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GRIEF AND MOURNING Loss in a Paediatric Context. Who grieves? Parents Siblings Grandparents Significant others School and activities friends A large community.

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Presentation on theme: "GRIEF AND MOURNING Loss in a Paediatric Context. Who grieves? Parents Siblings Grandparents Significant others School and activities friends A large community."— Presentation transcript:

1 GRIEF AND MOURNING Loss in a Paediatric Context

2 Who grieves? Parents Siblings Grandparents Significant others School and activities friends A large community Care providers

3 A Parent’s Loss; part of own sense of self connection to the future unfulfilled expectations & ambitions some of own treasured qualities/ abilities source of love and acceptance sense of power and control over what happens to them social status and contacts Celia Hindmarch

4 “She was my child… and she still is Don’t keep telling me what you think I am doing wrong. I’m doing it my way. It’s the only way I know how…” Beyond Words, Skylight, 2012

5 Anticipatory Grief Normal mourning when facing a death Can be as intense as grief after the death Varies in intensity May not occur especially in strong denial

6 Stages of Anticipatory Grief 1. realise death is eminent- sadness depression 2. concern for dying child- regrets, anxieties 3. rehearse death-concerns, fears, planning 4. imagine life afterwards; anniversary, stuff, grieving

7 Manifestations of Grief

8 Emotional Shocked, stunned, sad, desolate, afraid, lonely, let down, overwhelmed, helpless, regretful, angry, guilty, relieved, sense of injustice, numb, empty, drained Physical Crying, moaning, agitated, exhausted, sleeping changes, central constriction; dry mouth, tight chest, stomach ache, digestive issues, nausea, nervous laughter, more illness and accidents, sensory sensitivity Skylight2012

9 Manifestations of Grief Mental Blank, confused, forgetful, distracted, slow responses, difficult to make decisions, replaying, preoccupation, difficulty switching off, blaming, different world view, overwhelmed; too hard Social Needing to talk over, avoiding talk, wanting people or not, difficulty with commitments, changed reactions to touch, hurting others, differing family relations, risk taking Skylight2012

10 Manifestations of Grief Spiritual Sensing the presence of the child who has died, asking why, seeking beliefs or turning away from them, praying or abandoning prayer, seeking nature, looking for meaning Skylight2012

11 “Inside this Shell of Mine” Nancy Bright “ Aside from offers of absorbent products, what do we have to offer each other? My mother was a pragmatic girl who finally told me a safe place to grieve was lying on the floor. She said that on the floor, ‘there’s no place to fall.’ She was right. My body would collapse from the howling and it would curl itself up on its side on the wood floor like a salted slug, and the floor would not drop me. I still feel the smooth wide boards of the kitchen floor against my cheek; its cool bones against my heated ones.”


13 Words of Loss Bereavement is what happens to you Grief is what you feel Mourning is what you do Celia Hindmarch

14 Contexts culture community religion, spirituality male/ female environment concurrent stresses history society

15 And then there is Media

16 Tasks of Grieving William Worden to accept the reality of the loss to work through the to the pain of grief to adjust to an environment in which the deceased is missing to emotionally relocate the deceased and move on with life Alan Wolfelt Acknowledging reality of the loss Embracing the pain of the loss Remembering the person who died Developing a new sense of identity Searching for meaning Receiving ongoing support from others

17 Practical Advice for Mourners Eat healthy, drink water, rest and sleep and exercise Talk to a trusted person, be with good people who care about you, be by yourself Ask for what you need, be honest It’s ok to grieve, cry, not cry, feel what you feel Talk with people who have been there, don’t cut off permanently Listen to music, go to nature, get creative Have massage, hugs, treats Keep safe, get help, forgive self, be patient Skylight2012

18 Transition A new sense of self connecting to the deceased inner representation identification incorporation rituals, remembering “death is a transition not an illness” Phyllis Silverman

19 Reconciliation Making friends with grief Carrying on without physical presence New sense of meaning and purpose Hope and commitment to future An ongoing journey

20 Advice Allow yourself to mourn Your grief is unique Allow yourself to feel numb This death is out of order Expect to feel a multitude of emotions Be tolerant of your limits Talk about your grief Watch out for cliches Develop a support system Embrace your treasure of memories Gather impt keepsakes Embrace your spirituality Move toward your grief and heal Dr Alan Wolfelt

21 Risk factors who the person was nature of attachment mode of death history personality social context concurrent stresses

22 Masculine Style Quieter, less visible Less connected with past, more with future Less passive, more aligned with action Not as well accepted “When a woman feels lost, she tends to ask for help. When a man feels lost, he looks for a map” Tom Golden

23 Grandparents “a grandparent’s grief is like a fork with two tines—one representing the loss of a grandchild, the other representing the pain of your own child’s suffering.” M.H.Gerner-”For Bereaved Grandparents” Listen to your bereaved child Talk about your grandchild Consider your needs Survivor guilt & anger Hope for a better day

24 Siblings Charter We need to respect their rights to; Bereavement Support Express feelings and thoughts Remember the person who has died Education & information Appropriate and positive response from school Voice in impt decisions Everyone involved Meeting others Established routines Not to blame Tell their story Winston’s Wish 2003

