Chapter 4

Question 1

External Factors Influencing Grief Reactions in Children & Adolescents

Answer 1

• Media depictions of Losses and Grief
• Family system reactions to loss (values, beliefs, behaviors)
• Relationship between the child/adolescent
• And the person from whom they are separated by death or symbolic loss
• Reactions of peers and other adults

Question 2

Developmental Issues: Infancy and Early Childhood

Answer 2

• Dependency/Attachment
• Limited object constancy
• Limited ability to verbalize
• Lack coping strategies to regulate tension

Question 3

Developmental Issues: Children under 2 ½

Answer 3

Understanding of illness/death

• Cannot “understand” death.
• Cannot differentiate parent’s absence for a short time from a long time.
• Can sense loss or change in something but cannot verbalize it

Reactions to loss

• Expresses discomfort or insecurity through frequent crying or protest
• Expresses distress or sadness through withdrawal, loss of interest in usual activities
• Changes in eating and sleeping patterns
• May cling or scream when parent tries to leave

Interventions

• Maintain normal routines, familiar surroundings
• Provide a consistent caregiver who can give frequent and
• Lengthy periods of love & attention, hugging
• Explain changes in terms of how they will affect child
• Consistent, gentle physical and verbal reassurance and comfort
• Express confidence in the child and the world

Question 4

Toddlers (2 ½ to 4 years)

Answer 4

Reactions to loss

• Toddlers react to changes they see around them
• They may have difficulty communicating distress in words; communicate in behavior
• They take cues from others’ behavior-if others cry, they cry
• They may become very active-running, jumping, yelling to show themselves
• And show others they are not dead or to get attention they are missing.
• They may intermittently express sadness, listen to explanations, then return to play.
• They may express anger at dead parent for leaving them
• And at others for changes/disruptions in routines.
• They may ask repeatedly for parent and cling to substitute caregiver

What can help

• Physical expressions of affection & closeness
• Reassurance that they will be loved and taken care of
• Maintain familiar routines and surroundings
• Explore what they know and understand
• Reinforce that they did not do anything to cause the illness or death
• Share feelings in simple, brief ways- “I’m sad, I miss mommy”
• Reassure them about the health and wellbeing of the surviving parent
• Use correct terms for death
• Avoid equating death with sleep or the child may be afraid to go to sleep

Question 5

Developmental Issues: School Age Children 6-9

Answer 5

• Relationships with both peers and adults important
• Striving for mastery of information, tasks
• Superego and sense of responsibility developing
• Concrete thinking
• Understanding of illness/death
• Curious about death, ask concrete questions about what happens to one’s body
• Death is personified as a person or spirit: skeleton, ghost, angel of death, bogeyman
• Although death is perceived as final and frightening it is not universal
• Children this age begin to compromise, recognizing that death is final and real
• But mostly happens to the elderly (not to themselves)

What can help

• Clear explanations of death, without euphemisms
• Acknowledgement of feelings
• Address questions honestly and directly.
• Provide reassurance that they did not cause death
• Provide reassurance about their own security

Question 6

School Age: 10-12

Answer 6

Understanding of illness/death

• Recognizes that everyone will die (even themselves)
• Interested in and capable of understanding biological processes
• Heightened emotions and sensitivity to others’ emotions (guilt, anger, shame)
• Regressive and impulsive behaviors indicate stress
• Increased awareness of vulnerability

Reactions to Loss

• Reactions often reflect what has been learned from parents and other adults around them
• Family’s spiritual beliefs often evident in the child’s statements about death and coping
• Most bereaved children do not show serious emotional/behavioral disturbances
• Capable of empathy & expressing caring to others who grieving/share similar experiences

Question 7

Developmental Issues: Adolescents

Answer 7

• Searching for identity
• Interest in sex and intimacy
• Peer relationships very important
• Abstract thinking
• Exposure to maladaptive behaviors
• Responses to stress

Understanding of Death

• Adolescents comprehend that death is permanent, irreversible, and affects everyone.
• While they cognitively understand that death is final and inevitable
• Their behavior may indicate denial

Reactions to Loss

• Capable of mature and thoughtful reflections on the meaning of life and death
• And may struggle with existential questions
• Exposure to maladaptive coping strategies
• Substance use, risk taking, and sexual experimentation; “parentification”
• Talking openly about death, indicating that the subject is not off limits
  
  • Verbal or written explanations that tears, sadness, anger, guilt, and confusion
  • Providing opportunities for adolescents to hear from & talk with peers experiencing loss
  • Bereavement groups & retreats can be effective

Question 8

Needs All Children Have in Coping with Trauma and Loss

Answer 8

• Information
• Emotional Support
• Room to Act
• Respite and Renewal
• Hope