Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. I'm Melanie Cole. And here to tell us about supporting our youth during grief and bereavement is Miranda Wichelns. She's a licensed clinical social worker at Hyundai Cancer Institute at CHOC.

Miranda, thank you so much for being with us today. When there's a death in the family, we all want to support our children during a difficult time. I'd like you to start by how do we tell them what's going on without causing them more distress? Because there's so much here to talk about. We're dealing with our own grief and our own feelings of bereavement. How do we talk to them about this right at the outset?

Miranda Wichelns: Sure. Well, thank you so much for this opportunity. My recommendation is always honesty. I feel like children and teens, they're so smart and they think and they feel so much that what they are worried about or afraid of is often worse than the actual truth. And if we give them the actual truth, then we're able to support them and they're able to have the grounding of knowing what has actually happened. So, I recommend using the real language. So instead of cliches that might be confusing or just sometimes even scary to children, I recommend using the real words of what happened, that the person died, that they had a heart attack, their body stopped working, whatever it is in a developmentally age-appropriate way, we really should say it. Certain things like, "I'm sorry for your loss," or "They passed away," those words might feel comforting to us as adults. It might be the way adult society talks, but we lose our keys, we don't lose our mom. Or if somebody passed away, what does that mean? Where did they go? So, you know, explaining things in real words that they can understand is the best policy.

Melanie Cole, MS: Miranda, I hear you. And I agree with you about being honest and certainly age-appropriate discussions. But in this day and age, and we're seeing suicide rates among teens going up, we're seeing all of these different feelings of anxiety and problems, and there's a mental health epidemic among our children anyway. What if it is something like suicide of one of their friends, of someone they knew at school or something like that? Being honest, yet how do we discuss something that difficult?

Miranda Wichelns: Well, I don't have, you know, magic words or a perfect script. You know, every situation is different and every grieving child or teen or adult is different. That being said, I don't think that we should shy away or make what we are saying try to feel more comforting. If something tragic and traumatic happens like that, I think that the most comforting thing we can do is to put that in the light and be with them to support them as they digest that news and as they figure out how to process and how to ultimately feel okay. That process is what I'm hoping to speak more about.

But things like suicide, talking about it not going to cause it. I think talking about it, especially if it is in the context of maybe a high school where there's so much chatter amongst peers, there's so much on social media, hearing what happened from a trusted adult, and knowing that they really can trust that the information that we are telling them is the truth, is going to be less scary than the what-ifs and the wondering and the Googling on their phones and just trying to find the information, being able to tell them and support them and have that connection with them I feel is a much more supportive thing to do than to not talk about it.

Melanie Cole, MS: I agree with you completely. So then let's talk about that process. How do we handle involving them? in things like the funeral and afterwards or the day-to-day family routine norms, milestones, how do we involve them? Tell us about that process of grief and bereavement and what comes next.

Miranda Wichelns: Sure. So, many times parents might feel that they should not have a child go to a funeral or participate in a memorial service or something like that, that maybe shielding them from that is better, it's a very sad occasion and they should protect them. However, giving them the opportunity to make their own decisions whenever possible is really what we would recommend. So, that might mean telling them in advance what to expect. You know, what these words like viewing or celebration of life or terms like that are meaningless unless you've done something like that before. So, telling them, "We're going to go to this funeral home. And at this particular time, they will invite us into a room. We're going to see your grandma and she will be lying in a box and she will be dressed up and look very nice. And you will be here with us. Where would you like to stand? Where would you like to sit? Who would you like to sit by?" Things like that, to have an idea of what to expect and some choice in it is helpful. Not every child or teen will want to go or it won't feel right to them to go to certain aspects, but telling them in advance what to expect as much as possible and giving them that choice is really beneficial.

Also, giving them the opportunity to participate if they would like, you know, maybe they would like to say a few words, maybe they would like to draw a picture for the program, maybe they would like to choose their favorite pictures for slideshow or something like that. Maybe they have memories to share that are special to them that other people might not know. That would be beautiful if they could share those things in a way that feels right to them. So, that's what I would recommend.

