[This is a little long for a blog. Perhaps you want to improve on it or comment.] One of my colleagues asked for info regarding response to/from a three year old. Here’s my response:
Hi Bev,
As I mentioned, there is not too much material for helping 3 year olds and death of a loved one, and I would like to receive any better information that you get. I was always amazed at how differences appeared quickly, for we know a 3 year old has a different perception from the usual 4 - 5 year old, and of course quite distinct from a 7 year old. The behavioural/ language development of the 3 year old is rapid, moving into various forms of representation.
Loss to a child is significant - any kind of loss. A child, even a three year old, may act more profoundly to death than an adult. "When children between the ages of two and five are distressed by a loss, they are even more likely to blame themselves for the death because of their imagined 'badness.' As a result, they are particularly vulnerable to failure to mourn adequately." The importance of addressing the death at the child’s level is that if it is not done, then they may have difficulty in forming intimate relationships when they are adults (and may become depressed too). But that’s getting a little deep for what you want, perhaps. Just wanted to indicate the importance of responding to this scenario. Compounding the situation is the view of researchers that children ages 3 - 5 simply do not understand the meaning of death. Add to that the sadness of the grieving of others around the child, the cocktail of suppression and non-understanding can be difficult for the healing of the child.
The meaning of death for the three year old is only understood in degrees. You know that the child cannot conceive of "forever". They think that death is reversible (like the cartoons and TV). Yet they are very sensitive to the emotional climate in their home. Regressive behaviours (clinging, toilet issues, outbursts) can likely occur.
Mary Lou and I have a list which may help a child, although we acknowle that three is a young difficult age.... 1. Tell the truth (the person’s body has stopped working). 2. Let the child share in the grieving. 3. Assure the child of the comforting presence of an adult "You are not alone." 4. Relieve the child of self blame - "This is not your fault" 5. Avoid euphemisms (even for a 3 year old) - lost grandpa; - gone to be with God; asleep... 6. Encourage talking about [grandpa]. 7. Have pictures. 8. Don’t prevent or inhibit expressions of feelings (theirs or yours) Kids can sense that. 9. Don’t mind physical expressions (relate to feelings) pounding the pillow, crying, kicking... 10. Sharing tears is important - crying alone is often not enough. 11. Don’t be alarmed, aggressive behaviours serve a function... help the child substitute other behaviours for aggressive behaviours. 12. Be honest about your own sadness and grief. 13. Accept the child as is... the anger and questioning will pass. 14. Restore or keep a sense of security - asking where grandad is may be a realization that the world is not controlled by the child. 15. Never use a child for one’s own emotional needs (even at that tender age). 16. Help the child get on with a three year old’s interests.
‘Being with’ is as important as ‘speaking with’.
Here is a mnemonic I picked up and adapted from the book A Physician’s Guide to Coping with Death and Dying (Swanson & Cooper, 2005) Remember the C H I L D
* C is for CONSIDER. Treat the child as unique, and not as any child or a little adult. The child has a special relationship to the person who died, especially a grandparent.
*H is for HONESTY. Children can sense when adults are avoiding issues. Even with small children, use the word death, and do not avoid the difficult questions. Where is Grandpa?
*I is for INVOLVE. Although it is late for this situation Bev, suggest they involve the child in the rituals of grief - remembering grandpa at family grace, being thankful for how nice he was, showing pictures.... Do not neglect the child when others are continuing their grief and celebrations.
*L is for LISTEN. Never cut the child off, even when the topic is difficult to discuss (or understand). Adults can help children to identify some of their feelings, including anger and sadness - through drawing for example. Be alert to give assurance that the little one’s thoughts or actions did not cause the sickness or death.
*D is for DO IT OVER AND OVER AGAIN. When parents and adults talk with their children honestly, and as often as necessary, about death and their honest emotions, children learn to deal with their own ‘grief’ - loss. BTW, it also helps the adults in their grieving I think!
(I adapted the following from both Karen Carney, creator of the Grief Education and Support Series, and from the "Crisis, Grief and Healing" website: www.webhealing.com)
Noted child psychologist Alan Wolfelt has said, "Anyone old enough to love is old enough to grieve." Children, then, also need avenues for expression of their fears, sadness, guilt and anger. Their grief response will not "look" the same as an adult. They behave differently in terms of overt reactions. They may appear as though they are disinterested or don't understand the significance of what has happened.
A [child], upon being told that her mother would soon die from metastatic cancer, responded by asking, "When we go to dinner tonight, can I order extra pickles?" She was sending a message that she had "heard enough" for that moment. This child served as the family's "pressure release valve" and would frequently try to lift the mood when it became heavy. To someone unfamiliar with the grief of children, her reaction may have seemed uncaring, or that she did not understand what was being said. Children do grieve in their own way and in their own time.
When a child-centered, age-appropriate explanation and opportunity for commemoration and expression is absent, there may be adverse consequences. A mother was very concerned about her 3 year-old daughter. The child's grandmother died the previous month and the child did not participate in any of the commemorative rituals. The mother explained that she had consulted with the child's pediatrician, who told her that 3 year-olds are too young to attend, because 3 year-olds don't understand death(!) Since Grandmother's death, the little girl had been afraid to go to sleep, and when she did fall asleep she experienced nightmares. During the day she was uncharacteristically anxious and clingy.
Fortunately this child is remarkably resilient, as are most young children. The problem was corrected by offering simple, direct, child-centered, age appropriate explanations. She was told what happens to the body upon death (it COMPLETELY stops working, etc.) and she was also given an explanation of the type of ritual that the family chose based on their religion and culture. She responded by sleeping well, having no more nightmares, and returning to her usual outgoing behavior.
While it is true that 3 year-olds don't understand that death is permanent, final and irreversible, they do understand that something terribly sad has happened. They will miss the presence of people who have died, and they will worry about the sadness they feel around them. Lying to children or hiding the truth increases their anxiety. You can't fool them -- they are remarkably perceptive. When children (of any age) are not given a proper explanation, their incredible imaginations may create images of dead loved ones being buried alive, gasping for air and trying to claw out of the ground. In the case of cremation, they may imagine their loved one being burned alive and suffering horrifically.
Egads Bev, what we put kids through, eh? Or, what they put us through - making us honest!
With warm regards,
David.
Dr. I David Morrison
Cancer Treatment Centre &
Integrated Palliative Care Team
Charlottetown.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment