interwoven tasks of grief · pdf filedevelopmental responses to grief and loss ages 4-7 years...

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© 2007 Baylor College of Medicine

Working with Pediatric

Grief

Teen Club Community Partners Training Programme


Interwoven Tasks of Grief

� To understand the person is dead.

� Thinking Process

� Honest and factual information

� Curiosity is healthy

� “dead” is an abstract concept

�Will use before really grasp meaning

�Lag time between hearing “dead” and feeling emotions related to the death

�Younger the “thinker” – longer the lag time



� How do we accomplish this task?� Always tell the truth

� Honor need to talk, and need to NOT talk

� Allow choice

� Repetition

� Use the correct phrases

� Allow them to observe adults and their grief



� To Feel the Feelings about Death.

� Feeling/Affective Process

� Grief is a wound to our psyche

� Can be physical – need physical outlets

� Feelings/emotions can be scary –initiates defense mechanisms like acting out, withdrawal, over-achieving

� Feel responsible



� How do we accomplish this task?

� Encourage safe physical expression

� Listen and provide acceptance

� Reassurance that guilt is common

� Allow time to return to normal standards of performance



� To Go On Living & Loving After the

Person has Died.

� Faith process.

� “Get over it.”

� “Fill the hole.”

� “Live with it.”

� Why did it happen? � What can I do now? � How am I going to do this?

� Begin enjoying life, then feel guilt

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� How do we accomplish this task?

� Believe in the individual’s grief process

� Celebrate steps taken towards reconciliation

� Be aware of your own grief

� Allow “time outs”


General Pediatric Grief

� Concrete thinkers� Confused by euphemisms

� Will ask for more details if they want them

� Describe the death in concrete terms

� As gain more experience with loss, will begin to understand deceased is not returning

� As mature, will gain abstract thinking ability



� Generalize from Specific to General

� Hospitals, sleep

� Will accommodate for new truths if

allowed to express themselves and try things out

� Repetitive in Grief

� Learn by repetition and questions

� Answers do not resolve searching

� Questions are indicative of thoughts© 2007 Baylor College of Medicine


� Physical in their grief

� What they do with their bodies shows their feelings and thoughts

� Movement and active play yield communication

� “speak through their play”

� Grieve Cyclically

� Re-experience and re-process with each new developmental level and new skills

� Stimulated by events



� Behavior Changes

� Natural defense against psychological pain

� Acting out

� Over achieving

� Withdrawal

� Need Choices

� Death is a major disruption

� Life appears undependable and unstable

� Allow choices with regards to death, and daily life



� Grieve as part of a family

� Effects the family as a whole –shifting all relationships

� Mourn change in structure

� Emotions about shift in roles

� Children often do better when they can witness other family members’

mourning

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General Pediatric Grief: Emotions and Feelings

� Fear and Anxiety

� most basic feeling after loss; fear past and anxiety for the future

� Guilt and Regret

� Magical thinking; protects child from the

senselessness of the death

� false reassurance – try harder in future

� Caregivers being overprotective will withhold information – perpetuates guilt


General Pediatric Grief: Emotions and Feelings

� Anger and Frustration

� Comes from different sources

� Counteracts feelings of vulerability

� Protest the death

� Antidote to the fear

� Sorrow and Sadness

� For loss of deceased, but also loss of safety and security

� May be ready to accept death

� Acceptance / Resolution / Reconciliation


Developmental Responses to Grief and Loss

A child old enough to laugh and experience pleasure can also experience grief and trauma

� Ages 2-4 years� Egocentric, world centers around them

� Death is reversible

� Responses: crying, general anxiety, regressive behaviors

� Needs: Consistent routine, play, nurturance



� Ages 4-7 years

� Exploring world outside of self

� Gaining language

� Magical thinking

� Still see death as reversible

� Responses: Repetitive questions and story telling, regressive bx, nightmares, concerns about safety and abandonment

� Needs: supportive play, consistency, allow discussion and questions, simple and honest answers



� Ages 7-11 years

� Concrete thinkers

� Progressing toward peer attachments

� Beginning to understand death permanence

� Grappling with how death will impact their lives

� Responses: anxiety, difficulty concentrating, withdrawal, “big energy”

� Needs: Provide “expressive” activities, give choices, be a good listener



� Ages 11-18 years� Begin to process abstract/existential thoughts

� May question meaning of life and their place in the world

� Heavy reliance on support outside family

� Responses: Risky behaviors, repetitive thoughts around death, inability to modulate emotions, unwillingness to discuss with auth. figures

� Needs: consistency, encourage expression of feelings – don’t minimize, be patient and a good listener, connect with support systems

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THANK YOU

� Thank you to all our Partners

interwoven tasks of grief · pdf filedevelopmental responses to grief and loss ages 4-7 years...

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