It is terribly painful to watch our children suffer loss — whether it’s the loss of a grandparent, a friend, or even a pet.
Children struggle to understand separations and death, and their feelings of missing the person they loved are powerful.
But it is important to understand that loss is part of life — and it is not something we should protect our children from.
We do not need to sugarcoat the experience for them. Nor do we necessarily need to keep our children at home during the funeral.
What we do need to do is to explain to them what has happened and to be there for them through all of their questions and feelings. And I am talking about children from the earliest years, on through adolescence. Even two and three-year-olds are interested in why someone is not there anymore. Whether the person has gotten angry and left, or the person has moved away, or the person has died, we can explain this in terms that they will understand. And we can understand that being with them to help them talk about and process their loss helps them to grow.
Researchers have looked at this phenomenon. Calhoun and Tedeschi called this “post-traumatic growth,” and they observed that following a loss, some people experience a number of positive effects. Some develop a greater appreciation for life, some experience a strengthening of close relationships, some feel increased compassion and altruism, some identify new purpose and new possibilities in life, some feel a greater recognition of personal strengths, some experience enhanced spiritual development, and some develop enhanced creativity. And they found that the activity which most helps people to grow following loss is talking about and processing the loss.
Another researcher and clinician, Jessica Koblenz, specifically looked at children. She found that following loss, some children expressed a heightened sense of life and a new appreciation for the value of time. They were aware of not wanting to waste time or have regrets. Some learned to seek help from others, and they figured out how to determine who was capable of giving them the help they needed.
Two other researchers looked at college-aged kids and found that the greater the loss was, the greater the growth could be – but only in those who did not avoid their feelings.
George Bonanno, in his research as described in his book The Other Side of Grief, also looks at the importance of understanding that many of those who suffer loss do so with resilience. While he does not study children, Ann Masten does, and she has found that the majority of children who suffer loss, even traumatic loss, come through the experience without developing any major mental illness.
These findings support the importance of not over-pathologizing the grief process and not protecting our children from feeling the feelings they have around loss. In fact, these finding support helping our children to explore, express and process their feelings — whether this is through talking, art work, or play.
References
Bonnano, George. (2009). The other side of sadness: what the new science of bereavement tells us about life after loss.
Calhoun, L. and Tedeschi, R. (2001). Post traumatic growth: the positive lessons of loss. In R. A. Niemeyer, Meaning, Reconstruction and The Experience of Loss (p 152 – 172), APA Press.
Koblenz, Jessica (2016). Growing from grief. Omega, 73(3), p. 203 – 230.
You may find this hard to believe – but up until the 1990’s infants were routinely subjected to medical procedures including surgery without the benefit of anesthesia.
Pain research’s most famous infant, Jeffrey Lawson, was born prematurely in February 1985 and underwent open heart surgery shortly thereafter. (1) What made this particular surgery noteworthy was the fact that Jeffery was awake and conscious throughout the entire procedure. The anesthesiologist had administered only Pavulon, a paralytic that has no effect on pain. Only after Jeffrey died 5 weeks later did his mother, Jill, learn the truth about his surgery. Jeffrey had been too young to tolerate anesthesia, the anesthesiologist said, and anyway, “It had never been demonstrated to her that premature babies feel pain.” 1 This was not the case of a rogue anesthesiologist; textbooks at the time taught that the surgery Jeffrey underwent “could be safely accomplished with only oxygen and a paralytic”. (1)
Not until a research report from Anand and Hickey, “Pain and Its Effects in the Human Neonate and Fetus,” was published in the New England Journal of Medicine in 1987 did this practice finally begin to end.
Similar to the denial of infant physiological pain has been the denial of psychic pain, including the pain of separation from parents in infancy and childhood. Until the 1970s, infants and children who were hospitalized were actually denied visitation by their parents.
The need for parental love and care and the distress that children suffer without this, were considered unimportant in the physical recovery process for babies and children in the hospital – and the attachment needs of the young child went completely unrecognized in medical circles.
