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Article 7

Understanding Grief and Loss in Children

Jody J. Fiorini and Jodi A. Mullen

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The Land of Myth and Make Believe

Once upon a time there existed a land where death was never talked about. In this land children were always happy and resilient and bounced back from any loss or trauma they might experience. In fact, children in particular were thought to be incapable of feeling depressed or truly understanding or experiencing loss. Children in this land held their heads high and were “strong little troopers” when faced with issues like death, divorce, or other life transitions. In this land, parents and other adults decided that it would be better not to talk about traumatic events with their children so as not to “confuse” them or make them feel upset. The less said the better. In fact, the parents and other adults around these children decided that they should also hide their own feelings so as not to upset the children. The adults were very surprised then when the children began to behave differently, act sad or angry, or engage in risky behaviors after they experienced a traumatic event or life change. “How could this be,” the parents thought, “when we have tried our best to insulate our children from pain?” “Could we have been wrong all along?” “Do children grieve?” (Fiorini & Mullen, 2006, p. 10)

This passage illustrates a fundamental problem in how our society handles grief and loss issues with children and adolescents. In general, as a society we live in a very death-phobic culture. We use a variety of euphemisms such as passed away to describe death as though to even say the word died was taboo. We value people who are strong when faced with adversity. Counselors must help parents and other adults to understand the manifestations of grief and loss in children and adolescents.

Defining Grief and Loss

Defining grief and loss is very difficult because a sense of loss is very personal and idiosyncratic. Since there are many different definitions of grief, we challenged our students to come up with an all- encompassing definition of grief and loss. We were impressed with their definition:

Grief is an inevitable, never-ending process that results from a permanent or temporary disruption in a routine, a separation, or a change in a relationship that may be beyond the person’s control. This disruption, change, or separation causes pain and discomfort and impacts the person’s thoughts, feelings, and behaviors. Although loss is a universal experience, the causes and manifestations of it are unique to each individual and may change over time. (Fiorini & Mullen, 2006, p. 10)

This definition suggests that grief and loss occur not only as a result of an end to something (a death, end of a relationship) but also as a result of a change or disruption in the person’s life (moving, divorce). This accurately implies that even what we might consider to be happy events in our lives, such as going to school, getting married, and graduating from high school, are life-changing events that can and often do produce feelings of grief and loss. Our definition of loss also suggests that what is considered to be a loss is unique to each person and that grief can be expressed in an infinite number of ways. It is important to view grief as a normal and natural reaction to loss, not as a pathological condition. Although grief is often equated with a feeling of sadness, it is more realistic to view grief as a process which is expressed in thoughts, emotions, behaviors, and physical sensations.

In relation to children, we very often expect certain events in a child’s life to be exciting or happy when in actuality the child responds with fear and anger. For instance, parents might assume that moving to a nicer, larger home within the same school district would be a rather exciting, positive opportunity for their child since the disruption would seem, from their perspective, to be minimal. Therefore, when the child responds with anger or sadness the parents are dumbfounded.

Mourning

Mourning used to commonly be seen as a task that required detaching from a lost loved one or object. For example, Worden (1991) defined mourning as a “process of separating from the person who has died and adapting to the loss” (p. 10). More recent definitions suggest, however, that mourners do not just move on and relinquish the relationship to the lost person, but continue to have a relationship with the lost person or object throughout their lives (Webb, 2002). This approach is a much more hopeful and satisfying one for counselors who work with children and adolescents who have experienced grief and loss. Instead of insisting that the children work through and “get over” their feelings of grief, counselors are able to help children and adolescents redefine their relationship with their lost loved one or object and hold on to meaningful memories.

Types of Losses

Children and adolescents experience a wide variety of losses throughout their lives such as death, divorce, moving, parental job loss, parental military deployment, breakups, changes in friendships, school transitions, birth of a sibling, or even natural disasters. Parents and other caregivers often feel particularly helpless in trying to help a child or adolescent who has experienced loss. They are confused as to what to say and how to react. They are torn between the urge to protect their child and the desire to be honest with them. In addition, parents and even counselors tend to focus on the presenting loss without examining the hidden or intangible losses that surround the presenting loss that are often most troubling to the child. Examples of intangible losses include loss of trust, safety/security, control, stability, and/or support.

