Grief Resources

While many children are initially exposed to the rituals associated with funerals through the death of older relatives, the first experience for other children may be through the death of a friend or peer. And although burial rituals are obviously tied to culture, ethnicity, and religion and reflect many variations in the actual activities that take place, there is generally a consistency in the concerns children experience about attending funeral events. Unfortunately, for us as parents, our children may not be able to articulate these concerns. Even teenagers may be embarrassed to acknowledge their uneasiness about going to funeral activities.

So here are some simple guidelines to help you sensitively broach a conversation about funeral attendance and understand and address what may be your child’s unspoken concerns:

First, defuse your own anxiety about talking about death and funerals by remembering that most of your child’s concerns come from being exposed to an unfamiliar situation. While there may certainly be questions about what happens when we die, this does not have to be that kind of conversation. This is simply a way of helping prepare your child for another new life experience. If you frame it in this context, it doesn’t become such a big deal and it fits in more easily with more common parenting discussions. In any unknown situation, understanding what will happen is the easiest way to feel prepared. Describe what the experience will be like in as much detail as possible.

Consider saying something like what this parent explained to her middle school son:

“When we go into the funeral home, there will be a book at the door where we can sign our names so Jamie’s family will know we came to visit. We’ll probably have to wait on a long line because lots of other people will be there, too. In the front of the room there’ll be this big box that’s called a casket. That’s where Jamie’s body will be. The top of the casket may be open so people who want to see Jamie for one last time can go and say goodbye. If you’d like to do that we can, but it’s not something we have to do. The casket may be closed, with lots of flowers on top of it. Jamie’s family will be in the front of the room and everyone will walk past them and tell them how sad they are that Jamie died.

Sometimes people will tell them a story about Jamie‐ how much they liked him, or what they did together. You can think about this and see what you feel like saying when the time comes. If you don’t want to say anything, that’s okay, too. There will probably be lots of pictures of Jamie and his family and friends around the room and, if you want, we can take a look at these before we leave. Do you have any questions?”

This step‐by‐step review of the process paints a mental picture that allows your child to mentally rehearse attendance at the actual event. The anxiety and worry about the unknown will be immediately diminished when your child enters the funeral home and sees the same picture you have described. This behavioral rehearsal works well for younger children, but even older children can benefit from similar explanations.

Acknowledge worries about looking silly or saying something stupid by making them universal and providing an example of what you child can say. “You know, most people worry about saying something silly or stupid at funerals because it’s so hard to know the right things to say or do. The best rule is to keep it simple. ‘I’m sorry for your loss,’ or ‘I’m sorry Jamie died’ is absolutely enough!” Funerals, especially those of children, tend to be pretty emotional events, and children may worry that they’ll be upset. Be honest, validate the feeling but outline an escape. “You know, a lot of people do get upset at funerals‐ that’s why there are always a lot of boxes of tissues at funeral homes. What happened is very sad, so crying is a really normal reaction and most people are so caught up in their own feelings that they’re really not paying any attention to anyone else. But I’ll carry some extra tissues with me just in case you or I need one. And if you change your mind about staying, just let me know and we can leave at any time.”

For whatever reason, some children may balk at going to funeral events. Let it be. Being forced to attend, changes the event into an unnecessary power struggle. There are lots of ways to offer support and condolence to the bereaved family so simply suggest something else, like writing a short sympathy card.

Accompany your child. Having your support at an unfamiliar, emotional event like a funeral helps model an important life skill‐ how being together at a time of sadness helps get us through. If you can, pair your attendance at the event with something nurturing, like a stop on the way home to get a snack or a treat.

