Transcription:
Talking to Kids about Grief and Loss

Dr. Fritz: Welcome to Mind Cast, Healthy Mind, Healthy Child. This podcast features child mental health professionals from Bradley Hospital, sharing their expertise in an informal conversational format. I'm child and adolescent psychiatrist, Dr. Greg Fritz. And this is my cohost, child psychologist, Dr. Anne Walters.

So in the past 18 months, they've been the most unusual and unprecedented series of months in my experience. And everybody agrees that there's been a huge impact on children's mental health, every realm of children's mental health. Today, we're going to focus on the subject of grief and loss and how children experience it and what parents and caregivers can do about it and how they can be helpful.

Our guest is Dr. Mary Sullivan, Chief Nursing Officer at Bradley Hospital and an expert on children's grief. Welcome, Dr. Sullivan.

Dr. Mary Sullivan: Thank you.

Dr. Fritz: Thanks for joining us. And we know that the loss of a loved one is a serious mental health challenge when it impacts any child. And certainly, the pandemic has intensified children's experience of loss. What trends have you noticed over the past months, like mainly since the COVID-19 pandemic started when it comes to children dealing with grief and loss? How are they doing?

Dr. Mary Sullivan: Well, you know, Dr. Fritz, during the pandemic, children suffered tremendous losses. Tens of thousands of children across America lost a parent or a caregiver. And for those that didn't suffer that, they lost the schedule, the normalcy of their lives. Schools closed down without warning. You couldn't go on play dates anymore. Some children couldn't leave the house because they were sheltering in place. This all caused a lot of anxiety and depression in children, and larger than normal numbers of children and adolescents started to report these symptoms.

COVID also created barriers to getting treatment. So, you know, people were afraid to go to emergency rooms. There were waiting lists as private practices closed down. So between those two things, there was a real mental health crisis in America with children waiting a long time for a smaller number of beds or spots open for therapy. All these factors, again, led to a mental health crisis. And it was through the rapid initiation of telehealth and remote services that we were able to continue to serve some of these children, but certainly not all.

Dr. Ann Walters: Dr. Sullivan, can you tell us a little bit about how children grieve? How does this vary for different ages and different developmental stages?

Dr. Mary Sullivan: Okay. Well, you know, children don't grieve like adults do. They grieve quite differently. After a death, children feel bombarded with emotions that are troubling and unfamiliar to them. And when the feelings get too intense for a child, their mind takes them to a less painful place, to something more pleasant.

So you can be talking to a child about a loss and they'll be crying one minute and then they want to go and play with a friend the next. This is perfectly normal. This is how they grieve. This doesn't mean that because they show their grief in a different way than adults, they are not grieving or that they don't require support. This is how children grieve, so it's important to understand that while children may still be playing or not talking about the death, they are dealing with it in their own way, and they are still hurting and they need our time and support.

Two emotions that children frequently feel after death is fear. "If it happened to that person, who's next? Is it going to be another relative of mine? Is it going to be my best? Is it going to be me?" So if you can let them know how the loved one died, maybe they had a heart condition and that there will be people around to take care of them, that's a really important message.

The other emotion that they feel a lot is guilt. "Why didn't I see that my grandfather was pale? Why didn't I notice that there was a cough? I should've called 911 right away. Why didn't I do that? Why didn't I mention it to mom?" So it's important to let them know that they're not responsible for the death and that they're not being held accountable and that people are there to reassure them and comfort them.

Dr. Ann Walters: That makes a lot of sense. So you're really sort of saying we want to meet children where they are in a moment and know that they may be ready to move on really quickly from that moment.

Dr. Mary Sullivan: Exactly.

Dr. Ann Walters: And then perhaps also to be alert for these moments where you can probe for the more common feelings like fear and guilt.

Dr. Fritz: A lot of people wonder what to say to kids who are grieving. You know, I think it's they need to have a script or something. What's your suggestion there? What should parents say to kids who are grieving?

Dr. Mary Sullivan: You know, what I've noticed, Dr. Fritz, is that many well-meaning adults avoid talking about the deceased person in front of a child for fear that it's going to be hurtful or it's going to make them feel worse. So they tend not to mention the person at all and that has an adverse effect on the child. They feel like, "How come I have all of these feelings of loss and grief and nobody is? What's wrong with me? And have they forgotten about my mother already? Am I the only one that's feeling this loss?" So I think that it's challenging for parents and caregivers to know what to do or what to say or how to help children who are obviously hurting and, you know, that you don't want to inflict pain on the child. But in actuality, you have to share the hard honest truth, because that will build trust and open up communication. And it will allow a child to approach us with questions in the future, because they know that we're going to give an honesty answer.

