Coping with the anxiety that illness brings to us | Psychology Festival of Learning
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Rev Peter Fox, who is qualified in Psychology, will be talking about how Insurance Companies insure for dread disease and how the process of dealing with serious illness is always a hard and difficult road.
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Coping with the anxiety that illness brings to us | Psychology Festival of Learning
- 1. Welcome Please follow us on Facebook (SACAP) & Twitter (@SACAP) – please use #psychologyfest in all Tweets)
- 2. Bereavement in Children Presented by Khaliah A. Johnson, MD Pediatric Palliative Care Consultant Children’s Healthcare of Atlanta, U.S.A. Bigshoes Foundation, S.A. August 15th , 2012
- 3. A Special Thanks to a Special Being
- 4. A Discussion • Who are the children we should consider when we think about bereavement? • What have been some of the challenges you have encountered in supporting bereaved children? • What approaches have worked for you in caring for bereaved youth?
- 5. A Case Tia* is an eight year old girl with diagnosis of acute lymphoblastic leukemia, who was just recently hospitalized when diagnosed with her third relapse. What would you do?
- 6. What is bereavement? • Bereavement refers to the process of losing someone or something to which we are bonded. • Grief is the multi-faceted response to loss (may include physical, cognitive, behavioral, and philosophical dimensions). • One’s grief through the bereavement process is influenced by resilience.
- 7. Do children grieve differently? • Children learn to adapt to a wide variety of changes (i.e., being weaned, moving houses or schools, the death of a pet). • How children cope with loss will depend upon their personalities and the guidance they receive from caregivers. • Though previously thought that children do not grieve, we know that they experience loss in ways consistent with their cognitive and social
- 8. 4 General Responses to Grief I hurt inside I do not understand I am not enough I do not belong
- 9. Infants and Toddlers “If a child is old enough to love, he is old enough to grieve.” • Concept of death- will not understand death but will respond to changes in his/her routine that death causes • Grief Response- irritability, respond to emotions of adults & caretakers • Signs of Distress- regression, changes in eating or sleeping patterns • Possible Interventions- reestablish routine, comfort, touch, hold infant or toddler
- 10. Preschoolers (3-5 years) • Concept of death- “engage in magical thinking”, view death as reversible or temporary • Grief Response- may ask questions about the death over and over again, may reenact death through play • Signs of Distress- regression, bedwetting, separation anxiety, sleep disturbances • Possible Interventions- answer questions honestly, use appropriate language to explain death, participate in play with children, maintain a routine
- 11. School-Age Children (6-9 years) • Concept of death- engage in “magical thinking”, associate death with old age, personify death (e.g. ghost, Bogeyman, Grim Reaper) • Grief Response- may regress emotionally or behaviorally, aggressive behavior (especially in boys), may be curious about death and what causes death • Signs of Distress- regression, nightmares, violent play, tries to take on the role of the person who died • Possible Interventions- give children an opportunity to participate in memory making activities, share stories of person who died, model appropriate grief responses
- 12. Pre-Adolescents (9-12 years) • Concept of death- understand that death is final and that it will happen to everyone including themselves, view death as punishment • Grief Response- finality of death creates anxiety, fear the death of other people they love, want to know details of how the death happened • Signs of Distress- regression, problems in school, withdraw from friends, extreme weight loss or gain, suicidal thoughts • Possible Interventions- offer constructive “venting” alternatives like sports or exercise, give as much factual information regarding the death as possible
- 13. Adolescents (12 and up) • Concept of death- understand death cognitively, struggle with spiritual beliefs surrounding death, search for meaning behind the death, understand possibility of their own death • Grief Response- may act out, may express that “life is not fair,” may prefer to discuss feeling with their friends, may develop an “existential” response • Signs of Distress- intense anger or guilt, poor school performance, longterm withdraw from friends, opposition/defiance • Possible Interventions- sharing own experiences with loss, explore religious/spiritual beliefs with them
- 14. Developmentally Appropriate Language • When talking to children ask questions to assess their level of understanding of the events. • Identify fears and misconceptions, offer reassurance, and provide opportunities to play. • Avoid euphemisms such as “sleeping” to explain death. • Explain what death means medically. • Ask what death means to them in religious terms- if they believe in an afterlife ask them what that looks like . • Remember: you don’t have to have all the answers, practice reflective listening.
