Part A: Section A.2 Understanding Grief and Loss in Children 1 Part A: Understanding Grief and Loss in Children and Their Families
Objectives 1.1 Describe the overarching process of grief and loss, including: a. ranges of grief reactions: denial, anger, bargaining, depression, acceptance difference between “normal” and “complicated” grief b. 1.2. Explain how the child’s concept of death develops from toddlerhood through adolescence 2 Part A: Understanding Grief and Loss in Children and Their Families
Objectives (continued) 1.3. Demonstrate knowledge of the stages of acquisition of information that occur in children with life threatening illnesses, including: a. What children understand and know as their disease progresses. How to assist children’s understanding in discussions of b. medical information. 3 Part A: Understanding Grief and Loss in Children and Their Families
Term Definitions o Grief: a normal process in response to loss o Bereavement: the state of having suffered a loss o Mourning: the public expression of grief o Complicated grief: persistent separation distress lasting more than 6 months and interfering with daily functioning 4 Part A: Understanding Grief and Loss in Children and Their Families
Components of Grief o Denial: “This isn’t happening.” o Anger: “It’s not fair!” o Bargaining: “If I just behave better, things will be different.” o Depression: “Everything sucks, what’s the point?” o Acceptance: “I miss Shaggy, but things will be okay.” 5 Part A: Understanding Grief and Loss in Children and Their Families
Activity: Loss Exercise Each participant takes 5 pieces of paper and writes down something of personal value on each piece. (Can be a person, pet, object, skill, opportunity, etc.) Then each participant finds a partner. They then each take three pieces of paper away from their partner. 6 Part A: Understanding Grief and Loss in Children and Their Families
Expressions of Childhood Grief o Sadness o Explosive emotions o Guilt o Regression o Fear o Acting out behavior o "Big Man” or "Big o Numbness Woman" Syndrome o Withdrawal o Physical symptom o Disbelief 7 Part A: Understanding Grief and Loss in Children and Their Families
Grief in Children o How a child experiences grief will depend on their developmental stage and personality o Context of the relationship is also a key element o Other important elements are o Nature of the death o Prior experiences with death or loss o Availability of family/social support o Behavior, attitudes and responsiveness of parents and other support individuals in their environment 8 Part A: Understanding Grief and Loss in Children and Their Families
Pediatric Bereavement o Children have several “tasks” to accomplish during bereavement: o Accepting the loss o Experiencing the pain and other emotions associated with loss o Adjusting to a new situation/environment o Finding ways to memorialize/remember the individual who is gone 9 Part A: Understanding Grief and Loss in Children and Their Families
Complicated Grief o Invasive and debilitating grief symptoms lasting more than 6-12 months o Can include: o Yearning for deceased o Difficulty accepting death o Inability to trust o Excessive anger o Intense loneliness o Frequent pre-occupying thoughts about deceased 10 Part A: Understanding Grief and Loss in Children and Their Families
Complicated Grief Risk Factors o Deep attachment to deceased person o Child, spouse, parent, sibling o Unexpected death o Traumatic death o Prior experience with traumatic loss 11 Part A: Understanding Grief and Loss in Children and Their Families
Reflection PBS “It’s my life” on “Dealing with Death” (6:39) http://www.youtube.com/watch?v=WHUewQtLgNs&feature=r elated 12 Part A: Understanding Grief and Loss in Children and Their Families
Reflection o What grief responses do the children identify in the video? o What additional losses to the children identify? o What coping mechanisms do the children identify? 13 Part A: Understanding Grief and Loss in Children and Their Families
Changing Face of Death • Intergenerational family units • Limited effective medical interventions Before • Common to experience births and deaths in the home 1900s • Hospitals and medical technology advance • Resuscitation (CPR) developed in 1960 20 th Century • Emphasis on youth and health • Death as a medical failure • Death occurring in medical facilities > home 2000s 14 Part A: Understanding Grief and Loss in Children and Their Families
Adult Understanding of Death o Irreversibility o Death is permanent. o Nonfunctionality o All life-defining functions cease at the time of death. o Universality o All living things die, including self. o Causality o There are physical reasons someone dies. 15 Part A: Understanding Grief and Loss in Children and Their Families
Understanding of Death Age Developmental Perception or Anticipated Response Stage (Piaget) Concern Sensorimotor Sense separation Withdrawal < 2 years and the emotions Irritability of others Preoperational Dead = “Not Alive” Wonder about what the 2 – 6 years Death as dead “do” Temporary Magical thinking (I am the cause) Concrete Morbid interest in Exaggerated behavioral 6 – 10 years operational death reactions to the idea of Others die I die death and dead things Formal Adult concepts “But not me” Adolescence operational Existential Death as an adversary implications 16 Part A: Understanding Grief and Loss in Children and Their Families
Reflection PBS “Sesame Street” Big Bird learns about death (Mr. Hooper dies) (4:33) http://www.youtube.com/watch?v=9NjFbz6vGU8&feature=rel ated 17 Part A: Understanding Grief and Loss in Children and Their Families
Reflection o Where is Big Bird in his developmental understanding of death? o How do the adults help support his understanding? o How could you use this with parents or patients? 18 Part A: Understanding Grief and Loss in Children and Their Families
Reflection GENERATIONS; The Final Farewell, in a Child’s Eyes , in New York Times October 29, 2006 19 Part A: Understanding Grief and Loss in Children and Their Families
Reflection o What are your personal experiences with talking about death? o What are your personal experiences being told about a death? o What are your fears around talking about death with children? 20 Part A: Understanding Grief and Loss in Children and Their Families
Activity Role play explaining the death of a grandparent to a child aged 3, 8, and 14 years old. 21 Part A: Understanding Grief and Loss in Children and Their Families
Understanding of Death – Impact of Experience 22 Part A: Understanding Grief and Loss in Children and Their Families
Stages in a Sick Child’s Acquisition of Information about His/Her Illness Stage 1 o Child’s Information o “It” is a serious illness o Not all children will know the name of the disease o Experience Required for Passage to This Stage o Parents informed of the diagnosis o Child’s Self -Concept at This Stage o I was previously well but now I am seriously ill 23 Part A: Understanding Grief and Loss in Children and Their Families
Stages in a Sick Child’s Acquisition of Information about His/Her Illness Stage 2 o Child’s Information o The names of the drugs used in treatment, how they are given and their side effects o Experience Required for Passage to This Stage o Parents informed the child is in remission o Child is speaking to other children at clinic o Child’s Self -Concept at This Stage o I am seriously ill but I will get better 24 Part A: Understanding Grief and Loss in Children and Their Families
Stages in a Sick Child’s Acquisition of Information about His/Her Illness Stage 3 o Child’s Information o Purposes of procedures and treatments; relationship between procedures and specific symptoms o Experience Required for Passage to This Stage o First relapse o Child’s Self -Concept at This Stage o I am always ill and I might not get better 25 Part A: Understanding Grief and Loss in Children and Their Families
Stages in a Sick Child’s Acquisition of Information about His/Her Illness Stage 4 o Child’s Information o Larger perspective of the disease as an endless series of remissions and relapses o Experience Required for Passage to This Stage o Several remissions and relapses o Child’s Self -Concept at This Stage o I am always ill and will never get better 26 Part A: Understanding Grief and Loss in Children and Their Families
Stages in a Sick Child’s Acquisition of Information about His/Her Illness Stage 5 o Child’s Information o The disease is a series of remissions and relapses ending in death o Experience Required for Passage to This Stage o Child learns of the death of an ill peer o Child’s Self -Concept at This Stage o I am dying 27 Part A: Understanding Grief and Loss in Children and Their Families
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