Sickness & Death
Death with Dignity Act
Talk with Your
Kids about Sickness & Death
Because HIV/AIDS is so prominent in our society, it deserves special mention. Research shows that as many as 93% of children have already heard about AIDS by the third grade. Even though they hear about it at school, on the news, or in the media, what they learn is often inaccurate and frightening. Using a news report to initiate a conversation about HIV/AIDS is a great way to find out what your child already knows about the disease and gauge how much this topic frightens them. Above all, make sure your kids understand the facts of how you get AIDS and how you don’t. You may need to research this information for yourself. Be prepared to talk about sex when you talk about HIV/AIDS. Don’t shy away from conversations about death either. Conversations with kids about death can be extremely difficult, but they are so important. Helping children understand death may arm them with the skills they need to cope and grieve effectively when someone they love dies. Finding the right words to describe death to a young child can be challenging. Explaining the physical aspects of death can be done by simply saying “his body was so injured or so full of disease that it quit working. The doctors tried the best they could to fix him, but they just couldn’t.” Explaining the spiritual side of death depends on your religious beliefs and can be explained to children accordingly. Children need to be assured that death
is not the end—that love never dies. Just because the
person is no longer living, doesn’t mean we don’t
still love them. How to Talk to Your
Children About Death
1. Don't lie to a child, you are just teaching them to lie. Talk straight -- using code words will only confuse them later on. Show them dead plants, flowers and birds. Give a brief summary of what death is and the "circle of life." Show them movies like the "Lion King," it's a little less traumatic than Bambi. "All Dogs go to Heaven" may work well too if your family believes in the afterlife, but be aware that it shows the main character returning from the dead. (Only show movies like this if your children are old enough to comprehend the fact that the dead won't come back.) Discuss with them what your beliefs are, and a good rule of thumb, if they are old enough to ask the question they are old enough to get an answer. 2 Use real-life situations. When they overfeed their goldfish, and you find him belly up, don't flush him down the toilet and run out to the store to buy another. First, get them ready: "Ashley ,what happened to all Mr. Puddles's fish food?" Then will come the always expected "I don't know?" "I think you fed him too much and he went to fishy heaven." (Editor: This blames the child for "killing" their goldfish. Maybe it died of natural causes. Don't blame unless you are positive, beyond a shadow of a doubt. And even then, I wouldn't use this situation as a teaching moment about over-feeding a pet. It would be more helpful to point out that the dog or cat are getting too fat and why that might be and what to do about it.) 3. Explain what has happened and why we need to do the right thing for Mr. Puddles or he can get sick. Feed him the right amount of food, keep his bowl neat and clean, keep him where the cat can't get to him and eat him. 4. Explain that accidents can happen; this also helps to teach kids that we need to be careful, and alert because of things called accidents they happen when we are not paying attention to things going on around us. Like playing ball in the bedroom and it knocks the fish bowl over. 5. Ask the child what they feel, and
how the passing has affected them emotionally. Get them to
express their feeling by drawing a picture. Children need to
learn to show others the way they feel and it should be
encouraged, and it will help them to deal with such things
better when they are older. Sometimes it hard to deal with
grief, when you are not taught how. How Should I Talk
to My Child About Death?