Expressions of Grief

Talking to children about death must be geared to their developmental level, respectful of their cultural norms, and sensitive to their capacity to understand the situation. Children will be aware of the reactions of significant adults as they interpret and react to information about death and tragedy. In fact, for primary grade children adult reactions will play an especially important role in shaping their perceptions of the situation. The range of reactions that children display in response to the death of significant others may include:

• Emotional shock and at times an apparent lack of feelings, which serve to help the child detach from the pain of the moment;
• Regressive (immature) behaviors, such as needing to be rocked or held, difficulty separating from parents or significant others, needing to sleep in parent’s bed or an apparent difficulty completing tasks well within the child’s ability level;
• Explosive emotions and acting out behavior that reflect the child’s internal feelings of anger, terror, frustration and helplessness. Acting out may reflect insecurity and a way to seek control over a situation for which they have little or no control;
• Asking the same questions over and over, not because they do not understand the facts, but rather because the information is so hard to believe or accept. Repeated questions can help listeners determine if the child is responding to misinformation or the real trauma of the event.

Helping Children Cope
The following tips will help teachers, parents, and other caregivers support children who have experienced the loss of parents, friends, or loved ones. Some of these recommendations come from Dr. Alan Wolfelt, Director of the Center for Loss and Life Transition in Fort Collins, Colorado.

• Allow children to be the teachers about their grief experiences: Give children the opportunity to tell their story and be a good listener.
• Don’t assume that every child in a certain age group understands death in the same way or with the same feelings: All children are different and their view of the world is unique and shaped by different experiences.
• (Developmental information is provided below.)
• Grieving is a process, not an event: Parents and schools need to allow adequate time for each child to grieve in the manner that works for that child. Pressing children to resume “normal” activities without the chance to deal with their emotional pain may prompt additional problems or negative reactions.
• Don’t lie or tell half-truths to children about the tragic event: Children are often bright and sensitive. They will see through false information and wonder why you do not trust them with the truth. Lies do not help the child through the healing process or help develop effective coping strategies for life’s future tragedies or losses.
• Help all children, regardless of age, to understand loss and death: Give the child information at the level that he/she can understand. Allow the child to guide adults as to the need for more information or clarification of the information presented. Loss and death are both part of the cycle of life that children need to understand.
• Encourage children to ask questions about loss and death: Adults need to be less anxious about not knowing all the answers. Treat questions with respect and a willingness to help the child find his or her own answers.
• Don’t assume that children always grieve in an orderly or predictable way: We all grieve in different ways and there is no one “correct” way for people to move through the grieving process.
• Let children know that you really want to understand what they are feeling or what they need: Sometimes children are upset but they cannot tell you what will be helpful. Giving them the time and encouragement to share their feelings with you may enable them to sort out their feelings.
• Children will need long-lasting support: The more losses the child or adolescent suffers, the more difficult it will be to recover. This is especially true if they have lost a parent who was their major source of support. Try to develop multiple supports for children who suffer significant losses.
• Keep in mind that grief work is hard: It is hard work for adults and hard for children as well.
• Understand that grief work is complicated: Deaths that result from a terrorist act or war can brings forth many issues that are difficult, if not impossible, to comprehend. Grieving may also be complicated by a need for vengeance or justice and by the lack of resolution of the current situation: the conflict may continue and the nation may still feel at risk. The sudden or violent nature of the death or the fact that some individuals may be considered missing rather than dead can further complicate the grieving process.
• Be aware of your own need to grieve: Focusing on the children in your care is important, but not at the expense of your emotional needs. Adults who have lost a loved one will be far more able to help children work through their grief if they get help themselves. For some families, it may be important to seek family grief counseling, as well as individual sources of support.

Developmental Phases in Understanding Death
It is important to recognize that all children are unique in their understanding of death and dying. This understanding depends on their developmental level, cognitive skills, personality characteristics, religious or spiritual beliefs, teachings by parents and significant others, input from the media, and previous experiences with death. Nonetheless, there are some general considerations that will be helpful in understanding how children and adolescents experience and deal with death.

