Handbook for Mortals : Enduring Loss : How to comfort a child

Speak in simple language the child can understand. Ask the child what he thinks, knows, and feels, and respond specifically to those concerns. Don’t overwhelm the child with excessive detail and be sure to see how the child is putting it all together.

Be honest. Avoid half-truths. Don't tell a child something you will need to correct later on. For example, when the child insists that "Mommy will be back in the spring... like the flowers," don’t, out of compassion, agree. Instead, you can say something like, "That would be nice, wouldn’t it?"

Even the clumsiest statement is better than not discussing the loss at all. Children are quite aware when they are being shut out of a tragic event. They will judge correctly when a topic is taboo in a family setting and close off communication with adults. When this happens, angry outbursts, irritability, and changes in eating and sleeping habits will offer a clue that the child is suffering in his or her own private way. Remember that a child's imagination often creates more frightful images than reality ever could.

Expect expressions of anger -- at God, at the lost loved one, at the surviving parent, at the doctors, at anyone in their sight. They can also turn the anger inward on themselves. Because children believe in magic, they sometimes believe that they caused the death because they were "mad" at the parent or other person who died.

Watch children at play. This will offer you valuable clues, particularly with a very young child. One of the many ways children can express their feelings when they cannot express them verbally is by acting them out with dolls or toys. Listen to the stories they make up, in words or in play. You can then encourage memories of the good times and also provide alternative ways of understanding the bad things they remember.

Don't be upset if, after a clear explanation of what happened, children appear to toss it off -- seeming cold -- and go about their normal activities. It takes time for children to deeply internalize "bad news."

Expect the hard questions to come up eventually, perhaps many months later. Prepare yourself with answers because these questions will express the child's deepest fears. The four central questions are: "Did I cause Papa’s (or Grandma’s or Grandpa’s) death?" "Will I die, too?" "Are you going to die, too?" "If you die, too, who will take care of me?"

Include grieving children in events that precede and follow a death. Help a child to say goodbye in the hospital, to attend the funeral service, and to participate in rituals with the family. They can cope with most situations, provided they are given appropriate choices, are prepared for what to expect, given opportunities to talk it through, and supported emotionally. Simple ceremonies such as lighting a candle next to a photograph; placing a letter, picture, or special memento in a casket; or releasing a helium balloon with a message attached for the person who has died are effective leave-taking gestures.

Allow for the expression of emotions. The child may cry or may not. Adults can let their own tears flow, too. Children will find their own way, but they will look to adults, too, for some examples to follow.

Older children, especially adolescents, may need help to express their grief, especially over the loss of a parent. Adolescence is a difficult enough passage, and grief adds layers of complexity and emotion. Address a teenager’s needs early and often, and ask your child’s school for help or guidance.

Use books, TV, and movies, too. Many wonderful after-school specials and prime-time programs deal with the death of a parent, grandparent, sibling, or pet. The Yearling, All the Way Home, and Death Be Not Proud are available for rent. Among the many wonderful books written for children is Badger’s Parting Gifts by Susan Varley. Old Badger dies, leaving a note for his friends: "Gone down the Long Tunnel. Bye Bye, Badger." His friends -- the mole, fox, and rabbit -- talk about the things each learned from Badger, realizing that he has left them many good memories and abilities. This book can help you talk to a child about an older relative who is dying, or about anyone in the child's life who has died. Many communities offer special grief programs to provide support for children who are dying or whose parents or siblings have died. Such programs are frequently coordinated through local hospices, religious institutions, and Internet support groups. Some focus on losses through violence, AIDS, or other particular illnesses.

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Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.
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