Talking to our children about death, dying, and loss

I recently attend a workshop by Dr. Ajita Robinson, who is the founder and clinical director of Friends in Transition (FIT) counseling center in Bethesda, MD. I attended the workshop because I felt that I needed more resources on how to talk to our students and parents about death and dying. As adults we tend to shy away from this topic, which is interesting because it is the one area in which we all hold common ground. We have all lost someone or something, and we will all experience other losses in our lifetime. I was looking for the tools to use in making the conversation topic more approachable, and am now sharing these tools with you.

Please feel free to reach out to me with any thoughts:

Why is it so important to talk about death?

1. It’s a universal fact of life

2. To clear up misconceptions

3. We must seek to normalize it

4. To decrease worries or fears we may have about death and dying

Your first step is to think about this statement “What do I believe?”

• This is important for everyone one to understand, so that we do not pass along transference[1] to our students, friends, relatives, etc.

• Example: Karen’s cat died over the weekend. When Karen returns to school on Monday she starts to cry, for she suddenly remembers how sad she feels. Karen shares with her class the news about her cat. Robert, who is sitting next to her, says “it’s just a cat!”

• Death comes in all shapes and sizes, and we all grieve in different ways. We most understand our own beliefs about death, so that we are ready to talk to others in a way that does not mix our own beliefs, thoughts, or opinions into their grieving process.

WHAT TO SAY

• I capitalize this for I can not express the importance of “what to say” to an individual who is grieving

• Often we have no idea what to say, so therefore we say nothing.

• THE BEST TIME TO TALK ABOUT DEATH AND DYING IS BEFORE IT HAS HAPPENED

• How amazing would it be for our younger generations to understand death and to be able to better navigate it when it occurs?

• According to Dr. Robinson’s research, what you say to an individual greatly depends on two things:

1. The individuals chronological age

2. The individuals developmental age (a summary of the developmental stages is provided below)

1. Sensorimotor Stage occurs from birth to 2 years old. During this stage children experience the world through their senses and actions such as touching, looking, mouthing, smelling, etc. Once the child accomplishes the milestones of Object Permanence (for example, the knowledge that an object exists even when hidden from view) and Stranger Anxiety they've successfully completed this stage and move to the next stage.

• An infant would not be able to identify the loss of someone/something at this stage. They need to accomplish object permanence first.

2. Preoperational Stage occurs from 2 years to 6 years old. During this stage, children are able to represent the world with words and images, but they're still not able to use true logical reasoning. In this stage children think in concert, literal terms. Their focus is on the here and now. Developmental milestones are pretending and egocentrism.

• When a child enters Kindergarten their development greatly increases for they have more individuals/classmates whom will influence their thoughts and actions. So, let me break down the following into two separate age groups: 1-4 years old and 4-6 years old

• 1-4 year olds:

• Believes death is temporary and reversible. Will have no concept of time, therefore when speaking with a child in this stage about a person who has died you will need to repeat “…no, she/he is not coming back”. Will not understand that death is universal. Does not understand that dead persons are non-functional (this is different at times based on your families personal belief system, and can cause some confusion in children at this stage) (example: an individual will have lots of questions about how they are eating, sleeping, meeting new people, etc.).

• Behaviors: bedwetting, clinging, crying, whining, tantrums, aggression, biting, hitting, yelling

• Thoughts/Feelings: Intense occasional sadness/crying, anger, and low frustration tolerance. Fear of abandonment, needing to be close, or separation anxiety.

• What parents can do: reassure them of being loved. Provide consistency, warmth and understanding. Set firm limits on misbehaviors with appropriate consequences (example: brief time outs of three to five minutes).

• 4-6 year olds:

• Start to understand that death is irreversible, and that an individual whom has died is non-functional (based on personal belief). A child in this late stage will start to understand that death in universal.

• Behaviors such as: temper tantrums, worrying (“Am I to blame?”), and attempts to get parents back together.

• What parents can do: Set clear limits and consequences. Offer age appropriate explanations (also based on family beliefs). Allow consistent contact with support persons. Keep consistent schedules and routines. Reassure them of being loved.

