about His/Her Illness

Stage 3

o Child’s Information

o Purposes of procedures and treatments; relationship between

procedures and specific symptoms