If a parent tells a child whose sibling has died that the sibling is sleeping, the child may expect the sibling to wake up. If the parent says the sibling will not wake up, the child may fear going to sleep and not waking up. Though the words are difficult to say, professionals agree that parents should use terms like "die," "dead," and "dying." If parents cannot say these words, the palliative care team can help explain as much as the parents want their children to know. How Do I Break Bad News to My Children? Maintaining open communication with children from the time of diagnosis onward lessens the likelihood of suddenly surprising a child with bad news later on. Keeping children up to date at every stage of treatment can make breaking bad news easier. When a child has been following the progress of treatments, a parent or palliative care professional can say something similar to, "Remember the medicine we hoped would make you better? It's not doing what we hoped it would do." Still, it won't be easy to start the conversation. Social workers and child life specialists recommend a number of resources -- such as story and activity books -- that may help break the ice and help explain difficult concepts. Professionals also encourage parents to use children's questions as opportunities to start a conversation. What Should I Expect? When a family member has a life-threatening condition, frequently children will ask questions. The older they get, the more specific their questions will be. As teenagers, they may even be the ones guiding the conversation. Although the answers to their questions may bring bad news, children do not process bad news in the same way that adults do. Parents may be hurt by this. Adults understand the permanence of death immediately, so we respond with tears. Children, especially those under 12, may not understand the permanence of death right away, so they may not have a strong initial reaction to bad news. Children can feel insecure during heavy or serious conversation. They may want to get back to normal as soon as possible. This may mean returning quickly to the game they were playing or the TV show they were watching. This doesn't mean the child didn't hear or understand. Parents can join the child in the activity in order to be there when questions arise. When a child is dying, many parents want the siblings to be at the child's bedside with the rest of the family. Child life specialists will help facilitate this, but they advise parents that siblings may want to leave the room quickly and return to what they were doing before. Parents shouldn't be hurt by this but should understand that this behavior is normal. What Can My Child Understand? Each year of a child's life brings enhanced ability to understand the reality and permanence of death. Infant and toddler siblings of a sick or dying child can feel loss through:
These tips may help manage the feelings infant or toddler siblings of a sick or dying child may have:
3- to 5-year-olds have response that are shaped by the way they see the world:
Tips for helping 3- to 5-year-old siblings cope with their feelings about a sick or dying child:
6- to 9-year-olds have a more evolved sense of dying:
Tips for helping 6- to 9-year-old siblings understand their feelings about a sick or dying child:
10- to 12-year-olds understand the permanence of death:
Tips for helping 10- to 12-year-old siblings of a sick or dying child:
Teenagers understand death with a more personal and long-term view:
Tips for helping teenage siblings of a sick or dying child:
Children can be included in discussions about death and dying, but parents need not do it on their own. Palliative care professionals can help parents decide whether, when, and how to open this difficult conversation. Source: www.webmd.com/palliative-care/talking_to_children_about_death#2 Kids Health - When
a loved one dies
How much kids can understand about death depends largely on their age, life experiences, and personality. But there are a few important points to remember in all cases. Explaining Death in a Child's Terms Be honest with kids and encourage questions. This can be hard because you may not have all of the answers. But it's important to create an atmosphere of comfort and openness, and send the message that there's no one right or wrong way to feel. You might also share any spiritual beliefs you have about death. A child's capacity to understand death — and your approach to discussing it — will vary according to the child's age. Each child is unique, but here are some rough guidelines to keep in mind. Until kids are about 5 or 6 years old, their view of the world is very literal. So explain the death in basic and concrete terms. If the loved one was ill or elderly, for example, you might explain that the person's body wasn't working anymore and the doctors couldn't fix it. If someone dies suddenly, like in an accident, you might explain what happened — that because of this very sad event, the person's body stopped working. You may have to explain that "dying" or "dead" means that the body stopped working. Kids this young often have a hard time understanding that all people and living things eventually die, and that it's final and they won't come back. So even after you've explained this, kids may continue to ask where the loved one is or when the person is returning. As frustrating as this can be, continue to calmly reiterate that the person has died and can't come back. Avoid using euphemisms, such as telling kids that the loved one "went away" or "went to sleep" or even that your family "lost" the person. Because young kids think so literally, such phrases might inadvertently make them afraid to go to sleep or fearful whenever someone goes away. Also remember that kids' questions may sound much