It has been 540 days since the World Health Organization (WHO) declared COVID-19 a pandemic. Since then, it has become a daily reality to hear about and to see death. This year, some children will be returning to school after summer—another year spent in masks—missing someone they love. Their families, too, are grieving.
When we try to talk about death, the conversation usually feels awkward. Furthermore, when someone we know loses someone they love, we are often not sure what to do to help them. Despite our own difficulties, children need adults to support and guide them as they grow up. This presents us with several difficult responsibilities: How do we talk to children about death? What does grief look like in children? And how can we help a child who is grieving?
This article contains a condensed version of the research of J. W. Worden, a grief counsellor and psychologist. He led the Harvard Child Bereavement Study and wrote the book Children and Grief [4]. Some information in this article also comes from resources provided by the Canadian Counselling and Psychotherapy Association [1].
Throughout this article, look for the underlined sentences. These are all suggestions by Worden of ways to help a child who is grieving. A visual summary is given at the end of the article.
How do we talk to children about death?
Death is a normal part of life. Grief is a natural response to any loss, which includes the death of a loved one. Discussions about death and grief cannot be avoided and we should not lie to children about these topics. Giving clear and complete information to children is helpful as it helps prevent misconceptions. This means actually using the words “death,” “dying,” “died.” We can also say “I do not know” when we really do not know the answer to their questions. It is okay to not know what to say. Sometimes, silence is best.
Children will have questions as well as anxieties, concerns, fears, and worries. They need to talk about these things, and we need to acknowledge and address them. Again, we do not need to answer every question, especially if we do not know. However, we need to counter misconceptions about death. Here are some common misconceptions: “the person is coming back some day,” “crying is weak,” “grief is a weakness,” “if I start crying I will never stop,” “if I let go of the pain then I am letting go of the person,” “if I get rid of the feelings they will not come back.” None of these misconceptions are true—The person is not going to come back; Crying and grief are natural and good; Allowing yourself to show emotions is the mark of a strong person; It is possible to let go of the pain and still hold the memory of the deceased person; and feelings, if we push them down, will only come back again later at an unexpected time.
There will be more than one conversation. We need to be able to listen empathetically. This means putting aside time to listen to the child, focusing on them only, taking what they say seriously, trying to understand things from their point of view, acknowledging and validating their feelings, and naming their feelings. In these conversations, we also need to reassure them they will be cared for, they are not to blame, they are loved, and we will protect them. Every child will express themselves in a different way and they need the freedom to express themselves in their own way—art, clay, journaling, poetry, puppets, talking, play, and so on.
Intense feelings are normal after someone dies. These feelings may include anger, anxiety, confusion, disappointment, fear, guilt, sadness, numbness, regret, and even relief. Both children and adult may experience these feelings. Sometimes these feelings can become overwhelming. Children need our help to feel calm and grounded again when they are getting overwhelmed. For some children this may mean a hug, words of reassurance, and showing them how to breathe deeply and slowly. For others, it may be having some space, squeezing a squishy toy, and doing some light exercise such as walking.
Adults can also talk about and show our own feelings, which includes crying. Modeling healthy grieving behaviours is helpful. Read on for examples of healthy and unhealthy grief.
Finally, children need to go on with their lives, just like we do. Having a consistent routine at home helps to provide predictability and structure. Participating in normal, age-appropriate activities such as sports, music, and clubs also helps children to remain engaged in daily life. Furthermore, children benefit from being involved and included in making choices and decisions about their own life. This can help to build up their confidence and self-esteem, both of which can be affected by the death of a loved one.
What does grief look like in children?
Children may experience many different changes after the loss of a loved one. When a parent has died, it is common for children to fear for the other parent’s safety. It is also common to want to blame someone for the loss, even though no one is to blame. Young children especially may also have trouble understanding the reality of death, thinking that the deceased person is just “away for a while.”
Health problems can show up in many different ways. It is important to seek professional healthcare even if it is thought they may be a response to grief. Sleep problems are especially common, including having distressing dreams, early waking, and so on.
