Written by SMH Palliative Care Medical Director Dr. Joelle Vlahakis
My years of working with hospice and palliative care programs have taught me that the way each person — and each family — copes with loss is truly unique. Some people are boisterous and tell funny stories during times of grief, while others are more quiet and thoughtful.
Children also have their own unique ways of coping with the loss of someone they love. One difficult thing about being a parent is that our instinct is to always protect our children from hurt — especially if we also are grieving. However, we miss an important teaching opportunity if we shield them (or try to shieldd them) from completely experiencing loss, in their own way. Whether it be the loss of a beloved pet, the loss of a friend who moves away, the broken heart of a teenager, or the loss of a grandparent, the grief they feel is very real and should be acknowledged.
Adults tend to underestimate children’s abilities to understand and to cope, and as parents, we feel obligated to act as guides for our children. But when confronting a significant loss, it can be best to follow your child’s lead instead.
When helping children navigate loss or death, be honest and straightforward, offering a little information at a time. Give them time to process the information. They will likely ask questions when they are ready for more information. For example, “Grandpa is going to the hospital because he is sick” may be enough information at first. Most children will ask for more details (What does he have? Will he get better? Is he going to die?) as they are ready for them. Be prepared to not be prepared when they are finally ready to process more. They have their own timetable, and it’s guaranteed to not coincide with yours.
Some children (and some grown-ups) do better when they actually see their loved one going through the process of dying. Visits to the hospital may be tough, but they may be necessary for some to grasp the health decline and eventual loss of someone we love.
Signs of Grief in Kids
Grief in a child may appear in different ways:
- Sometimes no reaction at all
- Regression of developmental milestones (bedwetting, etc.)
- Withdrawal from normal activities
- Sleep disturbance
- Somatisizing (physical symptoms not explained by injury or illness)
- Desire to be with peers/friends more than family
- Anxiety about others leaving them
Signs of Grief, Beyond Tears
When it comes to children, not all grief is expressed as tears or even sadness. There may be changes in appetite, sleep disturbances (like nightmares) or complaints of physical symptoms such as stomachaches. Younger children may regress temporarily or become more physically dependent while school-age children may become withdrawn for a time. All of this is normal. Some of these behaviors are because of their own feelings, and some of them are simply a response to the stress and sorrow of those around them.
Adolescents — who have a difficult time relating to other’s feeling to begin with — may prefer the company of their peers to family when grieving. Try not to feel slighted or blame them for insensitivity. Teenagers often seek safe harbor with peers who are not sharing in the grief experience as a way to escape feelings that are overwhelming to them. Most young adults deal with their feelings of loss and abandonment this way. As with younger children, let them pace themselves a bit with the amount of information they can handle at a time. Try not to assume that what helps you cope will help anyone else around you.
Tips for Parents
If your family is dealing with loss, consider these tips to help children cope with the grieving process.
- Ask children what they know or want to know about their loved one’s illness or death
- Avoid euphemisms (i.e. “he’s just asleep.”)
- Admit your own sadness
- Notify your child’s teachers about your family’s loss or anticipated loss
- Involve children in rituals and activities surrounding death
- Provide “breaks” from sorrow by allowing kids to participate in normal activities and/or be with friends
- Maintain a routine the best you can
- Anticipate anxiety about losing other important people in their lives
- Speak to your family doctor or guidance counselor if your child seems especially sad or depressed; ask about any concerning, grief-related behaviors
Preparing A Child for a Hospital or Hospice Visit
When a loved one is in the hospital, parents must weigh the pros and cons of taking children to visit them. Here are other things to think about as you consider a hospital visit with your child.
- Is the patient likely to return home? Consider postponing the visit until your loved one is home.
- Be respectful of visiting hours and any staff concerns. Noise and crying may be stressful to other patients, so try to minimize disturbances. Warn teenagers that cell phones are not allowed in certain patient care areas.
- Ask about resources for children such as books, guides or child life specialists who can help prepare your child for the visit.
- Do not force physical contact between your child and the patient. They may not recognize the person they love whose appearance may have been changed by the illness or its treatment.
- Pay attention to your child’s signs that they have “had enough” and be prepared to leave quickly.
- Prepare your child by describing to them what their loved one looks like, what they might see or hear and how everyone is working hard to help their loved one feel better. Consider showing your child a photo of the person in the hospital environment before the visit, so they know what to expect.
- Keep visits brief for both the patient and the child and/or take frequent breaks with visits to the cafeteria, gift shop or grounds.
In Palliative Care, we have come to appreciate that normal human grief looks like a lot of different roads all pointing in same general direction: Some lead to peace, some to healing, and all get there in their own good time.
Both Tidewell Hospice (941-894-1777) and The Dougy Center for Grieving Children offer grief support and other resources for helping children cope with loss.
There are also many great books on the market that offer guidance for parents to help kids cope, including: “Until We Meet Again,” by Susan Jones; “Tear Soup: A Recipe for Healing After Loss,” by Pat Schwiebert and Chuck DeKlyen; “The Next Place,” by Warren Hanson; and “Help Me Say Goodbye: Activities for Helping Kids Cope When a Special Person Dies,” by Janis Silverman.
Dr. Joelle Vlahakis leads Sarasota Memorial’s Supportive Care Services and is associate medical director of Medical Management. Board certified by the American Board of Internal Medicine, Dr. Vlahakis is a Diplomat in Hospice and Palliative Medicine and a fellow in the American Academy of Hospice and Palliative Medicine. Through her work, Dr. Vlahakis aims to extend the reach of Palliative Care services in her community while ensuring quality, high value, patient-centered medical care for all patients.