And even now, there are those who question whether trauma and/or loss occurring in the early months and years of life can be remembered. Many deny the importance of separations in the first weeks of life and some doubt whether separations or early trauma of other kinds are encoded in memory.
But this is what Susan Coates, a well known psychologist and the author of September 11: Trauma and Human Bonds (among other books) has to say:
It is now well documented that very young children show the same three basic categories of posttraumatic symptoms observed in adults: reexperiencing, numbing, and hyperarousal.(2) These three clusters of symptoms are the means by which posttraumatic disorders in adults are diagnosed. These clusters have consistently been shown to represent independent factors in the traumatic response process, and there are now over fifty published case reports documenting their presence in children under the age of four.(3)
She goes on to say:
Both Lenore Terr (1988) and TJ Gaensbauer (1995) report that children under the age of three, though unable to describe a trauma in words, enact it in play through motor behavior and somatic responses. Doing this requires a preverbal capacity to symbolically represent traumatic events in memory. Posttraumatic play in very young children is readily distinguishable from ordinary play. It is compulsively driven and it includes repetitive reenactment of the trauma. In addition, very young children show symptoms of reexperiencing the trauma that are highly reminiscent of what is seen in older children and adults: repeated nightmares, distress at exposure to reminders of the trauma, and episodes with features of flashbacks or dissociation.
What Coates is saying, in other words, is that babies, toddlers and young children who experience prolonged separations, or traumatic events, including medical procedures and hospital stays are affected by these events.
And if you have not read or heard about Susan Coates’ case of “Betsy”, you need to. This case involves a ten month old girl who was stabbed repeatedly by a psychotic man while sitting in her stroller in a park. Thanks to the fast action of her babysitter, a police officer and a surgical team, she survived. Her parents noticed no post traumatic symptoms, did not think she remembered the event, did not think it necessary to tell her about what happened and, in fact, were counseled not to do so.
One day, when she was three and playing in the kitchen sink with her father, she leaned against the counter and said “my line hurts”. When her father said, “Oh, you mean your special boo boo?” she said, “No” and made slashing motions with her hand. She said, “It was a very bad day”.
Clearly she had a memory of the traumatic event. And it was a somatic memory, that is, it was felt in her body and expressed through her physical action of replaying the stabbing motions of the man who attacked her. Her parents realized that she needed help to understand what had happened – and they took her to see Susan Coates for psychotherapy. Together, Betsy, her parents and Dr. Coates reconstructed what had happened and what it meant to Betsy.
So, not only do infants experience pain—and severe stress—when they are subjected to prolonged separation from parents or when they experience physical trauma such as catheterizations, lumbar punctures or other medical procedures without the benefit of anesthesia, but they are ALSO capable of forming symbolic representations and somatic – or bodily – memories of these experiences. In addition, we now know that their capacities for other kinds of memory are far more sophisticated than was thought even thirty years ago. And it is also true that these capacities include the rudiments of an episodic memory system even before the onset of language.
These two factors—the experience of pain and its memory—create necessary and sufficient conditions for traumatization and the development of PTSD – whether around trauma – or loss – in infants and children.
So, why is this important for parents to know?
It is important to recognize that early experiences of pain and separation may be important to your child and how she sees herself and the world. It is part of her life story and part of what has shaped her. And here we are not talking about separations of a few hours or a day, we are talking about long separations of weeks and months.
If a child has suffered an early and prolonged separation or a difficult medical experience, parents may be tempted to discount the possibility that this affected them or that they have any memory of what happened.
It is painful for parents to think otherwise. But it is important to acknowledge that these experiences do affect small children. It is important to talk with them about what happened in an age-appropriate way, and to empathize with how hard it may have been for them – even though they were very little at the time. It is important to be open to what the child has to say about it. And it is important to not make this a one-time conversation. It is important to talk about it with them from time to time and try to help them to understand what this experience might have been like for them and what it may have meant to them.
