Hospice Focus: Helping Children Deal with Grief

As we saw in the May 2009 issue of Insight for Caregivers, when we lose a person we love, grieving is the way we move toward healing. This month, hospice staff offer some important things to know if you are helping a child who is dealing with the final illness and loss of a loved one.

It is important to recognize the emotional process the child is experiencing, not only when his or her loved one passes away, but also near the end of the person's life. Here are some things we know about the grief process of young people:

Children re-grieve. They work through their grief in cycles. Each time a new developmental milestone is attained, children will integrate and use their newly acquired skills to gain further understanding of their grief. The child's history of loss and coping strategies, as well as the child's age and developmental stage, will affect the child's re-grieving experience.

Children are often repetitive in their grief. By asking the same questions over and over again, they are able to come to terms with their grief. Answering a child's repeated questions with the same information gives the child a sense of stability, constancy, and trust in their relationship with you.

Children grieve as part of a family. When a loved one is diagnosed with a terminal illness, it affects the way in which the family functions. Family roles and responsibilities may adjust to accommodate the new needs in the family structure. Children may grieve not only for the dying loved one, but also for the secondary losses which result, such as changes in routine, decreased attention from parents, or increased individual responsibilities.

Young children are concrete thinkers. Adults frequently use euphemisms (the substitution of a "good" term in place of one considered "bad") when describing death or dying to soften the blow of this harsh reality. Adults need to be careful when using euphemisms, so that children aren't even more scared or further confused. For instance, if an adult says, "We lost Grandma today," a child may want to know why people aren't looking for her. A child may also wonder, "If I get lost, will anyone come looking for me?" Similarly, an explanation like "Dad is sleeping peacefully now" may create in the child a fear of sleeping.

Providing a safe environment for children to experience loss.

Children need clear and honest information about their loved one's diagnosis (cause of illness) and prognosis (prediction of the outcome of the illness) at a level which they can understand.

• Include children in discussions of the patient's condition, changes in health status, and if relevant, the signs and symptoms of approaching death.
  
  
• Encourage children to express their feelings directly. Talk with them about their perceptions and understanding of what is happening with their loved one. Acknowledging your own feelings lets your children know it is okay to experience and express theirs.
  
  
• Offer choices whenever possible. For instance: helping with caregiving at an age-appropriate level; attending the funeral service; viewing the body; participation in good-bye rituals or symbols.

If you are working with hospice, the staff can help you help the children in your life during this emotional time.