deeper than they actually are. For example, a 5-year-old who asks where someone who died is now probably isn't asking whether there's an afterlife. Rather, kids might be satisfied hearing that someone who died is now in the cemetery. This may also be a time to share your beliefs about an afterlife or heaven if that is part of your belief system. Kids from the ages of about 6 to 10 start to grasp the finality of death, even if they don't understand that it will happen to every living thing one day. A 9-year-old might think, for example, that by behaving or making a wish, grandma won't die. Often, kids this age personify death and think of it as the "boogeyman" or a ghost or a skeleton. They deal best with death when given accurate, simple, clear, and honest explanations about what happened. As kids mature into teens, they start to understand that every human being eventually dies, regardless of grades, behavior, wishes, or anything they try to do. As your teen's understanding about death evolves, questions may naturally come up about mortality and vulnerability. For example, if your 16-year-old's friend dies in a car accident, your teen might be reluctant to get behind the wheel or even ride in a car for awhile. The best way to respond is to empathize about how frightening and sad this accident was. It's also a good time to remind your teen about ways to stay safe and healthy, like never getting in a car with a driver who has been drinking and always wearing a seatbelt. Teens also tend to search more for meaning in the death of someone close to them. A teen who asks why someone had to die probably isn't looking for literal answers, but starting to explore the idea of the meaning of life. Teens also tend to experience some guilt, particularly if one of their peers died. Whatever your teen is experiencing, the best thing you can do is to encourage the expression and sharing of grief. And if you need help, many resources — from books to counselors to community organizations — can provide guidance. Your efforts will go a long way in helping your child get through this difficult time — and through the inevitable losses and tough times that come later in life. Mourning the Loss Is it right to take kids to funerals? It's up to you and your child. It's appropriate to let kids take part in any mourning ritual — if they want to. First explain what happens at a funeral or memorial and give kids the choice of whether to go. What do you tell a young child about the funeral? You may want to explain that the body of the person who died is going to be in a casket, and that the person won't be able to talk or see or hear anything. Explain that others may speak about the person who died and that some mourners may be crying. Share any spiritual beliefs you have about death and explain the meaning of the mourning rituals that you and your family will observe. If you think your own grief might prevent you from helping your child at this difficult time, ask a friend or family member to care for and focus on your child during the service. Choose someone you both like and trust who won't mind leaving the funeral if your child wants to go. Many parents worry about letting their kids witness their own grief, pain, and tears about a death. Don't — allowing your child to see your pain shows that crying is a natural reaction to emotional pain and loss. And it can make kids more comfortable sharing their feelings. But it's also important to convey that no matter how sad you may feel, you'll still be able to care for your family and make your child feel safe. Getting More Help As kids learn how to deal with death, they need space, understanding, and patience to grieve in their own way. They might not show grief as an adult would. A young child might not cry or might react to the news by acting out or becoming hyperactive. A teen might act annoyed and might feel more comfortable confiding in peers. Whatever their reaction, don't take it personally. Remember that learning how to deal with grief is like coping with other physical, mental, and emotional tasks — it's a process. Nevertheless, watch for any signs that kids need help coping with a loss. If a child's behavior changes radically — for example, a gregarious and easygoing child becomes angry, withdrawn, or extremely anxious; or goes from having straight A's to D's in school — seek help. A doctor, school guidance counselor, or mental health organization can provide assistance and recommendations. Also look for books, websites, support groups, and other resources that help people manage grief. Parents can't always shield kids from
sadness and losses. But helping them learn to cope with them
builds emotional resources they can rely on throughout
life. HOSPICE -
Helping Younger People Cope with Death and Funerals
If you are concerned about discussing death with your children, you’re not alone. Many of us hesitate to talk about death, particularly with youngsters. But death is an inescapable fact of life. We must deal with it and so must our children; if we are to help them, we must let them know it’s okay to talk about it. By talking to our children about death, we may discover what they know and do not know - if they have misconceptions, fears, or worries. We can then help them by providing needed information, comfort, and understanding. Talk does not solve all problems, but without talk we are even more limited in our ability to help. What we say about death to our children, or when we say it, will depend on their ages and experiences. It will also depend on our own experiences, beliefs, feelings, and the situations we find ourselves in, for each situation we face is somewhat different. Some discussions about death may be stimulated by a news report or a television program and take place in a relatively