We need to give children credit for being fully feeling individuals – from the moment they are born and throughout their development.
In our 4 part series on loss, I talked about the little losses of everyday life, how children understand death, how to introduce the topic of death to children and what a child may feel when they lose a loved one. But something I did not talk about is the fact that, as hard as losing a loved one is for a child, they can also grow as a result of the experience.
This may come as a surprise.
But many people, including children and teens, not only manage to survive difficult losses, but they also grow as the result of their experience with loss.
Scientists who study trauma and loss have found that there can be a variety of positive psychological changes for some people following challenging life experiences.
Lawrence Calhoun and Richard Tedeschi called this “posttraumatic growth.” They mentioned the following positive changes as being prominent for many people:
· Greater appreciation of life
· Greater appreciation and strengthening of close relationships
· Increased compassion and altruism
· The identification of new possibilities or a purpose in life
· Greater awareness and utilization of personal strengths
· Enhanced spiritual development
· Creative growth
And, as it turns out, one crucial factor that allows people to turn a difficult event into one that promotes growth is the extent to which they explore their thoughts and feelings around that event.
Many people prefer “to look on the bright side” and to not focus on the difficult things that happen to them. In fact, one young woman who sees me in therapy told me that when she hurt herself as a child, her mother used to say, “pretend that didn’t happen”.
However, Calhoun and Tedeschi found that the ability to acknowledge that the event has happened and to think about and process the painful feelings associated with the event are what allow some people to grow from their difficult experiences.[i]
Two other researchers, Todd Kashdan and Jennifer Kane, also studied this subject. Using a group of college students, they looked at how much people tend to avoid difficult and painful thoughts and feelings versus how much they are willing to allow them. In their study, the most frequently reported traumas amongst their subjects included the sudden death of a loved one, motor vehicle accidents, witnessing violence in the home, and natural disasters.
Kashdan and Kane found that the greater the distress the person experienced, the greater the posttraumatic growth that resulted from it—but only in those people who did not avoid their feelings, or who did so infrequently.
These findings support the benefits of encouraging children to experience and talk about their feelings following loss. It also supports the importance of having children and teens who are having difficulty experiencing or expressing their feelings get involved in some form of expressive psychotherapy, whether that be individual, group, or family therapy.
Another researcher, Jessica Koblenz specifically studied children who had lost a parent to find out what helps and what hinders them in their grief process. And she also found that there is growth from loss. One child in her study said they had a heightened sense of life and didn’t want to waste time or have regrets. Another said he had become more independent. Some mentioned that they learned to seek help from those who were able to provide it. Some found that exercise was a good method for coping with painful feelings, and others found humor helpful.
Teigan, a young woman I met through Winston’s Wish, told me that what happened to her after she lost her mother shaped what she wanted to do with her life. She described how one of her teachers at school called her every week after her mother died and provided her with much needed attention, support, and guidance. This teacher was an inspiration for Teigan, and she decided to become a grief counselor for children and teens so that she could help other students, just as her teacher had helped her. In the meantime, she was training to lead grief groups just like the one she had participated in herself.
For years, Calhoun and Tedeschi, studied the positive effects of trauma—including loss. They also found that some individuals who had suffered significant trauma experienced positive changes. These changes include improved relationships, new possibilities for life, a greater appreciation for life, a greater sense of personal strength, and increased spiritual development.
They also found some interesting contradictions. People they interviewed said things like “I am more vulnerable, yet stronger.” Individuals who experienced traumatic events tended to talk about their increased sense of vulnerability; however, these same people also reported an increased sense of their own capacities to survive and prevail.
Another experience often reported by trauma survivors was a need to talk with other people about the traumatic events, which tended to deepen some of their personal relationships. Some also found themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experienced life difficulties.[i]
In my clinical practice, a teenager whose father had died at the beginning of Covid said to me, “My dad’s death gave me a different perspective. I used to think that if a friendship ended or someone died, all the time you put into that relationship was wasted. Now I think that it was valuable. I would rather have had my dad for the time I had him rather than some other dad who was around longer.”
