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When A Child/Teen Suffers A Loss

Children and teens process traumatic events differently than adults. It’s important to understand how a child or teenager might handle news of a troubling incident, in order to help encourage and reassure them.

Talking About a Traumatic Death to a Child

Be honest, open and clear. Whenever possible, adults should give children the facts regarding the death. While there is no need to describe in great lingering detail, the important facts should be given.

  • Reassure them that what they are thinking and feeling about what happened is very normal.
  • Be available, nurturing, reassuring, and predictable.
  • Share some of your own feelings and thoughts about the event as well. One of the most important elements in this process is that children of different ages have different styles of adapting, and different reactions to death.
  • Use age‐appropriate language and explanations.
  • Invite them to come and talk about it anytime they want.
  • Listen to questions with patience and answer them simply and truthfully.
  • When there are no answers to questions of why this could happen it’s ok to tell them you don’t know, it can be reassuring that you don’t understand either.
  • Understand that children will process and re‐process the events and may ask the same questions over and over.
  • Be sure not to associate sleep and death. When these two become associated, it is not surprising that children become afraid of sleep.
  • Get some idea of each child’s concept of death. Ask them about specific fears regarding death. The more you understand about the child’s concept of death, the easier it will be for you to communicate in a meaningful fashion.
  • Understand that surviving children often feel guilty. Guilt, as expressed by children, may often be best observed in behaviors and emotions that are related to self‐hatred and self‐destruction. Give them reassurance that they are in no way at fault.

What to Expect from Preschoolers After a Traumatic Death

Thought Processes in Early Childhood

  • The world is magical
  • limited perception of time
  • sensitive to sadness and distress in people around them
  • cannot sustain an emotional response
  • feel direct responsibility for the world around them

Reactions to Death

  • No concept of “dead” This condition feels impermanent and there is concern for the continued physical needs of dead person
  • The child will ask indirect questions seeking reassurance about others who might die.
  • The child will connect unrelated events that have importance to him.
  • The child may appear completely unaffected (remember the concept may not be comprehendible).

What do I say?

  • Use concrete vocabulary:
  • Body stopped working
  • Body doesn’t talk, see, hear
  • Body doesn’t eat, doesn’t feel cold or hot, doesn’t need to go to the bathroom

What do I do?

  • Create a safe environment
  • Attend to physical needs
  • Use calm voice
  • Provide individual attention
  • Provide consistency (bed‐time routine, story time, meal time) whenever possible

The don’ts

  • Don’t use avoidance words; dead person isn’t sleeping, didn’t pass away or pass over
  • Don’t pretend to be unaffected
  • Don’t ask them not to feel sad – validate emotional responses
  • Don’t ignore questions
  • Don’t lie to minimize facts

Behavioral Expectations

  • Temper tantrums, reversion to earlier habits
  • Unusual clinging
  • Problems being separated from caretakers or siblings
  • Regressive behaviors (back to thumb sucking, bedwetting, baby‐talk, etc.)

When to Seek Help

  • If there is new or increased hyper‐arousal.
  • On‐going separation anxiety that lasts for more than 4 weeks.
  • Loss of weight that is significant for the child.
  • On‐going regressive behaviors for more than 4 weeks.

What to Expect from Children ages 6‐11 After a Traumatic Death

Common Understandings and Beliefs

  • Understanding of the finality and irreversibility of death
  • Have their own ideas and theories explaining why it occurs
  • May see death as a punishment for bad behaviors
  • May wonder about consequences of death upon their relationship to the dead person
  • Ceremony and ritual are very important

What do I say?