unemotional atmosphere; other talks may result from a family crisis and be charged with emotions. This pamphlet cannot possibly deal with every situation. It does provide some general information which may be helpful—information which may be adapted to meet individual needs. Children are Aware Long before we realize it, children become aware of death. They see dead birds, insects, and animals lying by the road. They may see death at least once a day on television. They hear about it in fairy tales and act it out in their play. Death is a part of life, and children, at some level, are aware of it. If we permit children to talk to us about death, we can give them needed information, prepare them for a crisis, and help them when they are upset. We can encourage their communication by showing interest in and respect for what they have to say. We can also make it easier for them to talk to us if we are open, honest, and comfortable with our own feelings - often easier said than done. Perhaps we can make it easier for ourselves and our children if we take a closer look at some of the problems that might make communication difficult. Communication Barriers Many of us are inclined not to talk about things that upset us. We try to put a lid on our feelings and hope that saying nothing will be for the best. But not talking about something doesn’t mean we aren’t communicating. Children are great observers. They read messages on our faces and in the way we walk or hold our hands. We express ourselves by what we do, by what we say, and by what we do not say. When we avoid talking about something that is obviously upsetting, children often hesitate to bring up the subject or ask questions about it. To a child, avoidance can be a message - “If Mummy and Daddy can’t talk about it, it really must be bad, so I better not talk about it either.” In effect, instead of protecting our children by avoiding talk, we sometimes cause them more worry and also keep them from telling us how they feel. On the other hand, it also isn’t wise to confront children with information that they may not yet understand or want to know. As with any sensitive subject, we must seek a delicate balance that encourages children to communicate - a balance that lies somewhere between avoidance and confrontation, a balance that isn’t easy to achieve. It involves:
Perhaps most difficult of all, it involves examining our own feelings and beliefs so that we can talk to them as naturally as possible when the opportunities arise. Not Having All the Answers When talking with children, many of us feel uncomfortable if we don’t have all the answers. Young children, in particular, seem to expect parents to be all knowing - even about death. But death, the one certainty in all life, is life’s greatest uncertainty. Coming to terms with death can be a lifelong process. We may find different answers at different stages of our lives, or we may always feel a sense of uncertainty and fear. If we have unresolved fears and questions, we may wonder how to provide comforting answers for our children. While not all our answers may be comforting, we can share what we truly believe. Where we have doubts, an honest, “I just don’t know the answer to that one,” may be more comforting than an explanation which we don’t quite believe. Children usually sense our doubts. White lies, no matter how well intended, can create uneasiness and distrust. Besides, sooner, or later, our children will learn that we are not all knowing, and maybe we can make that discovery easier for them if we calmly and matter-of-factly tell them we don’t have all the answers. Our non-defensive and accepting attitude may help them feel better about not knowing everything also. It may help to tell our children that different people believe different things and that not everyone believes as we do, e.g., some people believe in an afterlife; some do not. By indicating our acceptance and respect for others’ beliefs, we may make it easier for our children to choose beliefs different from our own but more comforting to them. Overcoming the Taboos Death is a taboo subject, and even those who hold strong beliefs may avoid talking about it. Once death was an integral part of family life. People died at home, surrounded by loved ones. Adults and children experienced death together, mourned together, and comforted each other. Today death is lonelier. Most people die in hospitals and nursing homes where they receive the extensive nursing and medical care they need. Their loved ones have less opportunity to be with them and often miss sharing their last moments of life. The living have become isolated from the dying; consequently, death has taken on added mystery and, for some, added fear. Many people are beginning to recognize that treating death as a taboo does a disservice to both the dying and the living, adding to loneliness, anxiety, and stress for all. Efforts are underway to increase knowledge and communication about death as a means of overcoming the taboo. Scientists are studying the dying to help the living better understand how dying individuals experience their approaching deaths. Children’s perceptions also are being studied for a better understanding of how they think about death. Researchers have found that two factors seem to influence children’s conception of death - their developmental stages and their experiences [their environments, ethnic, religious, and cultural backgrounds, and their personal way of seeing things]. Developmental Stages Studies show that children go through a series of stages in their understanding of death. For example, preschool children usually see death as reversible, temporary, and impersonal. Watching cartoon characters on television miraculously rise up whole again after having been crushed or blown