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© 2007 Baylor College of Medicine
Working with Pediatric
Grief
Teen Club Community Partners Training Programme
© 2007 Baylor College of Medicine
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
© 2007 Baylor College of Medicine
Interwoven Tasks of Grief
� 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
© 2007 Baylor College of Medicine
Interwoven Tasks of 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
© 2007 Baylor College of Medicine
Interwoven Tasks of Grief
� 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
© 2007 Baylor College of Medicine
Interwoven Tasks of Grief
� 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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© 2007 Baylor College of Medicine
Interwoven Tasks of Grief
� 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”
© 2007 Baylor College of Medicine
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
© 2007 Baylor College of Medicine
General Pediatric Grief
� 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
General Pediatric Grief
� 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
© 2007 Baylor College of Medicine
General Pediatric Grief
� 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
© 2007 Baylor College of Medicine
General Pediatric Grief
� 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
3
© 2007 Baylor College of Medicine
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
© 2007 Baylor College of Medicine
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
© 2007 Baylor College of Medicine
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
© 2007 Baylor College of Medicine
Developmental Responses to Grief and Loss
� 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
© 2007 Baylor College of Medicine
Developmental Responses to Grief and Loss
� 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
© 2007 Baylor College of Medicine
Developmental Responses to Grief and Loss
� 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