  • Be prepared to answer all factual questions
  • Guide them as to what to expect at viewing or funeral
  • Find ways to commemorate the dead person
  • Reassure and validate feelings
  • Be available to listen
  • Be honest about how you are feeling; school‐age children will react to your feelings.
  • Let them help you by telling them what you need (e.g. glass of water, tissue, a hug)

Behavioral Expectations

  • May still get caught in “I did it” thoughts but are unwilling to share them.
  • May ask direct questions about biological details of dead person.
  • General fearfulness
  • Sleep problems, headaches, stomachaches
  • Fear that others will die or leave
  • Clinging
  • Change in eating habits
  • Helpless, passive, not talking, withdrawing from friend and family
  • Feeling that he/she was the cause of death
  • May appear totally unaffected
  • Anger (including outbursts of rage)
  • Disbelief/denial
  • Feelings are turned on and off quickly and switch emotions quickly (from crying to laughing in minutes)
  • Caretakers (focus on others so do not need to focus on self)
  • Change in attitudes or beliefs

When to Seek Help:

If after three or four months if you still observe:

  • Withdrawal from social activities or poor performance at school.
  • Change in sleeping or eating habits, significant weight gain or loss.
  • Inability to focus.
  • Extreme acting out behavior that puts child or others at risk.
  • Self‐injurious behavior or making suicidal statements.

What to Expect from Early Adolescents (10‐13 for girls, 12‐15 for boys)

Common Understandings and Beliefs

  • A solid concept of death.
  • Preoccupied with peer relationships and begin to distrust or challenge adult interpretations of the world
  • Very emotional in response to emotion‐laden events.
  • Ideals and commitments are viewed as a sacred trust. Betrayal of promises, vows, or relationships is rarely tolerated, even when the person making such vows is incapable of honoring them.

What do I say?

  • Be prepared to answer all factual questions honestly including saying “I don’t know”
  • Be patient with questioning and challenging you version of events
  • Reassure and validate feelings
  • Be available to listen
  • Be honest about how you are feeling, this can help reassure them about their own feelings.
  • Allow them to be part of the planning for funeral arrangements when possible
  • Keep them abreast of plans

Behavioral Expectations

  • Disbelief and denial
  • Physical reactions (headaches, dizziness, nausea)
  • Care-taking; focusing on the needs of others rather than their own emotions.
  • Questioning of religious beliefs.
  • Numbing and withdrawal from friends and family
  • Clinging; not wanting to sleep alone
  • Anger and blaming
  • Constant replaying of the event
  • Taking personal responsibility. “it’s my fault because…”

When to Seek Help

Behaviors that persist more than three weeks

  • Change in sleep or eating patterns; significant weight changes
  • Destructive or risky behaviors, substance abuse, self‐mutilation
  • Change in friendship groups, poor school performance
  • Suicidal ideation or statements about “trading places”

Reactions to a Traumatic Death in Adolescence (Adolescents ages 13 ‐18)

Common Understandings and Beliefs

  • Death is a natural enemy, absolute and universal
  • Strong sense of self resulting in a felling of immunity to unexpected tragedy
  • Reliance upon natural order of the aging process.

What do I say?

  • Adolescents frank and direct answers to questions
  • Provide them with the factual truth and the source of your information i.e. “the coroner said…, according to the ED physician…”
  • If you do not have answers honestly tell them you do not know rather than providing guesses or assumptions. · Talk about coping skills
  • Validate feelings, particularly anger and emphasize that this is a normal reaction. · Encourage support from peers in a supervised setting
  • Don’t attempt to force discussion but try to have health discussion in their presence.

Behavioral Expectations

  • Anger (including outbursts of rage)
  • Disbelief/denial numbness or apparent apathy about the loss
  • Mood changes quickly and emotional reactions switch from crying to laughing in minutes
  • Withdrawal from friends/family
  • Change in eating patterns
  • Care-taking (focus on others so do not need to focus on self)
  • Change in attitudes or beliefs
  • Blaming of deceased, self or others
  • Inability to concentrate
  • Physical symptoms such as oversleeping, nausea, dizziness, forgetfulness, headaches
  • Sudden emotional outbursts
  • Inappropriate humor

When to Seek Help

When the following behaviors persist more than three weeks:

  • Change in sleep or eating patterns; significant weight changes
  • Destructive or risky behaviors, substance abuse, self‐mutilation
  • Change in friendship groups, poor school performance
  • Suicidal ideation or statements about “trading places”