Bereavement Care - A Guide for Adults Supporting Children

Bereavement Care - A Guide for Adults Supporting Children

A guide for adults supporting children and adolescents

Contents 3 Introduction – supporting children & adolescents

4 Support after death 5 Children and death 6 Age development stage model 8 Effects of grief 9 Traumatic grief 10 Common reactions to traumatic grief in children 11 How to help children cope with grief 12 A guide for adults 13 Anticipatory grief 14 Children at funerals 14 Memorials 15 Ideas for bereaved children/ adolescents 16 Other losses 17 Cultural & multi faith considerations 18 Helpful books 19 Where to get help

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Support guide

Supporting children & adolescents Bereavement Care recognises how difficult it can be to support grieving children and adolescents. With this in mind we’ve developed a guide full of information and tips for adults and teachers that will hopefully giving you a better understanding on how to provide that support. One of the most important points is to accept a child/adolescent as a bereaved person.

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Support after death Alison Penny, Child Bereavement Network, 2010

Most bereaved children require a number of support mechanisms: • Adequate information about a death and what has happened • Addressing their fears and anxieties about who will care for them and the safety of their surviving relatives • Reassurance they’re not to blame for the death • Someone to listen carefully to their fears and questions • Acknowledgement of their feelings and that they’re respected and valid

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Support guide

Children & death

Barbara Monroe, The Child Bereavement Trust Death is inevitable in the world in which children live and grief is a normal and deeply felt human emotion. However, death can be a subject that children receive very little information on and if directly affected by it, can leave them with painful and confusing thoughts and feelings. Sometimes children fail to receive help because adults think they will not understand death, and want to protect them as much as they can. The way in which we help children to deal with a death will have a profound impact, both on their future development and their ability to cope with this and other losses throughout their lives. If children are excluded from grief on the grounds that it is too distressing for them to be told the truth, they may become puzzled by what is going on, and form a taboo subject attitude towards death, which could carry on into adulthood.

Young children see themselves as the centre of their own world and in the event of a death close to them, it’s common for them to believe they’re at fault. How do we prevent such ideas forming? How on earth does one begin to explain to a child what death is? How can they be helped through the grief they will be feeling if the death was of a parent or someone else close to them? The key to addressing these difficult issues, if at all possible, is to acknowledge the shared loss and to grieve together, dealing honestly and gently with the child concerned.

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Age development stage model Judy Sanderson, Acorns Hospice, the Child Bereavement Trust

2-5 years Children develop power of fantasy/ imagination, partly to deal with an increasingly difficult world. ‘Magical thinking’ can make dangerous things feel safer. If a sibling dies there is a risk that a child of this age may believe they caused this through their destructive fantasies. Children of this age think in literal, concrete items, and therefore euphemisms sometimes offered to soften the blow of the death can cause confusion and misunderstandings, so are best avoided. Many adults may wish to exclude children of this age group from the knowledge of a loved one’s fatal illness. However, fantasies can build into mysteries, which are scarier than reality. Children may seem to take things in their stride and this can be hurtful to parents eg a five-year-old asking for her dead sibling’s toys in a practical response.

0-2 years Most clear and focused implication is of separation from those who are loved and needed. Babies as young as six-months-old are likely to respond to the disappearance of a close attachment figure i.e. significant carer who provides security, love and continuity. Also, an 18-month-old toddler who sees an insect squashed and says “no more”, “gone”, reveals a rudimentary understanding of death. However, they do not generally understand the more subtle qualities, such as the dead creature cannot feel.

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Support guide

Adolescents 12+ Adolescents are able to grieve as adults do. However, they have added pressures of coping with all the physical and social changes that happen to them. It may often be hard to tell whether their conduct is an expression of grief or merely typical adolescent behaviour. Friends play an important part of the grieving process for adolescents. unaffected. This is a type of conscience development, which may heighten a sense of guilt. Irrational links may be made between ‘naughty’ behaviour and the death of a younger sibling. 5-8 years Most children now develop an awareness of death having a cause, being irreversible and as something that can happen to anyone. Children are more developed verbally and may convey a cognitive understanding. However, defences such as denial of painful feelings are natural and outwardly, a child may appear

8-12 years Children’s understanding of the finality of death is

nearly equivalent to that of an adult, though abstract concepts may still be difficult. An important factor is the child’s deepening realisation of the possibility of their own future death and the fear this engenders. However, children’s ages do not provide an automatic level of understanding. Children mature at different rates; in addition, significant losses may cause regression to a previous stage of development. Knowledge comes through experience: what a child understands depends as much on his or her experience of the world as on age. Be as truthful as you can be.