apart tends to reinforce this notion. Between the ages of five and nine, most children are beginning to realize that death is final and that all living things die, but still they do not see death as personal. They harbor the idea that somehow they can escape through their own ingenuity and efforts. During this stage, children also tend to personify death. They may associate death with a skeleton or the angel of death, and some children have nightmares about them. From nine or ten through adolescence, children begin to comprehend fully that death is irreversible, that all living things die, and that they too will die some day. Some begin to work on developing philosophical views of life and death. Teenagers, especially, often become intrigued with seeking the meaning of life. Some youngsters react to their fear of death by taking unnecessary chances with their lives. In confronting death, they are trying to overcome their fears by confirming their “control” over mortality. The Individual Experience While it can be helpful to know that children go through a series of stages in the way they perceive death, it is important to remember that, as in all growth processes, children develop at individual rates. It is equally important to keep in mind that all children experience life uniquely and have their own personal ways of expressing and handling feelings. Some children ask questions about death as early as three years of age. Others may outwardly appear to be unconcerned about the death of a grandparent, but may react strongly to the death of a pet. Some may never mention death, but act out their fantasies in their play; they may pretend that a toy or pet is dying and express their feelings and thoughts in their make-believe game, or they may play “death games” with their friends, taking turns dying or developing elaborate funeral rituals. No matter how children cope with death or express their feelings, they need sympathetic and nonjudgmental responses from adults. Careful listening and watching are important ways to learn how to respond appropriately to a child’s needs. The Challenge of Talking to a Young Child Communicating with preschoolers or young school-age children about any subject can be challenging. They need brief and simple explanations. Long lectures or complicated responses to their questions will probably bore or confuse them and should be avoided. Using concrete and familiar examples may help. For instance, Dr. Earl A. Grollman suggests in his book, Explaining Death to Children, that death may be made more comprehensible by explaining it in terms of the absence of familiar life functions - when people die they do not breathe, eat, talk, think, or feel any more; when dogs die they do not bark or run any more; dead flowers do not grow or bloom any more. A child may ask questions immediately or may respond with thoughtful silence and come back at a later time to ask more questions. Each question deserves a simple and relevant answer. Checking to see if a child has understood what has been said is critical; youngsters sometimes confuse what they hear. Also, children learn through repetition, and they may need to hear the same question answered over and over again. As time passes and children have new experiences, they will need further clarification and sharing of ideas and feelings. It may take time for a child to understand fully the ramifications of death and its emotional implications. A child who knows that Uncle Ed has died may still ask why Aunt Susan is crying. The child needs an answer. “Aunt Susan is crying because she is sad that Uncle Ed has died. She misses him very much. We all feel sad when someone we care about dies.” There are also times when we have difficulty “hearing” what children are asking us. A question that may seem shockingly insensitive to an adult may be a child’s request for reassurance. For instance, a question such as, “When will you die?” needs to be heard with the realization that the young child perceives death as temporary. While the finality of death is not fully understood, a child may realize that death means separation, and separation from parents and the loss of care involved are frightening. Being cared for is a realistic and practical concern, and a child needs to be reassured. Possibly the best way to answer such a question is by asking a clarifying question in return: “Are you worried that I won’t be here to take care of you?” If that is the case, the reassuring and appropriate answer would be something like, “I don’t expect to die for a long time. I expect to be here to take care of you as long as you need me, but if Mummy and Daddy did die, there are lots of people to take care of you. There’s Aunt Ellen and Uncle John or Grandma.” Other problems can arise from children’s misconceptions about death. Dr. R. Fulton, in Grollman’s Explaining Death to Children, points out that some children confuse death with sleep, particularly if they hear adults refer to death with one of the many euphemisms for sleep - “eternal rest”, “rest in peace.” As a result of the confusion, a child may become afraid of going to bed or of taking naps. Grandma went “to sleep” and hasn’t gotten up yet. Maybe I won’t wake up either. Similarly, if children are told that someone who died “went away”, brief separations may begin to worry them. Grandpa “went away” and hasn’t come back yet. Maybe Mummy won’t come back from the shops or from work. Therefore, it is important to avoid such words as “sleep”, “rest”, or “went away” when talking to a child about death. Telling children that sickness was the cause of a death can also create problems, if the truth is not tempered with reassurance. Preschoolers cannot differentiate between temporary and fatal illness, and minor ailments may begin to cause them