Dr. Ann Walters: When you say, you know, that a child might say, you know, "Have they forgotten about my mother?" What are your thoughts about families developing certain routines that they have, like on an anniversary of a death? I worked with a family that had a way that they would remember their father who had passed away each year by going somewhere and doing something. What are your thoughts about that?

Dr. Mary Sullivan: I think that's wonderful. What you want to do is keep the memory alive, so that children can pull comfort from that as they go forward in their lives. Once a year is great. I think more often. Maybe anytime that you happen to think of the person that's deceased, you might say to the child, "Do you remember how much grandmother loved this park? Do you remember watching the 4th of July fireworks with your dad?" Anytime it comes up, it's nice for children and adults to be reminded of the person that's died by these little reminders so that they can stay alive in our memory. If we, as I mentioned before, try to avoid the pain, it can actually make the pain a little worse.

Dr. Ann Walters: What are some of the ways parents and caregivers can help young kids through the grieving process?

Dr. Mary Sullivan: I think my number one suggestion is that it's important to allow children to express their worries and give them time to adjust to all the changes in their lives. If a child receives love and warmth and understanding from a caring adult, they can begin to recover a sense of safety, which is what children lose when there's a death. Their world is just turned upside down and that's why the guilt and the fear is so powerful because they're a young person and somebody very important has been taken away. So they're not quite sure how to adjust to that. So it's important to give them time. And I think grief is about teaching children how to keep and treasure the loving memories that they have and ways to keep that person alive in their memory.

I think one of the, if I had to say one key sentence that people could use just to open up the conversation is "I know this is hard and I'm here for you.

Dr. Fritz: What about funerals? I've had people say that they thought it was essential that a kid go to a funeral and they input their instinct was to almost force it. What do you think of that? Suppose the kid is afraid to go.

Dr. Mary Sullivan: I think the parents have a really good understanding of what their kids can tolerate in this awkward, uncomfortable time and what they can't. So if your instinct is that it would help them to see that person one last time and to see how other people cope with the loss, that would be helpful. If it's going to be overwhelming because of the suddenness of the loss or the circumstances around the loss or any other item like that, probably best to allow them to skip the service and find other ways to help them attack the immediacy of the grief.

Dr. Fritz: Something like saying, a prayer or writing a story or drawing a picture or something that is more in their purview. Funerals are strange things for adults even, and for a child, they may not have the same ritualistic healing force that a funeral would for an adult.

Dr. Mary Sullivan: I really like what you've said about art work and writing letters. I think any type of method to express themselves in their grief is phenomenal. So If you can read a story, Freddie The Leaf is a great book and maybe jump start the conversation after reading the book or coloring or any type of mindful activity. You know, going to the ice cream shop, where they used to go with their father would be a great way for them to pay tribute to that memory and help them move on.

Dr. Fritz: So you recently authored a -- is that how you say it authored -- a coloring book for kids. Tell us a little bit about that?

Dr. Mary Sullivan: So when the pandemic first started and schools closed down right away, and children had no way to get information, two of my coworkers developed a coloring book called Rizzo Raccoon, Coloring My Way Through COVID Virus. And they gave a lot of information about how children could keep themselves safe, how they could form a support system and how they could express their mixed emotions. It got a lot of positive feedback.

And in that feedback was a request, "You know, we've had a lot of children lose a caregiver. Can you also do a book on grief?" So introducing Tory Turtle whose grandmother becomes ill and subsequently dies. And Tory learns about the stages of grief, how to find support something called memory visits, where he remembers when he and his grandmother used to garden together And then how to form a support system. It also has some mindfulness activities at the end of the book in case children need another springboard to open up conversation with a caring adult.

Dr. Ann Walters: Thank you so much, Dr. Sullivan. To download a coloring book to help children cope with the loss of a loved one, please visit bradleyhospital.org/kidsgriefandloss. And for more information, please visit bradleyhospital.org And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library at bradleyhospital.org/podcast for topics of interest to you. This is Mind Cast, Healthy Mind, Healthy Child, a podcast from the experts at Bradley Hospital. I'm Dr. Walters with Dr. Gregory Fritz. Thanks for listening.