• Infants and Toddlers: The youngest children may perceive that adults are sad, but have no real understanding of the meaning or significance of death.
• Preschoolers: Young children may deny death as a formal event and may see death as reversible. They may interpret death as a separation, not a permanent condition. Preschool and even early elementary children may link certain events and magical thinking with the causes of death. For instance, as a result of the World Trade Center disaster, some children may imagine that going into tall buildings may cause someone’s death.
• Early Elementary School: Children at this age (approximately 5-9) start to comprehend the finality of death. They begin to understand that certain circumstances may result in death. They can see that, if large planes crash into buildings, people in the planes and buildings will be killed. In case of war images, young children may not be able to differentiate between what they see on television, and what might happen in their own neighborhood. However, they may over-generalize, particularly at ages 5-6—if jet planes don’t fly, then people don’t die. At this age, death is perceived as something that happens to others, not to oneself or one’s family.
• Middle School: Children at this level have the cognitive understanding to comprehend death as a final event that results in the cessation of all bodily functions. They may not fully grasp the abstract concepts discussed by adults or on the TV news but are likely to be guided in their thinking by a concrete understanding of justice. They may experience a variety of feelings and emotions, and their expressions may include acting out or self-injurious behaviors as a means of coping with their anger, vengeance and despair.
• High School: Most teens will fully grasp the meaning of death in circumstances such as an automobile accident, illness and even the World Trade Center or Pentagon disasters. They may seek out friends and family for comfort or they may withdraw to deal with their grief. Teens (as well as some younger children) with a history of depression, suicidal behavior and chemical dependency are at particular risk for prolonged and serious grief reactions and may need more careful attention from home and school during these difficult times.

Tips for Children and Teens with Grieving Friends and Classmates
Seeing a friend try to cope with a loss may scare or upset children who have had little or no experience with death and grieving. Following are some suggestions teachers and parents can provide to children and youth to deal with this “secondary” loss.

• Particularly with younger children, it will be important to help clarify their understanding of death. See tips above under “helping children cope.”
• Seeing their classmates’ reactions to loss may bring about some fears of losing their own parents or siblings, particularly for students who have family in the military or other risk related professions. Children need reassurance from caregivers and teachers that their own families are safe. For children who have experienced their own loss (previous death of a parent, grandparent, sibling), observing the grief of a friend can bring back painful memories. These children are at greater risk for developing more serious stress reactions and should be given extra support as needed.
• Children (and many adults) need help in communicating condolence or comfort messages. Provide children with age-appropriate guidance for supporting their peers. Help them decide what to say (e.g., “Steve, I am so sorry about your father. I know you will miss him very much. Let me know if I can help you with your paper route….”) and what to expect (see “expressions of grief” above).
• Help children anticipate some changes in friends’ behavior. It is important that children understand that their grieving friends may act differently, may withdraw from their friends for a while, might seem angry or very sad, etc., but that this does not mean a lasting change in their relationship.
• Explain to children that their “regular” friendship may be an important source of support for friends and classmates. Even normal social activities such as inviting a friend over to play, going to the park, playing sports, watching a movie, or a trip to the mall may offer a much needed distraction and sense of connection and normalcy.
• Children need to have some options for providing support—it will help them deal with their fears and concerns if they have some concrete actions that they can take to help. Suggest making cards, drawings, helping with chores or homework, etc. Older teens might offer to help the family with some shopping, cleaning, errands, etc., or with babysitting for younger children.
• Encourage children who are worried about a friend to talk to a caring adult. This can help alleviate their own concern or potential sense of responsibility for making their friend feel better. Children may also share important information about a friend who is at risk of more serious grief reactions.
• Parents and teachers need to be alert to children in their care who may be reacting to a friend’s loss of a loved one. These children will need some extra support to help them deal with the sense of frustration and helplessness that many people are feeling at this time.

Resources for Grieving and Traumatized Children
At times of severe stress, such as the trauma of war or terrorist attacks, both children and adults need extra support. Children who are physically and emotionally closest to this tragedy may very well experience the most dramatic feelings of fear, anxiety and loss. They may have personally lost a loved one or know of friends and schoolmates who have been devastated by these treacherous acts. Adults need to carefully observe these children for signs of traumatic stress, depression or even suicidal thinking, and seek professional help when necessary.