unnecessary concern. When talking to a child about someone who has died as a result of an illness, it might be helpful to explain that only a very serious illness may cause death, and that although we all get sick sometimes, we usually get better again. Another generalization we often make unthinkingly is relating death to old age. Statements such as, “Only old people die” or, “Aunt Hannah died because she was old” can lead to distrust when a child eventually learns that young people die, too. It might be better to say something like, “Aunt Hannah lived a long time before she died. Most people live a long time, but some don’t. I expect you and I will.” Religion and Death Religion is a prime source of strength and sustenance to many people when they are dealing with death. But if religion has not played an important role in a family’s life before death, a child may be confused or frightened by the sudden introduction of religious explanations or references. Children tend to hear words literally, and religious explanations that may comfort an adult may unsettle a child. For example, the explanation, “Baby brother is with God now,” or “It is God’s will,” could be frightening rather than reassuring to the young child who may worry that God might decide to come and get her just as He did baby brother. Also, mixed messages are confusing, deepening apprehensions and misunderstandings children may have about death. A statement such as “Jimmy is happy now that he is in Heaven with the angels,” when coupled with obvious and intense grief, can leave them not knowing which to trust - what they see or what they hear. They may wonder why everyone is so unhappy if Jimmy is happy. They need to hear something about the sadness we feel about losing Jimmy as we knew and experienced him, in addition to our expressions of religious faith. Regardless of how strong or comforting religious beliefs may be, death means the loss of a living being, the absence of a physical presence. It is a time of sadness and mourning. It is important to help children accept the realities of death - the loss and the grief. Attempts to protect children deny them opportunities to share their feelings and receive needed support. Sharing feelings helps. Sharing religious beliefs also helps if done with sensitivity to how children are perceiving and understanding what is happening and what is being said. It is important to check with them to find out how they are hearing and seeing events around them. The Unemotional Opportunity It is usually easier to talk about death when we are less emotionally involved. Taking opportunities to talk to children about dead flowers, trees, insects, or birds may be helpful. Some young children show intense curiosity about dead insects and animals. They may wish to examine them closely or they may ask detailed questions about what happens physically to dead things. Although this interest may seem repulsive or morbid to us, it is a way of learning about death. Children should not be made to feel guilty or embarrassed about their curiosity. Their interest may provide an opportunity to explain for the first time that all living things die and in this way make room for new living things to take their place on earth. This kind of answer may satisfy for the moment, or it may lead to questions about our own mortality. Honest, unemotional, and simple answers are called for. If we are talking to a very young child, we must remember that she can absorb only limited amounts of information at a time. She may listen seriously to our answers and then skip happily away saying, “Well, I’m never going to die.” We shouldn’t feel compelled to contradict her or think that our efforts have been wasted. We have made it easier for her to come back again when she needs more answers. Other opportunities to discuss death with children occur when prominent persons die and their deaths, funerals, and the public’s reaction receive a great deal of media coverage. When a death is newsworthy, children are bound to see something about it on television or hear it mentioned on the radio, in school, or in our conversations. In any case, it can rarely be ignored and, in fact, should not be. It is a natural time to give them needed information or to clarify any misconceptions they may have about death. If the death is violent - a murder or assassination - it is probably a good idea to say something to reassure children about their safety. The media tends to play up violence under ordinary circumstances, and the violent death of a well-known or admired person may stimulate their fears or confirm distorted perceptions they may have about the dangers around them. They may become worried that “bad” people or that the “bad feelings” in people cannot be controlled. They may need to hear that most people act responsibly and do not go around killing each other, even though everyone feels bad or angry at some time. Death in the Family - Some Children’s Reaction Studies have shown that when children experience the death of a close relative, such as a brother, sister, or parent, they often feel guilty. While most of us experience some guilt when we lose a loved one, young children in particular have difficulty understanding cause-and-effect relationships. They think that in some way they caused the death; maybe their angry thoughts caused the person to die. Or they may view the death as a punishment. “Mummy died and left me because I was bad.” Children may be helped to cope with guilt by reassurance that they have always been loved and still are. It also may help to explain the circumstances of the death. The notion that death is a form of punishment should never be reinforced. The death of a close relative also arouses feelings of anger in both adults and children. We feel angry with the person