SEND - Special Education Needs and Disabilities For a child with special educational needs and disabilities, their functional level of understanding (rather than actual chronological age) will be the biggest factor in how the child reacts to a death, and what they will be able to understand. Children with SEND can often have spiky developmental profiles and therefore do not always fit neatly into one box. The bereaved child you are supporting may display aspects of one or more of the age groups/developmental stages described above.

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Behaviours • Sleep disturbance • Separation difficulties • Irritability • Bed wetting • Social withdrawal • Anti-social behaviour • Avoidance of triggers • Poor school work • Reduced concentration The ways in which children experience grief vary and many of them are common to those of adults. However, other behaviour may not immediately be recognised as expressions of grief. One, some, or all of the following responses are likely to occur in bereaved children: Effects of grief Emotions • Sadness • Anger • Guilt • Disbelief • Denial • Regression • Anxiety

Acute physical signs • Loss of appetite • Appetite gain • Over-sensitivity • Increased vulnerability to illness • Lack of energy • Weakness of muscles • Tightness in chest/throat • Breathlessness • Dryness of mouth • Bowel/bladder problems • Headaches • Fatigue • Uncontrollable crying/ sobbing

• Confusion • Loneliness • Helplessness • Shock • Yearning • Relief • Numbness • Night fears • Depression

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Support guide

Traumatic grief Following a sudden or traumatic death, the process of grief may be more complex. It can affect a young person’s self-esteem, especially if they feel responsible for the death. Protecting the child from all the facts may be very unhelpful under these circumstances resulting in rumours that may exacerbate the child’s worries. Professional help may be useful.

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Common reactions to traumatic grief in children • Intense shock, with recurring images of the death – even if not actually witnessed • Avoidance of objects, places and events connected to the event • Prolonged search for an explanation or reason for the tragedy • Strained family relationships possibly resulting in blame • Feeling rejected or abandoned after suicide • Stressful media attention • Sense of isolation with stigma attached to suicide • Good memories unable to be retained as replaced by intrusive thoughts of the event • Outbursts of extreme unfocused rage • Anxious and preoccupied by the trauma, especially by threats of similar danger • Survivor guilt • May become withdrawn and avoid expressing feelings • Heightened awareness of threat and danger • Sleep problems/nightmares

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Support guide

How to help children cope with grief Each child is very different and will cope with grief in their own unique way. To best help children with grief the following guidelines are suggested: • Talk about the death whenever the child asks questions • Answer honestly and in exact terms the child can understand • Don’t say the person ‘went away’ – the child may feel abandoned or worry you might go away and not come back, when you have just gone shopping • Don’t say the person ‘went to sleep’ – the child may become afraid of going to sleep • Adequate information about a death and what has happened • Addressing fears and anxieties about who will care for them and about the safety of their surviving relatives • Reassurance they’re not to blame for the death • People to listen carefully to their fears and questions • Their individual feelings to be acknowledged and respected as valid • There are no silly questions • Listen, listen and listen some more

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A guide for adults Don’t: • Avoid them because you’re uncomfortable • Say you know how you feel • Say, ‘You ought to be feeling better by

Do: • Take care of yourself • Work on your own grief, guilt and blame • Allow your child or children to grieve in their own way • Find professional help for your children if you feel they need it • Try and find helpful ways to remember the person who has died • Find time for surviving children but also allow space • Prepare your children or child for unhelpful remarks

now’ or anything else which implies a judgement about their feelings • Tell them what they should feel or do • Change the subject when they mention their loss • Avoid mentioning the death out of fear of reminding them of their pain • Make any comments that in any way suggest that their loss was their fault. There will be enough doubts and feelings of guilt without any help from anyone else

It’s emotionally draining to be supporting a grieving child. You cannot ‘make things all better’ or remove the pain, and working through the child’s emotions as they learn to adapt to the loss places an enormous strain on school staff as well as family. Staff may well be grieving themselves if they also knew the person who has died, or it could trigger them due to previous losses. It’s also possible that staff neglect their own needs and feelings.