Resources to help you identify symptoms of severe stress and grief reactions are available at the National Association of School Psychologist’s website— www.nasponline.org. See also:

For Caregivers

• Deaton, R.L. & Berkan, W.A. (1995). Planning and managing death issues in the schools: A handbook. Westport, CT: Greenwood Publishing Group.
• Mister Rogers Website: www.misterrogers.org (see booklet on Grieving for children 4-10 years)
• Webb, N.B. (1993). Helping bereaved children: A handbook for practitioners. New York: Guilford Press.
• Wolfelt, A. (1983). Helping children cope with grief. Bristol, PA: Accelerated Development.
• Wolfelt, A. (1997). Healing the bereaved child: Grief gardening, growth through grief and other touchstones for caregivers. Ft. Collins, CO: Companion.
• Worden, J.W. (1996). Children and grief: When a parent dies. New York: Guilford Press
• Helping Children Cope With Death, The Dougy Center for Grieving Children, www.dougy.org.

For Children

• Gootman, M.E. (1994). When a friend dies: A book for teens about grieving and healing. Minneapolis: Free Spirit Publishing.
• Greenlee, S. (1992). When someone dies. Atlanta: Peachtree Publishing. (Ages 9-12).
• Wolfelt, A. (2001). Healing your grieving heart for kids. Ft. Collins, CO: Companion. (See also similar titles for teens and adults)

Adapted from material first posted on the NASP website after September 11, 2001. NASP has made these materials available free of charge to the public in order to promote the ability of children and youth to cope with traumatic or unsettling times. The materials may be adapted, reproduced, reprinted, or
linked to websites without specific permission. However, the integrity of the content must be maintained and NASP must be given proper credit.

© 2003, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, 301-657-0270, www.nasponline.org

• They need to know they are going to be taken care of:
  One of the questions frequently on the minds of bereaved children is “Who will take care of me?” Address this issue. Even if they have not said anything about it, they are thinking it. They need to be assured that even with the loved one gone, they will still be taken care of.
   
• They need to know that they did not cause the death:
  Especially between the ages of 3-5 and early adolescence, children may think that something they did may have caused the death of their loved one. Perhaps if they had been nicer to the person, or if they hadn’t had an argument with the person that person would still be alive.
   
• They need clear information about the death:
  They need to know clearly how the person they cared about died. They may wonder “Will it happen to me?” or “Can I catch what they had and die?” If the children don’t know how the person died, they will make it up. When explaining how the person died, keep in mind the level of understanding of the child. Don’t explain more than they will be able to comprehend.
   
• They need to feel important and involved: 
  The child should be included in any activity that memorializes the person who died. There are many different kinds of activities in which children can participate. These include decisions surrounding the service, memorial remembrances or other significant events associated with the deceased.
   
• They need continued structure:
  Children need continued structure in their lives. They still need to have a set bed time, a set schedule. Many times people will alter the child’s schedule or discipline to “go easy on them”, but this is incorrect. They need to know that there is still a schedule to keep and rules to follow, despite the death of their loved one.
   
• They need someone to listen to them:
  Children need someone who will be able to listen to their fears, fantasies and questions. They need permission to feel the way they do. They need to be allowed to grieve. They need to be told that it is O.K. for them to feel the way they do (sad, confused etc.) and that they have someone they can talk to, if not you, then another family member or friend.
   
• They need to be able to remember the person who died: 
  Children need to be able to talk about the person who died. They need to be able to share their memories and talk about what that person meant to them. For example, a memory book is an excellent activity for the family to work on together. 
   
• They need adults who can model appropriate grieving behavior:
  Children need to see adults grieving in an appropriate way. Children will look to the adults to determine how they should grieve. For example, if they see an adult who refuses to cry in their presence, they may internalize that to mean that it is not O.K. to cry. By observing appropriate grieving behavior, the child will feel more comfortable to grieve as well.
   
