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1Grief and Grieving of ChildrenBy: Cathy B.Herbert,MSN,RN

72Objectives By the end of this module students should be able to: 1. Describe the childs concept of death according to their developmental stage. 2. Describe the childs responses to death and loss. 3. Identify strategies to assist the child in coping with loss or death.

3Childrens Understanding And Response To Death

According to Their Stage of Development

4InfantsErikson Stage: Trust v. MistrustCognitive Stage: SensorimotorLacks understanding of deathMay sense caregivers stress, anxiety and sadnessMay sense separationResponds to altered routines

5Infant (cont.)Infants may be fussy, cry excessivelyMay sleep more than normalMay eat less and resist cuddlingMay regress

6ToddlerErikson Stage: Autonomy v. Shame and DoubtCognitive Stage: PreoperationalNo understanding of true concept of death and its finalityUnable to distinguish fact from fantasyFears separation (separation anxiety)

7Toddler (cont.)Fearful, shows distress by hitting, crying, bitingProblems sleeping and eatingClingy, refuses to let caregiver out of sightRegression in toilet training, weaning from bottle, talking, etc.Reacts to others around them ie. their stress, sadness

8PreschoolErikson Stage: Initiative v. GuiltCognitive Stage: PreoperationalBelieves death is temporary and dead person will returnMagical thinking (dead person can be brought back to life)Believes bad thoughts can cause death

9Preschool (cont.)May have beginning experience with death of animal, plantMay fear going to sleep, fear of darkMay have nightmares, temper tantrums, acting out behavior, crying spellsAsks a lot of questions, morbid fascination with deathDisplays anger at failure to keep person aliveRegression, complaints of abdominal pain

10School AgeErikson Stage: Industry v. inferiorityCognitive Stage: Concrete OperationsAcquires more realistic understanding of death- by 8-10 years understands death is permanent and irreversibleStill associates bad thoughts or misdeeds with causing death and feels guiltBelieves death is universal but happens to adults

11School Age (cont.)May have fear of own death, death of loved one; fear of going to sleep

12AdolescentErikson Stage: Identity v. role confusionCognitive Stage: Formal OperationsIntellectually capable of understanding death; better understanding of association between illness and deathHas a sense of invincibility therefore does not really believe anything bad will happen to them

13Adolescent (cont.)Able to recognize effect of death on othersMay suffer from severe depressionMay feel angry or guiltyMay have acting-out behavior ie. risk-taking, appear indifferentMay have difficulty sleeping and eating

14Coping Strategies for Infant and ToddlerTry to maintain usual routinesHold and cuddle infant to provide sense of securityTalk with child and answer questionsConsistent caregiver

15Coping Strategies for Preschool ChildrenListen to child and answer questions honestlyUse correct terms like death and dying; terms like sleep, gone away only cause confusionConsistent caregiverEncourage parents to stay as close to child as possibleBe tolerant of regressive behaviors

16Coping Strategies for Preschool Children (cont.)Provide play activitiesParticipate in rituals like visiting cemetery, planting tree or flowersProvide pictures, personal items to remind child of loved oneMay have to repeat information and answer same questions more than once

17Coping Strategies for School Age ChildEncourage child to talk about their feelings, or have them draw pictures about how they feelListen to the child and answer questions honestly using proper termsHelp keep memories alive with memory book, pictures, participating in rituals like planting tree or flowers, releasing balloons.

18Coping Strategies for School Age Child (cont.)Return to normal routines as soon as possibleUse support groups

19Coping Strategies for AdolescentShare personal grief with adolescentMay be confused, frightened, or angryBe available to answer questions honestly, but respect privacy and personal expressions of grief.Share internet resourcesAccess support groupsHelp keep memories alive with things like memory books, pictures, special memorial events

20Effect of Childs Death on Parents/FamilyDeath of a child is very stressful for entire familyFamily members may grieve in different ways and for different lengths of time causing stress on other family membersExtreme sadness may not allow parents to talk about the child who died or answer questionsFamily members may have somatic symptoms such as insomnia in response to grief

Review Questions1.The mother of a 4-year-old expresses concern about her child who believes that her grandmother is still alive 3 months after the grandmothers death. Which explanation by the nurse is most appropriate? a. The child is in denial regarding her grandmothers death b. This is a form of regression exhibited by the preschooler c. This is an example of the magical thinking typical of preschoolers d. There is a need for psychological counseling for the child

2. An adolescent appears indifferent to his best friends death in an auto accident. How does the nurse interpret this reaction? a. This is within the normal range of behaviors adolescents exhibit in response to death. b. This behavior is a cry for help by an adolescent planning to commit suicide. c. This behavior is indicative of a serious psychological problem requiring immediate intervention. d. This is evidence that the adolescent is in a stage of denial..

3. The parents of a 6-year-old boy whose infant sister has recently died of Sudden infant death syndrome (SIDS) ask the nurse how they can help their son cope with his sisters death. Which response by the nurse would not be appropriate? a. Listen to your child and answer his question s honestly. b. Encourage your son to draw pictures about how he is feeling. c. Do not share your feelings with your son to protect him from your sorrow. d. Return to your sons normal routines as soon as possible.

Answers1. C2. A3. C