During the grief experience children may have feelings that they have difficulty expressing externally and may cover up grief feelings in difficult social situations. The following activity can be beneficial in assisting children to recognise and respond to their grief feelings.

• Using paper plates and markers, ask the child to draw pictures of their face on one side of the plates showing how they feel in various situations. On the other side of the plate, ask the child to draw a face depicting how they feel inside during those same situations. (Situations could be…being at home with the family, at school, playing with a friend, alone at bedtime, or at a party)
• Point out the following:
  • Sometimes we appear to feel differently on the outside than we feel on the inside.
  • Feelings of grief are always a part of us even though we can participate in normal activities.
  • It’s normal to sometimes feel differently inside than we show others.
  • This can lead to a discussion of feelings such as “How can we express these feelings appropriately? What can we do to deal with these feelings?”

Mourning a major bereavement is a personal process with no set formula or absolute ending. Through mourning the child experiences the meaning of the loss for them and learns to live with their bereavement. Certain dates and times of the year such as Christmas time can be very difficult as it reminds the whole family of missing a loved one or it might make you more aware of the absence of a previously felt security. There are some things you can do to help a child to get through the tough times when they are reminded of a loss. Most of these things have to do with remembering. One of the most valuable techniques for getting through a particularly difficult period like Christmas is to commemorate the loved one in a meaningful way. For example, if your partner always said they wanted to visit the Christmas lights in Trafalgar Square but never got around to it, you can commemorate them by doing just that. As a family, you would honour your loved one by thinking of how much they would have enjoyed the festivities.        

Certain traditions may be particularly painful without your loved one, but you may not want to experience a secondary sense of loss by letting that tradition go altogether. Stick to doing the things that work for your child- even if they're a bit different! Sometimes doing quirky and unusual things snaps us out of the heavy black cloud of grief. So if your children want to watch your loved one's favourite action DVD on Christmas Day - even if it seems inappropriate - go ahead and do so!

Most importantly, create an atmosphere of openess whereby if you or your child feel like crying or even being quiet for a few hours, then that's OK. Allowing this time to grieve as a family is an important part of coming to terms with your loss.

Q: How do you get children to talk about their feelings?

A: Children’s feelings about a loss can often become buried and their reactions can often turn into complicated behaviour patterns. When they are grieving they might find it very hard to focus or concentrate, or be interested in their favourite foods or activities. At other times they might become angry or irritable. When grief is intense a child might just feel numb. Feeling nothing when you should be feeling a lot can be confusing. Some children can feel guilty if their feelings are numb when something bad has happened however feeling numb in such situations is often the result of an overwhelming emotional experience. Expressing how they are feeling might become very difficult. Particular techniques involving play are useful to help such children make more direct contact with how they feel. One creative activity is to make a box that includes reminders about the person. Ask your child to paint it or colour it and add images and words that help them feel protected and strong. Draw a picture, write a story, or make some notes about special memories that had to do with the particular person. Modify what materials you provide to your child depending upon their age or understanding of the concept of death.

Some children have considerable confusion over exactly what happened, when it happened or in what order things happened. Sometimes remembering is too painful and they refuse to remember. Here again particular techniques can be useful, such as making a life story book. The life story book is made with the child’s help, information about themselves, photographs of family, houses they have lived in, people or animals that have died, drawings, maps of journeys all dated in chronological sequence. Doing such an activity may enable events and their associated feelings to be recalled and ordered. Starting with “easier” events can initiate the process, which can then lead on to talking about more “difficult” events. Once children begin to express and share their held-in feelings and the grief work begins, then self esteem will begin to grow.  

Q: My child refuses to go to school, what should I do?

A: Although school refusal has been associated with both separation anxiety and social phobia, the easiest way to think about it is that school refusal is a difficulty attending school associated with emotional distress, especially anxiety and depression. It is not truancy and it's not the occasional day when your child doesn't want to go to school for a specific reason. It's when a child persistently avoids or refuses to go to school and is truly distressed with visible anxiety about attending.