• Take care of yourself: 
  You are also grieving. It is important that you deal with your own grief, so that you are better able to help your child. If you find that at times you are not able to do all of the things on this list, ask a relative or friend for help.

**This handout was taken in part from J. William Worden’s book Children and Grief.

When we lose someone or something we cherish, we will respond emotionally, psychologically,
physically and spiritually. Any or all of these responses may be considered normal and healthy
under the circumstances of grief in which we find ourselves.

Emotional Responses:

• Shock
• Denial
• Disbelief/Numbness
• Guilt and Self-blame
• Fear
• Feelings of Loss/Loneliness
• Emptiness
• Sadness/Depression

Psychological Responses:

• Inability to Concentrate
• Explosive Emotions
• Low Self-Esteem

Physical Responses:

• Tiredness/Lack of Energy
• Difficulty Sleeping or Prolonged Periods of Sleep
• Excessive Appetite or Lack of Appetite
• Tightness in Chest
• Shortness of Breath

Spiritual Responses:

• Anger with God
• Doubts about Belief System
• Questions Regarding Meaning of Life
• Interest in Afterlife

General Responses:

• Disorganization
• Panic
• Relief
• Powerlessness
• Anger/Rage
• Hopelessness
• Shame
• Lack of Interest
• Prolonged Withdrawal
• Inability to Experience Pleasure
• Ulcers
• Heart Problems
• Stomach Pain
• General Nervousness and Trembling
• Lump in the Throat
• Headaches
• Loss of Muscular Strength
• Changed Priorities
• Search for Meaning in the Event
• Gratitude for Time Spent Together
• Belief that Person is Happier, No Longer Suffering, in a Better Place, etc.

Because grief can be so painful and seem overwhelming, it can frighten us. Many people who are in a grief situation seem to wonder if they are grieving in the “right” way, and wonder if their feelings are normal.

It may be reassuring that most people who suffer a loss experience one or more of the following:

• Feel a tightness in the throat or a heaviness in the chest
• Have an empty feeling in their stomachs and lose their appetites
• Feel guilty at times; angry at others
• Feel restless and look for an activity but find it difficult to concentrate
• Feel as though the loss is not real, that it didn’t really happen
• Sense the child’s presence. Example: find themselves expecting the child to walk in the door, hearing his/her voice or seeing his/her face
• Wander aimlessly, forget and be unable to finish projects
• Have difficulty sleeping and dream of their child frequently
• Experience an intense preoccupation with the life of the child
• Feel guilty or angry over things that did or did not happen in the relationship with the child
• Feel intensely angry at the child for leaving them
• Need to tell and retell and remember things about the child and the experience of death
• Feel mood changes/cry unexpectedly over the slightest thing
• Feel out of place with other people

How We Respond to Loss

When we face the death or ending of someone or something we love, the loss may be expressed emotionally, physically, spiritually and psychologically. Due to the intensity of the grief, the responses expressed are considered normal and healthy.

Physical Experiences:

• Inability to sleep or excessive sleep
• Exhaustion, no energy
• Appetite disturbances
• Tightness in chest area
• Sighing
• Loss of muscular strength
• Headaches
• Ulcers
• Shortness of breath
• Tightness in throat or lump in throat
• Nervousness

Emotional Experiences:

• Numbness
• Fear
• Inner hollowness
• Denial
• Shock
• Loneliness
• Panic
• Rage/anger
• Hopelessness
• Powerlessness
• Shame
• Guilt, self-blame
• Disorganization, difficulty in concentrating

Spiritual Responses:

• Changes in priorities
• Searching for meaning in the loss
• Thankfulness for the precious time with loved one before death occurred
• Strong interest in life after death
• Interest in premonitions
• Questioning and eventually maturing prior belief system
• Belief that loved one is now healthy, whole and always with them
• Belief in the ‘mystery’ of life and a purpose in every life, even though profound loss is inexplicable from an intellectual perspective

Psychological Responses:

• Mood swings
• Irritability and explosive responses
• Low self-esteem
• Inability to experience any type of pleasure
• Isolation over an extended period of time
• Lack of interest
• Prolonged negativity

Parents, with their greater life experiences and wisdom, can place the events in a child’s life in its proper context or perspective. Children look to adults for an
interpretation of events, and measure the meaning of it, including the degree of danger they are in, by the reaction of their parents and other adults around them. It is critical that children are able to maintain a positive view of the world and a positive opinion of themselves in spite of the event.