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Support guide

Anticipatory grief • Liaise with the family to confirm what the child knows about the illness and prognosis • Be aware that children value honesty and inclusion. If either of these are missing, the child is more likely to develop emotional or behavioural issues • It may be useful to work in conjunction with outside agencies such as Macmillan service or Young Carers Groups • May need to request that school staff make allowances to allow the child to function within the school setting • The child’s wishes should be considered when deciding what information is to be shared at school • When a death becomes imminent, a child should have the opportunity of extra time off school

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Children at funerals The answer will of course depend on the child. Often our first reaction is to try to spare them an upsetting experience, but attending the funeral may help them to come to terms with the death. It is not advisable to force a child to go if they do not want to, if they want to go then it is usually best to let them. Not being allowed to go may raise all kinds of worries in their mind about what is happening and You may be undecided about whether to allow a child to go to the funeral. why they are being kept away. If you take a child to a funeral it is important to prepare them beforehand by telling them what to expect. Someone close to the child should stay with them throughout the service to comfort them when it is needed.

Memorials It may help the child to identify a “memorial” to the person who has died, especially if they were very close. This doesn’t need to be an ‘official’ memorial but simply a thing or place which can be associated with the deceased. For example, a favourite tree in the garden or seat in the park, a simple keepsake such as a vase or a watch, or a photograph which the child can keep. Opinions vary, but most people believe it is better to help the child remember someone they knew than expect them to forget.

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Support guide

Ideas for bereaved children/ adolescents • Ask them to draw a picture of what happened, how it felt before, at the time and after the death • Plant a plant/bulb in the garden/ pot - put it in a special place where you can go and have some time on your own • Write a letter to the person who has died or make a card • Put feelings down into a notebook or draw pictures • Take a walk in nature • Fly a kite • Paint a picture on a stone and put it in the garden or bedroom • Light a candle • Make a memory box

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Other losses While this guide is primarily about someone has died, we do recognise that there are other losses such as when parent’s divorce, moving house or schools, siblings leaving home, a pet dying etc and even anticipating a death, when a friend, grandparents or parents have a terminal illness. Children can experience similar emotions as in this guide.

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Support guide

Cultural and multi-faith considerations

The family’s spiritual values and beliefs as well as racial and cultural heritage will have an impact on the grieving process and may affect the child’s behaviour. It’s beneficial to gather information and understanding of the different values, customs and traditions of various communities. When communicating with the family, an interpreter or Minister of that Faith can help to avoid incorrect assumptions on either side, and gain insights into what may be expected of the child.

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Helpful Books Muddles, Puddles & Sunshine – Dianna Crosely Remember Me Always – Penhaligons Friends When Your Grandparent Dies – Victoria Ryan Bereavement Support for Young People – Simon Says

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Support guide

Where to get help

Bereavement Care 08081 691 922

Winston’s Wish 08088 020 021

Bereavement Care is a leading bereavement organisation in the south of England, offering free video call, email or telephone bereavement support. bereavementcare.uk Off the Record 023 9247 4724 Provides free and confidential mental health support and information to young people aged 11-25 years old.

Offers support, information and guidance to people caring for a bereaved child. winstonswish.org Child Bereavement UK 0800 02 888 40 Helps children and young people (up to age 25), parents, and families, to rebuild their lives when a child grieves or when a child dies. childbereavementuk.org Cruse Bereavement Care 0808 808 1677 Offers support, advice and information to children, young people and adults when someone dies. cruse.org.uk

otr-south.org.uk Simon Says 023 8064 7550

Provides child bereavement support to children, parents, teachers and carers throughout Hampshire. simonsays.org.uk

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Bereavement Care is a non-profit organisation that provides FREE emotional, social and practical support for bereaved people. If you or someone you know would like to find out more about the services we provide, please contact us: 08081 691 922 [email protected] bereavementcare.uk

Mutual Services (Portsmouth) Limited. Registered in England and Wales Company No. 05904980. VAT Registration No. 107 6564 68. NAFD Membership 2629. Registered office: 1000 Lakeside, Western Road, Portsmouth, Hampshire, PO6 3FE. Mutual Services (Portsmouth) Limited a subsidiary of The Southern Co-operative Limited. V1 Jan2021