This young woman gained a new perspective and came to a new appreciation of the relationships in her life. She came to understand the importance of the person that her father was despite her lifelong frustration with having had an older dad. And she also recognized that relationships are important in their own right, even if they end prematurely.
Calhoun and Tedeschi also found that some people who faced trauma were more likely to become engaged with fundamental existential questions about death and the purpose of life. A commonly reported change was for the individual to value the smaller things in life more and to also consider the religious, spiritual, and existential components of life. A common theme for many people in this study was that after a traumatic event, philosophies of life can became more fully developed, satisfying, and meaningful.[ii]
Researchers such as Calhoun and Tedeschi have found that growth can occur not despite adversity but because of it.
It is true that they looked predominantly at adults, but interestingly, very similar findings have been found in research on bereaved children.
In a study of what helps and hinders children and adolescents who lose a parent, Jessica Koblenz found multiple areas of growth in many of the children she interviewed.[iii]
Seventy-three percent of the participants in her study felt that navigating and understanding death at an early age made them grow up faster.
And it is interesting to think about whether “growing up faster” is a form of growth or a toll that is paid by children who have experienced early loss. I suspect that some children might consider it a form or growth, some might feel it was a toll they paid, and some might feel that it is both.
Some children in Koblenz’s study said they responded to loss by embracing life. One said, “I have a heightened sense of life, not wasting time, and not having regrets.” According to some grief theorists, this renewed sense of life is an adaptive form of meaning-making following loss.[iv]
Many of the children Koblenz interviewed said that support helped them to get through their loss. This finding is important because traditional psychological and psychiatric views of bereavement have minimized the role of relationships and support from others in coping with loss. However, more recently, evidence has shown that relational support plays a crucial role in a child’s ability to cope after a loss and may actually improve and intensify some existing relationships.
Interestingly, participants in Koblenz’s study stated that their most helpful source of support were other mourning children who could relate with their exact position.
Koblenz also found that becoming self-reliant was a coping strategy that some of the participants in her study utilized. In her study, kids said that they began to rely more on themselves once they decided that they could no longer depend on others. For some, it was easier to express they “were strong” and “could handle it alone” than to acknowledge their loneliness.[v]
Koblenz says that the sentiment of “needing to be strong” was expressed by many participants and reflected their inability to convey vulnerability. As one participant said of her childhood loss, “Everyone always said, ‘You’re so strong.’ No one ever said, ‘It’s okay if you’re not.’” From this Koblenz concluded that applauding children’s ability to handle their grief alone may make it difficult for them to feel they can be completely open and show their vulnerable selves. But some participants were able to find a balance of healthy independence while still reaching out to others in times when they needed help.[vi]
[i] Lawrence G. Calhoun and Richard G. Tedeschi, “The Foundations of Posttraumatic Growth: An Expanded Framework,” in Handbook of Posttraumatic Growth: Research and Practice, ed. Calhoun and Tedeschi (New Jersey: Lawrence Erlbaum, 2006), 3–23.
[ii] Richard G. Tedeschi and Lawrence G. Calhoun, “Posttraumatic Growth: A New Perspective on Psychotraumatology,” Psychiatric Times 21, no. 4 (April 1, 2004).
[iii] Jessica Koblenz, “Growing from Grief: Qualitative Experiences of Parental Loss,” Omega 73, no. 3 (March 2015): 203–230.
Part of this post is excerpted from my forthcoming book, How Children Grieve: What Adults Miss and What They Can Do to Help
Previously in this series I talked about the little losses of everyday life, about ambiguous loss and about how to talk to children about death. But eventually, most children suffer an actual loss when a loved one dies.
This is just so painful – both for the child – and for the adults who love the child and want to understand what she is feeling.
And there is so much to understand.