- 15. Reminders for Caregivers • If parents do not feel like they can directly tell their child, offer to be in the room as a support to help “guide” them through the difficult conversation • Remind parents that every child will grieve in their own way, in their own time (ie: grief bursts) • Give child the “choice” to visit with patient and always assure them they do not have too • PLEASE remind parents to not force the visit, or request to have the child kiss/touch the patient but offer as a suggestion (Ie: “if you want to hold your mom’s hand, you still can”) • Remind parents that children need breaks from the room and kids grieve through their play. Normalize the importance of “a play area” during this time and frequent breaks. • After reviewing the child’s needs, begin to explain the keepsake process and what you are able to offer...encourage parental/caregiver participation.
- 16. Keepsakes • Hand molds & handprints – Family handprints • Memory Box – Photos – Lock of hair – Clothes – Blanket – Drawings/Cards from loved one – Video
- 17. Taking Care of Yourself Formulating a self-care plan or strategy is an essential part of caring for bereaved families It is important to ask yourself: How do you cope with your own sense of loss? How do you “stay centered” so that you can help others?
- 18. A case Revisited Tia* is an eight year old girl with diagnosis of acute lymphoblastic leukemia, who was just recently hospitalized when diagnosed with her third relapse. What would you do?
- 19. Resources • http://www.childbereavement.org.uk • “Helping children cope with the loss of a loved one- a guide for grown-ups.” William C. Kroen, 1996. • Archives of Pediatric and Adolescent Medicine: http://archpedi.jamanetwork.com/articl e.aspx?articleid=1107705 • Black D. Bereavement in Childhood. BMJ 1998; 316 (7135): 931-33.
- 20. Thank you Please visit www.sacap.edu.za/events to view material from this talk and to add your comments Please follow us on Facebook (SACAP) & Twitter (@SACAP – please use #psychologyfest in all Tweets)
Hinweis der Redaktion
- Children may experience a wide range of feelings during loss, including anger, guilt, confusion, sadness and depression. So loss isn't unknown to children, although they may have little understanding of their reactions or how to express what they feel.
- The impact of a death on children results in 4 general responses: “ I hurt inside”- reactions normally associated with grief including: sadness, anger, frustration, loneliness, fear, anxiety, irritability, and guilt. “ I do not understand”- if children are not assisted in developing an understanding of their loved one’s death and events leading to it they are oftentimes confused or develop their own “story” of what must have happened to their loved one. “ I do not belong”- a death in the family disrupts day to day activities, children can feel overwhelmed with the flurry of activity. Children may feel that they’re not a part of the activity, that they don’t belong. Furthermore, bereaved children often feel different from their peers contributing to feelings of not belonging. “ I am not enough”- response when children feel that the child who died was the “favorite.” Children conclude that they should have died and not their sibling, that they are “not enough” to make their parents happy. Aside from the general responses, each child will have different understandings and reactions to death based upon their developmental level. We break down development into 4 levels, infants and toddlers, preschoolers, school age children, pre-adolescents, and adolescents.
- Concept of death- will not understand death but will respond to changes in his/her routine that death causes, toddlers will realize when someone is missing may ask for them over and over, may talk to them through play Grief Response- irritability, respond to emotions of adults & caretakers Signs of Distress- regression, changes in eating or sleeping patterns Possible Interventions- reestablish routine, comfort, touch, hold infant or toddler, encourage play, life cycles coloring books, use books with simple explanations of death
- Concept of death- preschoolers engage in “magical thinking” and egocentricity, he/she does not differentiate between thoughts and deed and therefore may believe that something they did or said caused the death, may view death as abandonment or punishment, view death as reversible or temporary Grief Response- may ask questions about the death over and over again, may reenact death through play Signs of Distress- regression, bedwetting, separation anxiety, sleep disturbances Possible Interventions- answer questions honestly, remind children that death is permanent and that their loved one will not be coming back, use appropriate language to explain death---simple concrete explanations work best, participate in “death play” with children, read books with characters dealing with death, discipline consistently, maintain routine which is so important to preschoolers, give child the choice to attend a funeral or “goodbye ceremony” prepare them for the funeral with explanations and identify a person who can specifically be with the sibling at the funeral in case they become upset or want to leave, this person should not be the parents, reassure children that they are safe and will be taken care of Refrain from using language such as: “God needed your brother” or “Your brother is sleeping” to explain death, use the word died and explain what that means, introduce concepts of after life if religiously appropriate