3. Concrete Operational Stage occurs from 7 years to 11 years old. During this stage, children learn conservation: that the quantity of concrete materials (objects, liquids) remains constant even if the organization and/or shape changes. For example, pouring liquid into glasses of different sizes does not change the amount of liquid.

• Understand that death in final, and a natural part of life. Has increased understanding of future without person who has died. Has more realistic understanding of the causality of death.

• Behaviors such as: rejection towards one parent, apathy, acting out, fighting, defiance/being oppositional, somatic complaints or perfectionism.

• Thoughts/feelings they may have: Shame, blame, feeling insecure, sadness, powerless, denial, “whose fault is it?”, “It’s no big deal”.

• What parents can do: Encourage kids to talk and share feelings and thoughts, teach anger management, and validate grief. Be flexible in permitting kids to talk about things.

• Honor those who have died (this depends greatly on religion/thoughts).

• Identify who your safe people are

• PROTECT CHILDHOOD PIECE (example: try not to let child do any care giving)

• CAREFUL WITH KIDS WATCHING NEWS (ALWAYS have a conversation with them about big news events).

4. Formal Operational Stage occurs from age 12 through adulthood. During this stage, adolescents learn to use abstract reasoning. This is a major step as reasoning now goes beyond the concrete (requiring actual experience) to abstract thinking which involves symbols and imagination. A milestone at this stage is the potential for moral reasoning.

• Most at risk for low self esteem

• Understand the reality of death. The death of a parent creates conflict as it disturbs developmental milestones and needs for autonomy at this stage/age.

• Behaviors: Increased risk for drug/alcohol use, promiscuity, defiance, argumentativeness, controlling behaviors, may reject remaining parent, increased risk for incorrigibility, withdrawal. May exhibit signs of adultification.

• Thoughts/feelings they may have: Sad, confused, angry, resentful, apathy.

• What parents can do: Be flexible; collaborate with adolescents in addressing their needs and wants.

Children & Death

• Children are aware

• Communication barriers

• Balancing act between confrontation and avoidance, know where they are

• We do not, and unfortunately, will not ever have all of the answers

• Kids can know this!

• It is better to say “honey, I don’t know”

• Two big factors influence children’s feelings about death

1. Developmental stage they are in

2. Experiences they have had

• Support kids through play and expressive approaches (examples are at the top of page 6)

• Kids need: play, routine, safety (yes, send them back to school it encompasses all of these things)

My notes: by saying “I’m not sure” or “I don’t know” we are normalizing uncertainty. It is important to normalize uncertainty for it seeks to reset expectations that are near impossible to meet. We should be honest about the boundaries of knowledge, saying for example, “I understand that you want more accurate information about the future. The reality is that it’s like predicting the weather, we can never be absolutely certain about the future. I do wish I could be more certain.”

-Children are need based Children are need based, they are survivalists

-They are trying to figure out what the world looks like

Children and the many questions we have:

• Should Children visit the dying?

• Depends on family belief about where person is

• **It is very important for the child to say goodbye!

• Should Children attend funerals?

• Children are not negatively impacted by funerals, but you have to inform them of how long the day may be and about others reactions to the dead (for example: “Honey, there will be a lot of people crying because they’re sad that ___ has died.”

• Should I send my child away from home?

• If at all possible keep them in place, home is a safe place for them

• Do children mourn?

• Yes, it just looks different from how adults mourn/grieve

Common Manifestations of Grief

• Cognitive capacity and understanding of the concept of death vary over time and influences how a child deals with the loss.

• An understanding of a child’s thought processes surrounding death provides important insight into how a child is responding to the loss and can also help guide appropriate support strategies

• Cognitive maturation during adolescence affect’s the individuals ability to comprehend death and related concepts

• Common worries: saying “RIP” or “he’s just sleeping” = a child being scared to go to sleep at night or “rest”, use appropriate language = “he/she has died”

My notes: **There is no RIGHT WAY to grieve!!!

*People make judgments on others and on their self=these are unhealthy thoughts

Families and Grief

• Specific factors that affect the mourning process and influence the degree of family disruption have been identified:

• Stages in family life cycle

• Roles played by the deceased

• Power

• Affection

• Communication patterns

• Sociocultural factors

Six Myths about Grief (please do not feel that there are only 6!)