Behind childhood grief is a world of feelings and beliefs, shaped and colored by the child’s age and stage of development but also by the child’s personality, the degree of closeness she had with the person who died, her particular family circumstances, her culture AND by the way her parents feel about this loss in particular and about loss in general.
The problem in understanding what your child feels about her loss is that it is often difficult for her to put this into words. And lacking an explanation, adults who try to help a grieving child often look at the child’s behavior – and when they look at the child’s behavior, they form ideas of what the child is feeling and how they are affected based just on external impressions.
And in doing so, they can miss a lot.
They can miss what is going on in the child’s inner world; they can miss what the child truly feels about the loss; they can miss what the child understands about the loss; they can miss the child’s misconceptions about death and loss in general; they can miss the child’s fantasies about this loss in particular and what role the child believes she played in causing the loss to happen.
And it is important not to miss these things.
When a child loses someone they love, the child doesn’t stop loving that person. The child may not even really believe that person is gone. The child may start searching for them everywhere they go, and each night they may see their lost loved one in their dreams.
When a child loses a beloved person, their love for that person becomes a one-sided equation. It is an unreciprocated, lonely kind of love that involves powerful feelings of missing their lost loved one.
All this missing can feel different for each child. It can feel like pain. Or it can feel like confusion. It can feel like an ongoing emptiness. It can feel like an ache in the pit of the stomach or a headache that never ends. Some children stop eating. Some start eating too much to fill that emptiness.
Most children can’t bear the feeling for long, and they take breaks from it by returning to play and school activities. This could make it seem like the child is no longer grieving. But, in fact, it does not mean the pain, the emptiness, the yearning, or most of all, the loving has stopped.
For example, Chloe was four years old when her grandmother died. She had been close to her grandmother, seeing her at least once almost every week of her life. After being told that her grandmother had died, Chloe went off to the family room. Her parents observed her playing quietly with her dolls, and they were relieved. They felt that she had taken the news very well and saw her as returning to her normal activities.
Several weeks later, when Chloe began to have trouble at bedtime, refusing to go to sleep without one parent or the other lying down with her, they did not link this to her experience of her grandmother’s death. They felt that she was being “clingy” without good reason.
What the parents missed was that her behavior at bedtime was a communication to them.
The truth was that Chloe was very frightened. She had been told that her Nana had “gone to sleep forever and was now with God in Heaven,” so she was afraid to go to sleep, fearing that she would never wake up and that she would go to be with God in Heaven.
When Chloe went to play with her dolls after being told the news of her grandmother’s death, she had played a game of putting her dolls to bed and having them go to sleep and then go to Heaven. She played this over and over, trying to work out both how someone could sleep forever and where Heaven was.
In addition to becoming frightened to go to sleep for fear that she too would sleep forever, Chloe was feeling more fearful of separations in general. She began to have tantrums each morning when it was time to go to preschool and when either her mother or her father left the house. She also had powerful feelings of missing her Nana and didn’t understand why she couldn’t still go to Nana’s house to visit. AND she was worried that others in her life might go away and not come back. Of course, her solution to this was to not let anyone she loved out of her sight!
Chloe’s parents had not thought to wonder how Chloe would understand the words they said to her about her grandmother’s death. They had four children altogether, and Chloe was the third. They were happy with Chloe’s adaptation to the news of her grandmother’s death and very caught up with their own grief, the reactions of their other three children and the funeral arrangements.
Chloe’s story is just one example of how a child might react to loss.
In How Children Grieve, I tell many other stories about children’s grief. And I take an in-depth look at the internal world of the child in order to help caregivers better understand the nuances of feeling and fantasy a child may experience when confronted by loss. I discuss how unique each child’s understanding and reaction to loss are and how strongly they are shaped by her personality, family circumstance, age, stage of development, and culture. I talk about losses of all kinds, including losses due to death, abandonment, deployment, divorce, and immigration.