Some children may become more aggressive and misbehave more frequently; however, others may become more detached and withdrawn from others, losing interest in things they once liked. In either case, these changes can affect their friendships as well as academic success at school. Concentration difficulties are also common and may affect schooling.
Intense feelings and mood swings have already been described. Increased anxiety is most common. Guilt, shame, and regret are some of the most painful feelings associated with grief. These feelings can fuel difficult, unsolvable thoughts, like “I wish I had shown more love while they were alive,” “If only I could apologize to them for what I did,” and “I should have stood up for myself to them.”
Although these changes in behaviour, feelings, thinking, and relationships are all common when a child is grieving, they do not have to suffer alone. We adults can help.
How can we help a child who is grieving?
You may have heard or read about the “stages of grief.” Unfortunately, the idea that grief has stages is a misconception and is not supported by research [2][3]. If we expect a child (or adult) to “move forward” through stages of grief, we may put unrealistic pressure on them that is more likely to hinder them.
So how do we help a child who is grieving? First, we have to accept that we cannot “cure” or “fix” grief either. If you think about it, this makes sense. A person feels grief because they love the person who was lost. So, why would we want to take that away? If we try to “fix” a child’s grief, we may put even more pressure on them.
Instead, it is more useful to think of “tasks” of grief:
Accept the reality of the loss
Experience the pain of loss and the feelings that go with it (with support)
Adjust to an environment and life in which the deceased person is missing
Find a new place for the deceased person in one’s life; Remember them in your own way
These tasks do not occur in any set order, and a person may “work on” one task at a time and at their own pace. “Healthy grief behaviours” include those that help with these tasks. For instance, it is healthy to talk with friends and family about the reality of the loss, how it is affecting you, to tolerate and express these difficult feelings through words and tears, and to make plans for a future in which your loved one is missing. It is also healthy to take time to remember and even to make a memorial for the deceased person (such as a Memory Book). This is especially important for children who have lost a parent. Children need to be able to remember the deceased person. The deceased person will continue to be an important person in their life, so finding ways to memorialize them will help them to grow and heal.
In addition to the underlined ways to help a child who is grieving, here are some other ideas:
Art: drawing, modeling clay, painting
Counselling: art and play therapy can be especially helpful for children
Memory book: the family works together to make a book of photos, stories, memories, drawings, and anything else that memorializes the deceased person
Quality time with the surviving parent (and with siblings)
Remaining socially active
Support from extended family, friends, and community resources
Using an active coping style: focusing on what can be changed rather than avoiding or denying problems
Writing: keep a journal for feelings, thoughts, questions; letters; poetry
There are also some factors which may hinder or even harm a child who is grieving:
Denying, minimizing, “pushing down” feelings and grief
Expecting a child to act more “grown up” after a parent’s death
High levels of change, instability, or stress
Lack of support from family, friends, and community resources
Misconceptions about death and grief
Using a passive coping style: avoiding and denying problems
Most of all, children need caring, consistent, and reliable adults in their lives to support them as they heal and grow. We cannot “fix” grief, but we can provide a caring and safe relationship to a child in need.
One-Page Summary
References
[1] Bereavement Support & Education-Ottawa. (2016). Living through Loss Workshop Series: Healthy vs Unhealthy Grief. Canadian Counselling and Psychotherapy Association. https://www.ccpa-accp.ca/wp-content/uploads/2016/05/Healthy-Vs-Unhealthy-Grief.pdf
[2] O'Connor M. F. (2019). Grief: A Brief History of Research on How Body, Mind, and Brain Adapt. Psychosomatic Medicine, 81(8), 731–738. https://doi.org/10.1097/PSY.0000000000000717
[3] Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning Health-Care Professionals. Omega, 74(4), 455–473. https://doi.org/10.1177/0030222817691870
[4] Worden, J. W. (1996). Children and grief: When a parent dies. Guilford Press.
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