who died for causing us so much pain and sorrow or for leaving us alone to cope with life. We feel angry at the doctors and nurses who could not save our loved one, and we feel angry at ourselves for being unable to prevent the death. Children are more apt to express their angry feelings openly, especially when they’ve lost someone on whom they depended for love and care. It is difficult enough to hear anger directed toward the dead and even more so when it is expressed in what appears to be selfish concerns. But anger is part of grief, and we can help children by accepting their feelings and by not scolding them if they express anger or fear. Children need to be reassured that they will be cared for. Some children turn their angers inward and become depressed, withdrawn, or develop physical symptoms. If this behavior persists over several months, professional help may be needed. After a Child’s Death The death of a child is particularly tragic and may create special pitfalls for families. As parents, we must share our grief with our surviving children, for they too will have grief to share, but we must try not to burden them with unrealistic expectations and concerns. For example, there is a tendency to idealize the dead, and we must take care not to make comparisons that could lead to feelings of unworthiness and increase the guilt of surviving children. It is also natural to deal with grief by turning our attention to the living. It is understandable that the loss of a child may lead to too much worry about the welfare of our other children. However, we must resist any tendencies to overprotect them or smother their efforts to grow independent, and we must encourage them not to over-identify with or try to replace the lost child. Each child must feel worthy in her own right and must be free to live out her own life in her own way. Should Children Visit The Dying? Most fatally ill people are hospitalized, and, as a rule, hospitals do not extend visiting privileges to children. But this is beginning to change as hospital staffs recognize the value that can be derived from having children visit. Whether or not a particular child should visit someone who is dying depends on the child, the patient, and the situation. A child who is old enough to understand what is happening probably should be permitted to visit someone who has played an important role in her life, providing that both she and the dying person wish it. Under the right circumstances, contact with the dying can be useful to a youngster. It may diminish the mystery of death and help her develop more realistic ways of coping. It can open avenues of communication, reducing the loneliness often felt by both the living and the dying. The opportunity to bring a moment of happiness to a dying individual might help a child feel useful and less helpless. If a child is to visit someone who is dying, she needs to be thoroughly prepared for what she will hear and see. The condition and appearance of the patient should be described, and any sickroom equipment she will see should be explained in advance. Also, it may be wise to remind her that although she is visiting someone who is dying, most hospital patients get well. If visits are not feasible, telephone calls may be a handy substitute. The sound of a child’s voice could be a good medicine for a hospitalized relative, providing the child wishes to call and the patient is well enough to receive it. Under no circumstances should a child be coerced or made to feel guilty if she chooses not to call or visit the dying or if her contacts are brief. Should Children Attend Funerals? Funerals serve a valuable function. Every society has some form of ceremony to help the living acknowledge, accept and cope with the loss of a loved one. Whether or not a particular child should be included again depends on the child and the situation. If the child is old enough to understand and wants to participate, being included may help her accept the reality of the death while in the supportive company of family and friends. If a child is to attend a funeral, she should be prepared for what she will hear and see before, during, and after the services. She should be aware that on such a sad occasion people will be expressing their bereavement in various ways and that some will be crying. If possible, someone who is calm and can give serious consideration and answers to questions she may ask should accompany the child. If she prefers not to attend the funeral, she must not be coerced or made to feel guilty. Sending Children Away From Home The loss or impending loss of a close family member taxes our emotional and physical reserves to the extreme, and it becomes difficult to meet everyday responsibilities. If is even more difficult to care for youngsters, and sometimes we are tempted to send our children to visit relatives or friends until we can “pull ourselves together”. Keeping children at a distance may also be a way to avoid talking to them about the death. Careful consideration should be given before children are sent away, for this is when they most need the comfort of familiar surroundings and close contact with family members. They need time to adjust to the loss and, if feasible, should be prepared in advance of the death. Even young children who do not understand the full implications of death are aware that something serious is going on. Sending them away may increase their fears about separation from their loved ones. Having familiar and caring people nearby before and after the death can reduce fear of abandonment or other stresses children may experience. On the other hand, we do not want to keep our children under lock and key as a way of dealing with our own anxieties and needs. Our children should be given permission to play with