My Child Lost a Parent/Sibling/Pet Etc. How Can I Best Support Them?

I just want to take their pain away.

Shockingly, approximately 1 in 12 children experience the death of parent or sibling before age 18. But it is important to note that grief or loss is not limited to death, it can also be parental or sibling incarceration, deportation, or even deployment. The circumstance of the loss impacts outcome significantly, age of child, development change, caregiver environment.  American culture generally tries to protect children from exposure to death when young but other cultures like Mexican celebrate and embrace death openly from a very young age, such as dia de los muertos (day of the dead). Research showed that families of color tend to have more open communication and intergenerational support surrounding death. Sadly, death in family occurs at a higher rate in marginalized populations, especially communities of color, which can be especially hard to accept and cope with if systemic racism or discrimination resulted in the death. Recently, prolonged grief disorder was introduced in the DSM-5 and ICD-11; however, as a newer diagnosis there is reduced awareness and research with limited reliability and validity. As it stands, prolonged grief disorder is diagnosed when a child is “atypically preoccupied with the death after more than 6 months with continued denial, dissociation, and withdrawal, exceeding cultural norms.” However, there has been much debate about whether prolonged grief disorder is a valid diagnosis, especially given the significant range of reactions and ability to process loss in children. Moreover, the idea of the 5 stages of grief, is generally not applicable, especially with children. This model is thought to be outdated and was actually intended for people facing death themselves, not those who experience the death of another person. Real grief is generally non-linear with regressions and progress.

Children experience a unique form of grief. Children often grieve in atypical patterns, grief can come out of nowhere. Children often feel lonely, panicked, confused, guilty, angry, and experience physical pain. Some children will react poorly to being comforted physically or verbally and may react poorly to silence and want company/want to be busy. Some children will try to take on interests and personality of deceased, can be healthy to an extent. Many accomplishments are in the context of the deceased parent/sibling, anticipated wishes/reactions. Many children will develop new concerns and fears that weren’t present prior. For example, some may develop acute fear of doctors/hospitals/illness as a result if their parent/sibling was medically ill. For some children, they may be significantly more affected by the death of a peer than a grandparent, because of proximity, relevance, and importance of support. With siblings and especially twins, many have expressed that it feels part of themselves have died. Children may also experience survivor’s guilt if their sibling passes, not understanding why they were left alive and well. Some children may feel comfort in knowing their parent/sibling is no longer in physical or emotional pain. Some children fear losing memories of their sibling will perseverate on what life “would have been” without the death. Some children may take out/project anger or sadness on peers and engage in “bullying” Some children perseverate on fixing and saving others in their life. Some children may persist in denial and create “imaginary siblings/parents.” Many children experience emotional pain anytime someone asks them if they have siblings. Children may be triggered by mothers day/fathers day, father-daughter dances, birthdays etc. Some children receive attention they don’t want/ understand if they are reserved and private, people in their home, shiva etc., need place to escape. It is important to note that kids can be just as affected even if the parent wasn’t living in home or they had inconsistent relationship.

Death causes significant disruption to life as they know it, practically and emotionally. From a functional sense, Some children may experience a change in living situation, where or who they are living with. Additionally, the loss can provide financial stress which may further complicate things. Children may need to adjust to new roles of family members after the others passing, which can be especially hard for children with less support/tradition. Children tend to develop a context for death, whether religiously or scientifically based, or both, neither right or wrong. Some children feel comforted by the presence of god, while other feels uncomfortable or confused.

For young children specifically, the are some special factors to consider. Children can experience grief from as young as 3. Children tend to re-process loss as they progress through developmental stages. Children may ask a number of questions about the body, heaven, and reality of dreams, how to prevent death, causes of death, who is to blame, and the meaning of death. Many young children struggle with the comprehension of the permanence of death, but will learn and understand about the concepts of finality, inevitability and causality over time, meaning understanding that death happens to everyone, is caused by certain factors, and is permanent in nature. Many experience a “removal of innocence” and perpetual fear of unpredictability. Young children may worry about their sibling’s afterlife experience (e.g., what is it like in heaven, where are they, feeling sad they are alone in the ground, etc.). Some children will blame themselves and think they caused the death of their parent or sibling. Some young children who lose a parent will wish to be dead with them, Young children may wait for parent to return even after explanation. Children often have unusual and selfish requests/reactions and some may even regress to thumb sucking or bedwetting, language loss, irritability, and excessive tantrums.

For most neurotypical children, a deeper understanding of death comes around age 9. For example, a child may realize in middle/high school that they won’t have their dad to walk them down the aisle or be present for other milestones. Adolescents often turn to peers after the loss of a close family member, especially if they are tasked with many adult responsibilities with limited explanation. While some older children may feel weird or different from their peers. Though resilient, children are often impacted long-term by death of a family member. Unfortunately, those who experience grief in childhood are at higher risk for depression, anxiety, PTSD, and prolonged grief disorder, which is why processing and supporting these children immediately is so critical. Studies have shown that those who lost a sibling in childhood experience: poor interpersonal relations, poorer academics, increased substance use, increased car accidents, increased nightmares/night terrors, and increased illness anxiety. Children who lose someone due to traumatic circumstances tend to have higher levels of guilt/shame, anxiety, suicidal ideation, and substance abuse.