The grieving process:
Grieving is a natural and temporary response to an important loss. People do not respond to a death related loss in any particular stage progression or pace. Some believe that the process is more like a roller coaster type pattern in which waves of various emotions are experienced. It is important to encourage children to cry if they feel sad. It can be said that when we feel really sad, letting ourselves cry is as important to our mental health as is eating when we are hungry, drinking when we are thirsty and sleeping when we are tired.

Most individuals return to their regular routines within one to three days. Yet a sustained period of bereavement may last four to six weeks. An intermittent pattern of bereavement continues in the form of painful thoughts and feelings which often resurface in the future more intensely at birth and death dates, holidays and special events, places or other experiences that are reminders of the deceased. Memories of the deceased may change or diminish over time but the deceased friend will not be forgotten.

Common reactions to the death of a friend:
In addition to sadness, it is common for people to feel confusion, fear, anger, selfblame and guilt. Other common reactions include feelings of loneliness, a sense of responsibility or regret, reminders and dreams of the deceased, concentration difficulties, minor sleeping difficulties and mild somatic complaints.

What can parents do? A parent’s emotional response to a grieving child can reduce the emotional effect or make it worse for the child.

• The following are suggested parental responses: Be physically present, show warmth, be patient, allow the child to talk about it, listen carefully, acknowledge feelings, show an understanding of what happened, give reasonable reassurance and follow through on promises and agreements made. Teens will try to make some sense of what happened and it is important for them to come to a resolution about the event. Carefully challenge any negative conclusions and reinforce the positive ones.
• The following parental behaviors can be harmful: Focus on self instead of the child, deny the seriousness of the event, shrug off the child’s feelings, tell the child not to think or talk about it, make assumptions, overreact with anxiety or anger, withdraw from the child, or make major changes in the normal household activities and routines.

Reactions to be concerned about:
Some children, because of their emotional proximity to the death event, may be more prone to develop the psychological symptoms of Major Depression. There are two causes for Major Depression. One is the result of a neuro-chemical imbalance in the brain. The other results from an experience such as a significant loss. Your child may have Major Depression if the following five (or more) symptoms have been present during the same two week period:

• Feeling really unhappy, sad or empty inside most of the day, nearly every day

[Or]:

• An obvious loss of interest or pleasure in all, or almost all, friends and activities most of the day, nearly every day

[Plus 4 or more of the following]:

• Weight loss when not dieting or weight gain (more than 5% of body weight in a month)
• Trouble sleeping or sleeping too much nearly every day
• Slowness of thought, speech and activity or extreme agitation/restlessness
• Feelings of low energy or fatigue nearly every day
• Feeling hopeless, worthless, shame or a lot of guilt nearly every day
• Difficulty concentrating, making basic decisions and doing school work nearly every day
• Frequent thoughts of death or suicide

Other undesirable reactions include denial, social alienation, escape from reminders of the deceased, numbing of feelings, ex. using drugs or alcohol, hostility or antisocial activities, a preoccupation or fascination with death and unnecessary risk taking behaviors. If you are concerned about your child you may want to contact your family physician, or a psychologist or social worker in your child’s school or community.

References:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.
Grollman, E. “Explaining Death And Dying To Our Children And Ourselves” Elgin, IL. January 28, 2000.
Johnson, K. (1989) Trauma in the Lives of Children. Alameda, CA: Hunter House.
Copyright 2000 and 2007 by Jerry Ciffone, LCSW School Social Worker, School District U-46, Elgin, IL.