Particularly after a death, children may be more sensitive to periods of separation from the remaining caregiver. This could manifest itself in the child having unrealistic and recurrent worries about harm occurring to loved ones, especially when they are apart. There may also be a reluctance to fall asleep without being near the remaining caregiver, the child may also have nightmares and tantrums when separation is imminent. Physical symptoms (especially frequent in older children and adolescents), such as dizziness, stomachache, cramps, vomiting, muscle aches, or palpitations, may also be present and problematic. When children seem sick and are trying to stay home from school, it is not always easy to recognise that they are avoiding school. That is why a visit to the Gp is usually a good first step. This can help ensure that your child doesn't have a physical condition causing their symptoms. Once a diagnosis of school refusal is made, it might help to:

• Listen and acknowledge their feelings about why they don’t want to go. Being aware of your own anxiety in your child’s presence is important as parents who tend to show they are upset with the child’s anxiety might worsen the situation. By giving lots of positive encouragement and modelling good stress management skills, parents can begin the process of reassuring the child that although it might be difficult for a while, they can cope with the separation. Bringing in a favourite small toy/object from home might also increase the child’s sense of safety within the school environment.

• Even though the child more than likely doesn't have a physical problem causing their symptoms, that doesn't mean that those symptoms aren't real. So the child isn't necessarily making up symptoms, such as stomachaches or dizziness. They may be caused by their anxiety about going to school. Relaxation techniques such as controlled breathing might be useful way to help calm the child down and focus on the “here and now".

• By working together with the school, parents and teachers can increase a sense of emotional safety in the school environment as well as warmly and openly allow for honest discussion about the anxieties associated with attending school. 

When a tragedy occurs, and a military parent does not return home, consoling a grieving child is a horrendous task. Dealing with their emotions in addition to yours must be overwhelming. During this time, a major factor to consider is how children experience the loss; that is, what do they feel they have lost with the death. According to Silverman (2011) “Children's reality has a logic, consistency, and integrity of its own. The meaning children make may seem strange to adults, if we do not consider that it reflects their age, stage of development, and experience in life”. As a mum of two boys, both under five years old, I thought I’d start by exploring the pre-school age group; what death might mean to them and how they might experience loss with a view to discussing some strategies that might help.

When someone dies, we not only lose the person who died but a relationship and the sense of self that existed in that relationship. Children’s sense of self depends on the presence of others. Their sense of safety in the world depends on others being available to take care of them. In general it is useful to make physical contact with young children who are trying to grieve; not to give false reassurance, to deny feelings or to change the subject, but to help the child feel safe enough to express and contain the feelings which may be raging inside. “Children of this age group are prone to magical thinking which results in their believing they caused the loss. Only when children feel safe will they be able to begin to let go of the fantasy and take reality on board” (Lendrum, 1992). In other words, they need to be told that the cause of their parent's absence has nothing to do with them.

Generally children between 3-5 years old however, recognise that people exist separately from themselves. “Children are much clearer about their dead parent's role in their lives, emphasising what the parent did for them, and with them. They focus on death as separation and are aware that with it comes sadness. They learn this from what they see in others. At this age, they become aware that their family is different from that of their friends, especially if they were very young when their parent died. They can begin to ask questions about what happened to their parent and where they are” (Silverman, 2011).

What might help children of this age group? I think children of any age should be given as honest an explanation as possible within their limits of understanding. They need to hear that their parent is not coming back and that it was not Daddy or Mummy's choice. There are some great books on the market that could help them understand something more about what dying means. It might also be useful to help the child label the emotions they experience, however for some children identification of feelings is very difficult and so more direct, active and playful ways of responding may also be important, such as drawing pictures or looking at photographs together. They need to be allowed to participate in the family’s loss and told that it’s alright to be sad. They also need to know that you may be sad for sometime to come, and that it might help sometimes to talk about the person who died; to remember together even if you both cry.

Ideally, children need a continuing relationship where they can rely on the comforting presence of a parent or another adult; however, this may not be available because the adults around a grieving child are usually grieving themselves. Many parents, overwhelmed by the pain of their own loss, might find it hard to be warm or empathic when feeling so hurt themselves. In addition the child’s reaction can be painful and the child’s questions, which do need answering, can be distressing. This means that seeking help from other adults such as relatives, doctors, teachers, friends or counsellors is important. Finally, children might also need to be helped to say “goodbye” to the person. If it is not possible to do this to the person themselves, then a symbolic “goodbye” using aids such as letters, photo’s, drawings might help. These techniques can help to round off the emotional work and enable the child to reinvest in their current life, reconnect with emotions and form satisfying relationships again in the present.