Not surprisingly, children generally look to parents to model how to grieve and cope with emotional pain, though interestingly, children can generally compartmentalize better than parents. Some children will feel suffocated by parents if they are the surviving child, because of attention, dependency, increased protection. Some may feel alone because parents withdraw or become self-destructive and children feel neglected, which can lead to increase risk for psychiatric disorders. “Ambiguous Loss” is also common, which refers to the perceived partial loss of someone, for example a parent who has lost a child and is alive but distant. As a result, the surviving children experience more difficulty grieving and some feel they don’t have permission to grieve/mourn. Disenfranchised grief occurs when the loss is not or cannot be openly acknowledged, publicly mourned, or socially supported. Some feel they are not allowed to talk about their sibling who passed. In fact, 62% never discussed the passing directly with their family. As a result, some children try to turn into the “perfect” child, essentially becoming similar to pressures experience by glass children, because they are “not allowed” to upset parents.

And now to the ways in which parents and professionals can support children who have experienced loss. From an emotional perspective, it is important for child to address and process grief ASAP after the death. Children need to be given the truth, but in a developmentally appropriate way. It is important to use the word death/died and not beat around the bush. Try not to only use “passed away” or “gone with god”, “in a better place”, which can be confusing and upsetting for some children. You may also need to be careful about using the word “body”, as some children may think head or other parts are separate. It is also helpful to differentiate between “deathly or terminally ill/sick” vs. everyday sickness, so they do not worry about others dying from mild ailments. DO NOT tell child, they have to be good, are the man/woman of the house, or the person was taken because they were “special.”  Children also need an identity aside from “so and sos” daughter/son/sibling. Keep in mind your child’s emotional profile, interests in how you choose to explain death. If there is a murder or suicide of parents/sibling, give information and be truthful but without unnecessary details of the passing. It is important not to keep suicide a “family secret.”

It is crucial for children to be able to say “goodbye” in some capacity. Explain the rituals of a funeral to the child ahead of time, Allow child to help plan funeral and honor parent/sibling In most circumstances it is beneficial to bring the child to the funeral/memorial with boundaries and support, but don’t force if they really don’t want to go, Sometimes they need to see body or casket to bring reality and “closure” to it, make sure child doesn’t find out about family members death from someone outside the immediate family, try not to co-sleep long-term with child, may be helpful immediately after but need to break pattern quickly. It is also a good idea to ask the child what they would like to share with their teachers and peers about their loss. Older children often want a friend with them during funeral processings and other events surrounding the death. Connecting with peers who have lost someone can be comforting and validating. Healthy coping includes acts of good service in honor of the deceased person and/or trying to prevent similar death in others.

It is important that the child knows the death wasn’t their fault and that it is ok to cry and feel angry. Anger needs to be released, don’t punish anger unless they harm others. Some will experience emotional pain somatically and need this pain to be validated. If they perseverate on fear of death of others, explain unlikely but try not to over-reassure. Be mindful that children may be triggered by mothers day/fathers day, father-daughter dances, birthdays etc. It can be helpful to explain to child that everyone’s grief does usually get easier to cope with over time. You can offer children a way to continue to communicate with the deceased. Some children feel comfort in visitation dreams from the deceased, in which case you can encourage discussion and validate. It is also helpful to maintain routine, consequences,  and return child to school as well as provide different outlets for children to express emotions. Try to show your child how death can also lead to bonding and happy memories. You may keep memories of the deceased alive for the child, scrapbooks, movies.

The death of a pet in early childhood can be an opportunity to help young children understand death and learn to cope with loss. As a parent or family member, don’t try to be or take on deceased spouses role for child. Teachers and clinicians can be essentially because not emotionally involved, Instances in which school staff are either to passive or too aggressive in response, need to know child’s wants and needs, need training for school staff on grief/loss. Children are sometimes more likely to open up to a teacher they know and trust and may feel more comfortable because they are not sad and affected by the death. There are many children’s books about death that are real and honest are most helpful. Grief support groups and camps can be very helpful for children. Parents themselves need to ensure they are receiving appropriate mental health care in order to best care for their children. Some behaviors that might indicate potential concern include: social withdrawal, not wanting to leave the home, not talking to family/friends, not eating, and/or frequent nightmares. Children had better outcomes when they: expressed emotions, used active coping strategies, had increased self-awareness, were in a supportive, encouraging, and compassionate environment, and had limited exposure to additional stress. In terms of psychotherapy specifically, Multidimensional Grief Therapy and Trauma and Grief Component Therapy, Family Bereavement Program all teach healthy coping skills to the child and their parents and support the child’s continued growth and identity. Therapy has been shown to be very protective in terms of PTSD, weekly sessions best post-loss, helpful is caregiver involved. Some other helpful resources have included: The Dougy Center, national alliance for children’s grief, shared grief project, Judi's house at JAG Institute, and the coalition to support grieving students.