• Was the death anticipated or sudden?
  Generally speaking, grief lasts longer in cases of sudden death.
• How close was the child to the deceased?
  The closer the relationship, the longer the grief will last.

General Guidelines for helping children work through the grief process:

• Give them opportunities for expression. The emotions that follow the trauma of a death may be new to them, and they may not have the words to describe them. Encourage them to draw, paint, and write letters, take photographs, make collages, write songs, and write poems…whatever they choose.
• Keep them physically active. Offer grieving children many opportunities to participate in physical activities and encourage them to be involved. Staying physically active can combat the effects of depression.
• Read a book together. Reading books together can be therapeutic. There are many books available to children that provide information about grief and about grieving. Don’t pass up this opportunity for closeness.
• Find a support group. Children often interact better with other children that they do with adults. Many mental health clinics, hospitals, and social service agencies sponsor support groups for children, who have suffered the loss of a friend or loved one. Children learn that they are not alone, they are not “different,” and it is okay to talk about what they are going through.
• Know when to seek professional help. Here are some indications that professional help may be necessary:
  • Excessive and prolonged periods of crying
  • Frequent and prolonged temper tantrums
  • Extreme changes in behavior
  • Noticeable changes in school performance and grades
  • Withdrawal for long periods of time
  • Lack of interest in friends and activities they used to enjoy
  • Frequent nightmares and sleep disturbances
  • Frequent headaches and or other physical complaints
  • Noticeable weight loss or gain
  • Apathy, numbness, and a general lack of interest in life
  • Prolonged negative thinking about the future, or lack on interest in the future.

General guidelines for helping children move on with life:

• Be patient but firm: Children may cry, get angry, ask questions and express insecurities and frustration, and parents will need to be patient with children during this time. Children still need limits during this time, especially when their emotions are in turmoil and their lives appear to be upside down. If they act out, refuse to do school work, avoid responsibility etc, they need to know these behaviors are not acceptable.
• Promote positive self-esteem: Try to work on promoting your child’s self esteem through compliments and praise, every opportunity you get. (Show interest in school work, outside activities and friends.)
• Listen when they talk, and give them individual attention when they need it (as often as you can.) Display your love openly to them, and tell them how proud you are of them.

Provide encouragement and direction:

• Children may withdraw into inaction as a way to protect themselves. After loosing a loved one, they may feel despair and that nothing matters. They also may feel as if the future is uncertain and unpredictable.
• Encourage your children to play and participate in activities they enjoy.

Give choices:

• This empowers children and gives them a sense of control again. Giving your children options and letting them decide when they are going to do certain things, within reason, they are able to gain a sense of control again.

Teach problem-solving skills:

• Teaching these skills helps to reduce anxiety and promote self-esteem.
• Presenting children with hypothetical dilemmas, and having them brainstormand evaluate possible solutions is helpful.

Stick together:

• Let your children know that you are still a family.
• Explain to them that working together to overcome grief as a family is better and more productive than an individual doing it on their own.

Give them permission to be happy again:

• Children who are mourning a loss need permission to be happy again.
• They need to know it is okay to play, laugh, learn and love again.
• Children will model what they see and the behavior of an adult caregiver during these times, so try to set good examples.

Normal Grief Reactions (All Ages):

• Not being able to communicate with my parents.
• How should I act?
• I’m so glad it’s over.
• I feel as if it isn’t real.
• My mood changes over the slightest things.
• Sometimes I feel angry.
• I don’t want others to see me when I feel sad.
• I have trouble focusing on school work.
• I sense my loved one’s presence.
• I have trouble sleeping.
• I have an empty feeling.
• I feel confused.
• I feel afraid.
• I feel sad and depressed.
• Physical symptoms
• Hostility towards deceased or toward others
• Assumption of mannerisms of deceased
• Idealization of deceased
• Anxiety
• Guilt and regret
• Difficulty concentrating in school & activities, poor grades or decline in grades
• My friends at school don’t know what I’m feeling.
• I forget the person died.
• Denial and possible risk taking behavior (i.e. promiscuity, substance use).
• These are natural, normal grief responses. It is important to reach out and talk with people, and to cry when you need to.