Manifestations of Grief and Loss in Children and Adolescents

Emotional Manifestations of Loss

The grief and loss experiences of children and adolescents are often demonstrated emotionally. Regardless of the type of loss, the child may experience feelings of emptiness, anger, confusion, desertion, and insecurity. In addition, he or she is almost certain to feel responsible, and guilty, about the loss he or she has experienced (Mack & Smith, 1991). According to McEntire (2003), children express guilt about remembered misbehavior or missed opportunities to express affection. Even the normal developmental tasks of adolescence with regard to rebelliousness and withdrawal from the family may prompt guilt feelings after the death of a loved one. Often adolescents feel that they should have spent more time with the loved one, not gotten angry with that person, or told the individual that they loved him or her. Children and adolescents may also feel that somehow they were responsible for the death and will often become anxious over the safety of other loved ones or themselves (Glass, 1991).

Cognitive Manifestations of Grief and Loss

It is helpful to view cognitive reactions to loss through a developmental lens. Emswiler and Emswiler (2000) concluded that prior to age 3, babies may sense an absence among those in their immediate world and miss a familiar person who is gone, but they are unlikely to understand the difference between a temporary absence and death. A preschool child may talk about death but may still expect the person to come back. Before age 5, most children do not realize that all people, including themselves, will die. By age 9 or 10, however, most children have developed an understanding of death as final, irreversible, and inescapable (Emswiler & Emswiler, 2000; McEntire, 2003; Worden, 1996).

After a significant loss, older children or young adolescents often will feel helpless and frightened. They may want to retreat to childhood, where they had a sense of protection from death or loss, but they often feel a compulsion by social expectation to act more like an adult. Therefore, they may suppress their emotions (Glass, 1991). Since adolescents function in the Piagetian stage of formal operations, theoretically, teens should be capable of abstract and formal thinking, problem solving, and deductive reasoning. At this age, adolescents can comprehend concepts of death, which serve as a vehicle for more in-depth spiritual and conceptual thought (Schoen, Burgoyne, & Schoen, 2004).

Behavioral Manifestations of Grief

The inability to handle grief feelings may result in angry outbursts, irritability, sleeping and eating disorders, and persistent questioning about the details of death. Other frequent expressions of grief in childhood and adolescence may include fear of personal fallibility, psychosomatic ailments, difficulties with schoolwork, nightmares or sleep disorders, changes in eating patterns, temporary regressions, and shock (Schoen, Burgoyne, & Schoen, 2004). Those with no notion of the irreversibility of death may want to “visit” a loved one. In adolescents, specifically, expressions of anger give them a sense of power to counteract their feelings of helplessness and fright (Glass, 1991). It is crucial to assess for suicidal risk in both children and adolescents who have experienced loss.

Disabling Grief in Children

Not all children who experience loss become disabled by it. We often assess complicated grief in terms of time, but disabling grief is not dependent on time but on how intrusive it is in the child’s life. Can the child carry out his or her usual activities? Can the child proceed with normal developmental tasks despite the grief? If the answer is “No,” then the child may be experiencing disabling grief. Symptoms of disabling grief include prolonged shock and numbness long after most grievers have returned to daily activities; continued denial many months after the loss; prolonged bodily distress; persistent panic; extended guilt; increasing idealization; enduring apathy; and increasing hostility.

Interventions

Dr. Sandra Fox (1985) outlined four tasks that children work through as they mourn a loss. These tasks include understanding, grieving, commemorating, and moving on. One of the first questions asked when a person has experienced a loss is “Why?” During the task of understanding, a child or adolescent seeks to determine what caused the loss and why it happened (Trozzi, 1999). The task of grieving means allowing children and adolescents to experience the painful feelings associated with a loss (Trozzi, 1999). In commemorating a loss, children and adolescents are encouraged to develop a personally meaningful way to affirm and remember the lost person or object. The last task in the process of mourning is the task of going on. During this task children and adolescents discover new ways to “maintain an inner connection with and representation of the deceased as they develop other friendships, attend school, play, and perform all the things that shape their daily lives” (Trozzi, 1999, p. 67).

We have found several interventions to be useful in helping children and adolescents tackle the tasks of mourning that they are faced with. Activities such as using loss genograms; play therapy; narrative therapy, such as a “Letter to Loss”; art therapy, such as drawing a picture of “What happens when someone dies?”; or assisting the child or adolescent to commemorate the loved one or object by creating a CD, tape, journal, or scrapbook are just some of the interventions we have found to be effective with this population.

Summary

As a society we have not done an effective job of helping our children and adolescents through their grief and loss experiences. Our children are hurting because we are reluctant to confront issues of loss within ourselves, let alone within children. Helping children through their loss experiences requires that we actually accept that children feel grief and are bright and capable enough to understand many aspects of loss. In the name of protecting our children we keep information from them and deny them the opportunity to feel their grief. Counselors have an opportunity to play an important role in assisting parents and other adults in understanding the way grief and loss manifests in children and adolescents, helping them to provide comfort and support to their children, and providing them with useful interventions that will allow their children to work through their feelings of grief without minimization or denial.