Following a loss, adults sometimes forget that young children who have never lost a loved one before may not know what death really is. For example, one little boy I saw in therapy lost his father when he was three. His grandfather told him that his daddy had gone “up there” and the grandfather pointed to the sky.
This little boy, who I will call Teddy, accepted this explanation — but then he started to regress. He became fearful of separations, he would not take a bath and his speech became babyish.
His grandmother brought him in to see me and in the first session, Teddy sat down in front of my doll house, took the daddy doll out and threw him behind the house. When I asked, “what happened to the daddy?”, he retrieved the doll and said, “The daddy’s on the roof”.
This is what he had understood when his grandfather had told him that “Daddy’s up there”.
He thought daddy now lived on the roof of their house.
Young children know so little about the world. Everything is new — and this includes the concept of death. It is common for them to believe that when someone dies, they have just gone to live somewhere else and that they can come back.
Older children may understand that death is permanent, but they often believe that if a death occurs, it is someone’s fault. This can lead them to blame others -or themselves – if someone they love dies or leaves permanently.
One little boy I saw in treatment was convinced that his parents had gotten a divorce and his father had gone to live abroad because he was not lovable enough. He told me in no uncertain terms that if only he had been better at soccer and a few other things, his father would have stayed.
When someone dies, children under the age five or six need frequent reminders about what has really happened. They need to be told that the person who died cannot come back, even if they might have wanted to. Fantasy is so powerful at this age that it can quickly replace a reality that is poorly understood (as well as being unwanted).
Children under the age of five or six need death to be explained to them in a concrete way, including the facts that when a person or animal dies, it cannot see or hear or breathe or feel anymore.
And when a child between the ages of six and ten loses someone, they need a slightly more nuanced explanation of what has happened. They need to know the truth and they need to be told face to face, soon after the loss has occurred. They need to be told some details about the sort of illness or the event that caused the death. They also need to be reminded that the death was no one’s fault (if this is true).
Teenagers may seem like they don’t need much help following a loss. After all, they understand what death is, and they manage a great many feelings on their own already.
But whatever age a child is — from infancy through young adulthood, support is needed following a loss due to death.
When a teenager retreats to her room following a loss, when she looks at her phone when you try to talk to her about her feelings or about what is going on in the family, this is NOT an indication that she does not need your help.
Like kids of all ages, teenagers may feel uncomfortable talking about their feelings and they may feel awkward when feelings are talked about with them.
But don’t give up. Keep asking how your teen is doing, keep checking in on how they are feeling and keep letting them know how you are doing and feeling.
There is a great deal to understand about children’s understanding of death and their feelings following the loss of a loved one. If you are interested in learning more, check out my new book:
For children of all ages, there will be grief and there will be mourning if they were close to the person who died.
But this grief may not take the form that adults expect.
Some children will show signs of sadness, much like an adult would. But others may not.
Some children may express their feelings readily and ask lots of questions. Others may not show many feelings and the adults around them may wonder whether they are grieving or not.
All children will pop in and out of grief — sometimes seeming sad or angry or irritable and other times going about their usual activities including playing and seeming completely unphased.
But whatever the child’s age, clinical experience and research show that a strong relational environment is one of the most important factors in helping the child to process their grief, tolerate their sad, confused, or angry feelings, and come out the other side.
Adults can help a grieving child by understanding the many forms the child’s grief may take, by tolerating their child’s feelings and by talking about how the child feels, whatever those feelings may be.
This task is complicated, however, because often, when a child is in mourning, the parent will also be in mourning. If a grandparent has died, the parent is grieving the loss of their parent or their parent-in-law. If a sibling has died, the parent will be in mourning for their child. And even if it is a close family friend who has died, the parent will also be affected.
This makes it more difficult for a parent to be available to a child. They may need to bring in help for a brief period of time — and have others provide the support their child needs.
Death is hard to accept for all of us. We all need a great deal of help and support when we lose someone we love — and this is all the more true for children and teenagers.
Thoughtful Parenting 