25 What do Children Understand? age environment experiences personality family coping Sara Fleming, NP

26 Concepts of Death Separation (age 5)-dead people do not co-exist with the living Causality (age 6)-death is caused by something, be it trauma, disease, or old age Irreversibility (age 6)-a dead person can not ‘come alive’ again Cessation of bodily functions (age 6) Universality (age 7)- all living things will die Insensitivity (age 8)-the dead can not feel fear or pain RCH website Sara Fleming, NP

27 What do Children Understand? Environment Physical Social Cultural Emotional Sara Fleming, NP

28 What do Children Understand? Experiences Personality Life journey Responses to stress Sex Capacity to adapt Bonding Sara Fleming, NP

29 What do Children Understand? Family Coping Extent of crisis Collective behaviours Communication style Alliances Resources Sara Fleming, NP

30 AgeGrief ResponseCompanioning Infants and Toddlers Baby-2 years Loss= absence “I’m upset”; cry, thumb suck Change in normal patterns in sleeping, eating, fussing Physical comfort Accept, get routine Preschoolers 3-6 years Death may be thought of as temporary and/or reversible May not understand new feelings, unable to verbalise Ask ? About death over and over. Reenact death in play Regress- potty, sucking, baby talk Provide terms for feelings Answer concrete & lovingly. No half truths Death play ok, join in and offer guidance These are normal. Offer presence and support Grade Schoolers 6-11 years Express grief primarily through play May “hang back” socially, scholastically May act out because they don’t know how else to handle their grief Use “older kid” play therapy Permit to take time to mourn, give them time Offer venting alternatives. Support groups can be helpful. Alan Wolfelt-Companioning the Grieving Child

31 AgeGrief ResponseCompanioning Adolescent 12 years and up Understand death cognitively but are only beginning to grapple with it spiritually May protest the loss by acting out/ withdrawing May feel life has been unfair to them, act angry May act out a search for meaning, test his own mortality Tolerate if no-one is being harmed. Withdrawal is normal short term only. Normal egocentrism. After he has had time to explore this, encourage to consider the impact on his larger social group. Teens explore the “why” about life and death. Encourage search unless it may harm Alan Wolfelt-Companioning the Grieving Child

32 When a sibling dies Layers of loss an ally a companion a carer, a dependent an identity innocence routine, normality balance Survivor Feelings Guilt Relief Fear Confusion Wolfelt Sara Fleming, NP

33 Behaviour acting out withdrawal disobedience insecurity inattention sleep disturbance appetite changes sensitivity, fears Sara Fleming, NP

34 What helps? Information, answer questions involvement, funeral etc discussion about loss normality, play special time, meaningful memory making and rituals peer and school support external support working with the parents/carers Sara Fleming, NP

35 Memory making and rituals Treasure box Plant tree, garden Christmas decoration Drawing Photo collection Touchstones Poetry, music Star naming Conversation Ongoing activities Anniversary actions Special places Mealtimes Sad, mad, glad space activities

36 Talking with Children our own anxieties, helplessness talking to becomes with repeat information reassurance, trust, security right place, right time, right person not what you say but how you say it! Sara Fleming, NP

37 How you say “it” talk at eye level speak directly to and with the child avoid confusing language and double meanings avoid cliches, platitudes keep it short and simple- repeat check the child’s understanding be truthful & honest- share your feelings keep them informed & talk open - Earl Grollman 1990 Sara Fleming, NP

38 Carpe Diem Alan Wolfelt Acknowledge the reality of the loss Feel the pain of the loss Remember the person who died Talk about the physical reality of death- may sure they understand how and why the person died Next time they cry, hold gently and let then cry as long and hard and often as they want to Invite to share a memory, or ask to show photo of who died then tell you what was going on when pic was taken

39 Carpe Diem Alan Wolfelt Develop a new self-identity Search for Meaning Receive ongoing support from caring adults Include Child in Funeral Ask child to draw 2 pictures; of his life before and after the death, talk about differences. Share your beliefs without pressure for child to believe what you do. Create a plan to help, mark dates to contact and spend time, mark important dates If funeral done, talk about ceremony answer ?, discuss ongoing way to honour who died.

40 Carpe Diem Alan Wolfelt Help child choose a keepsake Give permission to find comfort in linking objects Consider child’s relationship to the person who died Talk about keepsakes, ask about a chosen one’s significance or help plan to chose/ procure one Do they have one? Talk about this, affirm need to have and hold this. Think about this from her point of view. Set aside your thoughts and feelings and enter her world as you consider this point.

41 Schools inform of child’s loss identify others at risk provide simple information with permission support staff written resources + online develop memorial/ritual set up liaison with education department supports Sara Fleming, NP

42 Others Extended Family, friends Facebook contacts Neighbours Community groups Sometimes need some help here

43 Risk Factors Nature of the Loss traumatic, Unexpected Features of Child Psyche disorder, multiple losses, adolescent,<5years Nature of Relationships Ambivalent, low family support, father of teen boy, mother of young child Aranda.S, Milne,D, Sara Fleming, NP

44 Resources NALAG, Grieflink Child and Youth Health website SIDS and Kids, SANDS RCH Palliative Care website Compassionate Friends Skylight, NZ Starbear (S.A.), Anglicare Loss and Grief Centre Journeys folder- PallCareAus website Disease base associations Sara Fleming, NP

45 27/04/2015Sara Fleming, CYWHS Books

46 Questions If ever there is tomorrow when we’re not together… There is something you must always remember. You are braver than you believe, stronger than you seem, and smarter than you think, but the most important thing is, even if we are apart… I’ll always be with you. A.A.Milne

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