The other thing that I often hear is parents and adults are afraid to show their own emotion, their own grief around a child or around a teen and they feel as though they have to be strong and they have to be okay to be around them because they don't want to distress the child or to scare them. But again, I feel that authenticity is the best approach. So, showing them that It is absolutely okay to show emotion and you can still be okay even if you're crying or even if you're angry or even if you're worried too. You can narrate what you're feeling to them and you can model good self-care and caring for yourself through this. So often, kids are worried, "Will this happen to me? Who will care for me? Are we going to be okay?" You know, those sorts of needs and questions. And so, being able to show them that, even though I'm crying and I miss my own parent or whoever the loved one is that we're grieving, I do feel sad and I will be okay. And because I feel sad, I want to sit with you and I want to hold you and I'd like to maybe go for a walk, be in the fresh air, something like that. Those things will help them know that there is that sense of security, that there isn't a silent secret in the family that this thing just happened that we don't talk about, that is very scary. But instead, this thing just happened that makes us very, very sad. And it also makes us come together and go through this together and care for ourselves, care for each other as we walk through it.

Melanie Cole, MS: Well, you've just given us some wonderful ways, Miranda, that we can support our child or teen during their grief. But what are some signs that we may need to bring in professional help, a counselor, to help our children deal with and navigate their grief?

Miranda Wichelns: So, I recommend viewing grief as a normal part of life. You know, a normal part of loving someone, of caring for someone, something that we will all experience. And because of that, I recommend support even if there is no formal mental health diagnosis or even if there is no major complicated grief or something like that. Support is often a good thing, even trying a therapist or trying a group and seeing if there are things that we can get out of it, things that are helpful, things that are comforting, that's a good tool to have and a good way to care for ourselves.

In terms of what to look out for, those would be things like when grief is really impacting a child or a teen's ability to function, ability to go through their normal day-to-day life. Maybe they are not eating, maybe they are not going to school, maybe they are harming themselves in whatever way, things like alcohol or drugs or cutting themselves, you know, those kinds of very dangerous, harmful behaviors, those are really a red flag to get help even if that help is emergency help sometimes.

However, the other side of it is I think a lot of times parents or loving adults just are in so much pain witnessing a child or a teen having feelings, having emotional distress going through this. And so, sometimes I think adults worry that, "Oh my gosh, they're grieving, they need help, we have to do this and this and this." And really just taking some time to be honest, to be present, to be a safe, warm, calm comfort to that child, often having that relationship to lean on is often very, very important and comforting throughout their process. And even if something terrible has happened, many times parents are feeling sort of paralyzed. You know, "I can't believe this happened to my child. When I was 15 or when I was whatever age, I never had to deal with something like this." It feels to a parent like they are damaged or they are traumatized and will never get through it.

But really, even when awful things happen, we do find ways to get through. Children and teens and adults are resilient. And with enough support, they will have a story to tell, they will be able to experience post-traumatic growth, they will be able to cope with losses and painful experiences in the future, they'll be able to support others also. Whereas if we do things like encouraging them to move on or not talk about it or if we are panicked when they are showing emotion, those things tell them it's not okay to go through this normal human experience, this normal human feeling. We bottle it up and then it will come out many times in those unhealthy dangerous ways. So, that's how I recommend approaching it. Support is a good thing. Support can look like many things. It doesn't have to be a grief counselor or a therapist or a support group, even though those are wonderful tools. It can be special time with a parent. It can be extra time with a really supportive friend group. It can be, making sure that that daily routine, that normal routine that they had before the death continues. So, making sure they still go to school, they still participate in their activities, even if they might go through them differently. They might not feel like they are, for example, as good in school or as good on the sports team or whatever, as they were because they're healing, they're digesting everything that happened. Having that normal routine to lean on is a good comfort both for young kids, as well as adults.

Melanie Cole, MS: What great information, and I can hear the compassion in your voice. Miranda, thank you so much for joining us and really giving us amazing advice on helping our youth during a time of grieving and bereavement. And so many great ideas and tips to help our child through that. So, thank you again. And for more mental health tips and information, please visit choc.org/mentalhealth.

Thank you so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. Please always remember to subscribe, rate, and review this podcast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.