- Concept of death- younger children in this age range still engage in “magical thinking” feeling much guilt for the death of their loved one if they were recently mean to them for example, associate death with old age acknowledging that death occurs but it’s so far in the future that they don’t worry about it, personify death (e.g. ghost, Bogeyman, Grim Reaper) to cope with feelings and associate death with something dark studies by Fox and Nagy found that 6-8 year old children viewed death as happening to the elderly because they could not run fast enough to escape the pursuing ghost or angel who would cause their death therefore believing that children couldn’t die because they could outrun the demons, younger children may make superficial associations with death so if loved died in the hospital they may be fearful to go to the hospital because associate it with dying Grief Response- may regress emotionally or behaviorally (including thumb sucking, baby talk, being overly clingy with parents), may complain of imaginary illnesses like head or stomach aches, aggressive behavior (especially in boys), may be curious about death and what causes death Signs of Distress- regression, nightmares, violent play, tries to take on the role of the person who died especially true in siblings when a middle sibling suddenly becomes the oldest, may take on additional responsibilities that the oldest sibling previously had Possible Interventions- give children an opportunity to participate in memory making activities, share stories of person who died, model appropriate grief responses , set aside a daily “check in time” to talk with child about feelings, give children adequate explanations for how the death occurred– children in this age group understand functions of the body so death should be explained in terms of the body ceasing to function
- Concept of death- understand that death is final and that it will happen to everyone including themselves, view death as punishment Grief Response- finality of death creates anxiety, fear the death of other people they love, want to know details of how the death happened Signs of Distress- regression, problems in school, withdraw from friends, extreme weight loss or gain, suicidal thoughts Possible Interventions- offer constructive “venting” alternatives like sports or exercise, give as much factual information regarding the death as possible Pre-teens often have a lot of anxiety about death after experiencing the death of a loved one. This anxiety is not easily processed by the developing pre-teen, may result in pre-teen acting out inappropriately, laughing during periods where family is mourning, spreading rumors about the death or the person who has died, or behaving in a way that is inconsistent with the situation. Modeling appropriate responses to grief are good ways at guiding a pre-teen through grief process
- Concept of death- by age 12, children can engage in more abstract thinking, they understand death cognitively, and understand it’s irreversability and finality of death, struggle with spiritual beliefs surrounding death, search for meaning behind the death, understand possibility of their own death Grief Response- may act out, may express that “life is not fair,” may prefer to discuss feeling with their friends, may develop an “existential” response An “existential” response would be a teenager thinking that any future planning for their lives is futile because they could die at any time. Signs of Distress- intense anger or guilt, poor school performance, longterm withdraw from friends, opposition/defiance Possible Interventions- sharing own experiences with loss, explore religious/spiritual beliefs with them, it may be helpful for adolescents to join a support group in an effort to help them connect with other teens who have experienced loss Adolescents may engage in risk taking behaviors such as extreme sports, drinking, drugs, to test their own mortality*
- The most common question I’m asked by parents in a bereavement situation is “what do we tell the other kids?” It’s a conversation that parents never imagine having with their children. When talking to children ask questions to assess their understanding. Open ended questions like can you tell me why you’re at the hospital? Can you tell me what you know about what happened to your brother or sister? These narrative answers give medical professionals a good idea of how much information the sibling already knows. Use these answers as an opportunity to provide additional information as necessary. Avoid euphemisms such as “sleeping” to explain death. Something common that parents say is that “God needed your brother or sister” creates fear in young children who wonder “what if God needs my mom or dad” instills a fear that God will “need” others and that another death will occur. Explain what death means--- their loved one’s heart is no longer beating, they are no longer breathing, they can not move or walk anymore, they cannot speak or think. Offer medical comparisons to explain the dying person’s “unhealthy” heart/lungs/brain with that of the “healthy” child Ask what death means to them in religious terms- if they believe in an afterlife ask them what that looks like
- Jotam’s family- we took a big paint canvas and did handprints of all of the 4 kids with the heading “Mommy’s Blessings” and presented that to his mother on the day that Jotam passed away. Legacy activities are important to offer families in bereavement situations, although all families will not want to take part in them. Hand molds are historically done by child life specialists in the hospital setting with the mentality that we’re giving families a piece of their child to physically take home with them. I’ve had families call and say that they place their hand on top of their child’s plaster hand mold every day, that they trace the lines on their hands and feet, it is a representation of exactly what their hands and feet looked like at that time in their life. Brielle’s mom we did mom’s hand holding Brielle’s little hand in the mold.