When to refer for individual counseling:

There are some bereaved children whose needs will be met more effectively in individual counseling or therapy. The following “red flags” should alert you to the need for making an appropriate referral. Many of these behaviors are normal grief responses. What makes them “red flags” is a matter of degree.

• Total denial of the reality of the death
• Persistent panic or fear
• Prolonged physical complaints
• Prolonged feelings of guilt or responsibility for the death
• Chronic patters of apathy and/or depression
• Chronic hostility, acting out toward others or self
• Prolonged change in typical behavior or personality
• Consistent withdrawal from friends and family
• Dramatic, ongoing changes in sleeping and eating patterns
• Suicidal ideation or actions
• Drug or alcohol abuse

The death of a loved one can be a very stressful event for you and your teen. You may think, “How can I help him understand and cope when I am having trouble myself?” This handout serves as a guide in helping your teenager deal with the death of someone close to him or her.

Many different staff members can help your teen deal with the death of a friend or family member. A certified child life specialist is one of the team members who will work closely with your family. This staff member can help your teen understand death and teach him or her ways to cope with the loss. Child life specialists are here to work with your teen and his or her brothers and sisters at any time during your stay. They also can support you in talking with your teen about death. When needed, a specialist from the Child Life Program can send you resource materials about grief and bereavement that fit your teen’s age.

Keep in mind that teenagers are at risk for complicated mourning. If you are at home and feel that your teen needs more support, please call on local support services such as a grief counselor, chaplain, social worker or psychologist.

Understanding death:

• Teens typically have a full understanding of death.
• If the person who dies is close in age to your teenager, he or she may be faced with the reality that not everyone lives until they are very old.
• Your teen may begin to take on more responsibilities, feeling the need to be strong and care for others.
• He or she may show a wide range of feelings and emotions or no emotion at all.
• Your child may act indifferent to death to protect him or herself.
• Many teenagers begin to question their religion or spiritual beliefs.

Common Reactions

Every teen responds to death in his or her own way. These are some of the most common reactions for teenagers:

• Anger
• Denial
• Withdrawal
• Regression (acting younger than his or her age)
• Aggression
• Drop in grades
• Risk taking
• Changes in sleep patterns
• Feeling different than peers
• Increase in conflict with friends and family
• Assuming more responsibilities and adult roles
• Critical toward decisions made by friends and family of the person who has died

Some of these reactions may lead you to believe that your teenager is suffering from depression. Depression occurs when many symptoms, such as those listed above, last for several weeks and cause a big change in routine. If you believe that your teen is suffering from depression, please arrange for him or her to speak with a psychologist or counselor.

Ways to Help:

• Be there for your teen.
• Encourage your teen to seek support from others (such as a counselor or pastor, etc.) However, be
  careful not to push too hard.
• Relieve your teen of the burden of adult responsibilities
• Model healthy grieving (coping).

Offer your teenager books and journals that address teen grief. You can find these at your local library or bookstore.

• Some titles that other teens have found helpful are:
• Facing Change: Falling Apart and Coming Together Again in the Teen Years by Bonna O’Toole
• My Grieving Journey Book by Donna and Eve Shavatt
• Fire in My Heart, Ice in My Veins by Enid Samuel-Taisman

You may find these books helpful when preparing your teenager for a death:

• Preparing the Children: Information and Ideas for Families Facing Terminal Illness by Kathy Nussbaum
• Living the Dying Process: A Guide for Caregivers by Jody Gyulay

Questions?

If you have concerns about how your teen is adjusting to the death of someone close to him or her, please contact the Child Life Program at (916) 703-3024. 

Adapted with permission from St. Jude Children’s Research Hospital. Revised 7/05
UC Davis Cancer Center 12/06