1. Don’t feel bad -“They are in a better place” What if that individual doesn’t feel that way? -“They wouldn’t want you to feel bad” That statement makes the person grieving feel guilty for feeling bad.

2. Replace the loss

3. Well, how do you know that?

4. Grieve alone -Then you can’t get the support you need!

5. Be strong for others -There is nothing about grief that requires strength!

6. Keep busy -It has to happen! Make time to grieve. It is never going to be convenient.

7. Just give it time -There is no timeline. -It will always be different

What to say or not to say:

• Use correct language: “They died”

• NOT: sleeping, passed on, resting

• These statements confuse kids (for example: when you say that your phone is “dead” kids start to get confused for in order to “have it come alive again” you simply charge it. Or if you say “___ is just resting” a child may be fearful to going to sleep or taking a nap.

• No magical thinking

• Have to help kids understand

• No experts in grief in your life, you are the only expert!

• Don’t say “I know how you feel”

• You don’t know how they feel

• No two deaths are alike

• Don’t try to change the subject

• That makes it about you and not the person who is grieving

• Don’t try to “fix” the griever

• Don’t talk around death

• ALWAYS ASK “What can I do?”

• Be a listener!

Considerations for the Helper

• Presence

• Permissiveness

• Patience

• Predictability

• Perseverance

• We must offer: safe, non-judgmental space in which we:

• Comfort and stabilize, assess and educate, normalize the response, invite expression, and adapt and witness

What you need to know:

• Children do mourn, but differences in mourning are determined by both the cognitive and emotional development of a child

• The loss of a parent through death is obviously a trauma, but does not in and of itself necessarily lead to arrested development

• Children between the ages of five and seven are a particularly vulnerable group.Their ego skills and social skills are insufficiently developed to enable them to defend themselves

• We need to keep asking children:

• How are you?

• What do you need?

• It is important to recognize that the work of mourning may not end in quite the same way for a child as it does for an adult!

Children need to hear:

1. You are likeable…YOU CANNOT OVERWHELM ME

2. Others have experienced death …YOU ARE NOT ALONE

3. You are needed…YOU CAN MAKE A DIFFERENCE

4. You are not a bad person…IT’S NOT YOUR FAULT

5. This is a safe place…THERE IS HOPE (Beverly James, 1994).

Ideas for different play techniques:

1. Blowing bubbles

2. Blow the biggest bubble you can

3. Helps you to breathe

4. Calms you down

5. Make collages

6. Use instruments to make sounds of feelings

7. Create a memory box

8. Scrapbook

9. You can create one online

10. You can create a handmade one

11. Write to the event, person, or caregiver

12. Experiment with clay

13. Sand

14. Read stories

15. Take photos and create a life book

16. Music

17. Talk about what happened…LISTEN

18. Wonder together

19. Jokes

20. Doesn’t matter if you feel that they are morbid or if you feel that they are sad/inappropriate, remember that kids will make jokes that are tailored to their development

21. Kids make jokes in order to see how you will react, many times they do this so that they can see if you are comfortable talking about a certain subject

22. Defense mechanism

23. dive right in!

Books for children about death, dying, grief:

1. Goodnight Mister Tom by Michelle Magorian

2. Bridge to Terabithia by Katherine Paterson

3. Goodbye Mog by Judith Kerr

4. No Matter What by Debi Gliori

5. The Valveteen Rabbit by Margery Williams

6. Duck, Death and the Tulip by Wolf Eribruch

7. A Monster Calls by Patrick Ness

8. Michael Rosen’s Sad Box by Michael Rosen

Books in the Browne Academy Library:

1. When Dinosaurs die: a guide to understand death by Laurene Krasny

2. The Invisible String by Patrice Karst

3. Lifetimes: a beautiful way to explain death to children by Bryan Mellonie

4. That summer by Tony Johnston

5. Ghost girl: a Blue Ridge Mountain story by Delia Ray

6. Death customs by Lucy Rushton

7. What’s heaven by Maria Shriver

8. The Secret Garden by Frances Hodgson Burnett

9. Charlotte’s Web by EB White

[1] Transference –displacement of affect from one person or one idea to another (Farlex Partner Medical Dictionary, Farlex 2012).