friends or visit relatives if they wish to. Children Also Mourn Mourning is the recognition of a deeply felt loss and a process we all must go through before we are able to pick up the pieces and go on living fully and normally again. Mourning heals. By being open with our sorrow and tears, we show our children that it is all right to feel sad and to cry. The expression of grief should never be equated with weakness. Our sons as well as our daughters should be allowed to shed their tears and express their feelings if and when they need to. A child may show little immediate grief, and we may think she is unaffected by the loss. Some mental health experts believe that children are not mature enough to work through a deeply felt loss until they are adolescents. Because of this, they say, children are apt to express their sadness on and off over a long period of time and often at unexpected moments. Other family members may find it painful to have old wounds probed again and again, but children need patience, understanding, and support to complete their “grief work”. In Summary
Needs of A Grieving Child
Before the Death
Signals for Attention From a Grieving Child
Characteristics of Age Groups (to be used only as a general guide) Infants - 2 Years Old:
2-6 Years Old:
6-9 Years Old:
9-12 Year Old:
Teenagers:
Dying May Not Be
That Bad After All “When we imagine our emotions as we approach death, we think mostly of sadness and terror,” said psychological scientist Dr. Kurt Gray of the University of North Carolina at Chapel Hill. “But it turns out, dying is less sad and terrifying — and happier — than you think.” The study, which examined the writings of terminally ill patients and inmates on death row, suggests that we focus disproportionately on the negative emotions caused by dying, without considering the broader context of everyday life. “Humans are incredibly adaptive — both physically and emotionally — and we go about our daily lives whether we’re dying or not,” Gray said. “In our imagination, dying is lonely and meaningless, but the final blog posts of terminally ill patients and the last words of death row inmates are filled with love, social connection, and meaning.” Gray, his graduate student Amelia Goranson, and their co-authors Ryan Ritter, Adam Waytz, and Michael Norton started thinking about the emotional experience of dying when they came across the last words of death-row inmates in Texas, collected by the state’s Department of Justice. The researchers said they were surprised by how upbeat the statements were, and wondered whether our feelings about death and dying might be clouded by our tendency to zero in on negative experiences. In their first study, the researchers analyzed the emotional content of blog posts from terminally ill patients who were dying of cancer or amyotrophic lateral sclerosis (ALS). To be included in the study, the blogs had to have at least 10 posts over at least three months and the author had to have died in the course of writing the blog. For comparison, the researchers asked a group of online participants to imagine that they had been diagnosed with terminal cancer and to write a blog post, keeping in mind that they had only a few months to live. Using a computer-based algorithm, trained research assistant coders, and online participant coders, the researchers analyzed the actual and imagined blog posts for words that described negative and positive emotions, such as “fear,” “terror,” “anxiety,” “happiness,” and “love.” The results revealed that blog posts from individuals who were terminally ill included considerably more positive emotion words and fewer negative emotion words than those written by participants who simply imagined they were dying. Looking at the patients’ blog posts over time, the researchers also found that their use of positive emotion words actually increased as they neared death, while their use of negative emotion words did not. These patterns held even after the researchers took the overall word count and number of blog posts into account, suggesting that the increase in positive emotion words was not simply due to the effects of writing over time. In a second study, the researchers conducted similar analyses comparing the last words of inmates on death row with the poetry of death-row inmates and the imagined last words of another group of online participants. Again, they found that the words of those who were actually close to death were less negative and more positive in emotional tone than the words of those who were not close to death. Both the terminally ill patients and the inmates facing execution seemed to focus on things that help us make meaning of life, including religion and family, suggesting that such things may help quell anxiety about death as it approaches. The researchers acknowledge that the findings may not apply to all people who are approaching death. They noted that it is unclear whether individuals facing a great deal of uncertainty or those who die of old age express similarly positive emotions near the end of life. Ultimately, the study’s findings suggest that our expectations may not match the reality of dying, which has important implications for how we treat people who are dying, the researchers said. “Currently, the medical system is geared toward avoiding death, an avoidance that is often motivated by views of death as terrible and tragic,” the researchers wrote in the study, which was published in Psychological Science, a journal of the Association for Psychological Science. “This focus is understandable
given cultural narratives of death’s negativity, but
our results suggest that death is more positive than people
expect: Meeting the grim reaper may not be as grim as it
seems.”
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