Q&A: What to Say When a Child Dies

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By Melissa Tennen

Has someone close to you lost a child? What do you say? What can you do? Learn how from Elizabeth B. Weller, M.D., professor of psychiatry and pediatrics at the University of Pennsylvania, Children’s Hospital of Philadelphia.

What are the stages of grief that a parent may experience?

Elizabeth B. Weller: The first stage of grief is feeling shock, disbelief and denial. This usually lasts several days to weeks.

Second, there is an acute mourning period with bodily discomfort as well as emotional discomfort. During this time, people withdraw from societal functions. This can last several weeks to months.

Third is restitution, which happens after several months or years since the child has died. This is when parents acknowledge their loss and what it means for them. At this point, they can accept their loss and return to their routines.

Keep in mind that parents don’t expect to outlive their children hence the grieving period is often much longer than grief with other losses.

Is there a “right” or “wrong” way to grieve? Why?

Weller: Grief is individualized. Different cultures grieve differently. Different people grieve differently. Some are very quiet while they grieve. Others show outwardly that they are upset.

Do men and women grieve differently?

Weller: Often women verbalize more of their grief. In this culture, men are taught not to cry. In different cultures, men openly show their grief as women do.

How do you tell a sibling, and how can you help that child cope?

Weller: One of the parents or both parents together should tell the children about the loss of their sibling. Attention should be paid to the age or to the developmental stage of the child to know how to talk with them in simple language so they can understand. Often, the concept of death is not established in children who are younger than 6 years old.

What do you say to a child younger than 6?

Weller: A child who is younger than 6 years old or has not developed the concept of death should be given a more concrete interpretation of death. Often children have had pets that have died. So, one can talk about that or flowers that die. Explain death as part of life not something to be scared from. It is a part of the lifecycle. A goldfish often is a helpful pet for children as they die quite soon.

Helping the child go through the bereavement with the family as well as participating in funeral-related activities would help them understand and accept. Encourage the young child to go to the funeral but do not force them if they do not want to. If a child wants to go to the funeral, make sure there is a designated adult family friend who the child feels comfortable with to accompany the child as the parents are distraught with their grief and will not be able to help the younger siblings at this time.

Young children attempting to master the loss they have experienced will play acts of funeral or burial repeatedly. The more artistic child will draw dead people and ghosts.

Do not say the dead child is “sleeping” or “is on a journey” because you might have a child who will get scared to go to sleep. Do not say, “He was so nice that God called him home.” You might have a child who starts behaving very badly to avoid dying.

Instead tell them that dying is part of living and a part of the lifecycle.

How do you handle questions from friends and family?

Weller: When you are in a shape that you can talk, then you can talk. If you are not ready, tell them you are not ready.

How do you know when to move on and maybe even try to have another child?

Weller: First thing is to make sure parents are not depressed. The grief of losing a child is the hardest grief, and it lasts longer than grief due to any other loss. Often parents get depressed and if the mother conceives during that period, this will be additional burden on her worn-out system due to depression. Often children get neglected if a parent is depressed and there is no other help within the family.

Also, parents should make sure they understand that the new child is not going to replace the child they lost. This would put an unnecessary burden on the new child. The new child will have his or her needs and the parents should make sure that they are not expecting the new child to love them immediately and make up for their loss.

Do you advise family counseling? Why?

Weller: Most grieving families do not require routine counseling. When there is good support system, such as extended family, friends, church, synagogue and so on, and there is no family history of psychiatric disorders prior to experiencing the death in the family with time and with the help of their faith, they will do OK.

Counseling is recommended when grief is associated with suicidal thoughts or acts, as this does not happen in normal grief. If one gets severely depressed and dysfunctional, with change in appetite or weight, change in sleep, trouble concentrating and neglecting their hygiene, it is wise to get help.

If one or two of the above symptoms occur, just talk to your family physician. Often the grieving person will have trouble sleeping. If this is prolonged, one should get help because sleep deprivation may lead to further deterioration of their health. The most common psychiatric problem that follows bereavement is major depression. This is true in adults and children. So if one has most of the signs and symptoms of major depression, care should be sought immediately.

If you know someone who has just lost a child, what do you say or do?

Weller: You tell them you are very saddened for them and if there is anything you can do for them to help them out, let them know you will be there for them. Make specific suggestions such as helping with house chores, caring for young children and running errands. Most people send food, which is often thrown out after four or five days because there is too much of it.

After the first 40 days are over, things start settling down back to their routine in the family.

Also people seem to forget that for the grieving family, the death of a child is the worst for parents. So they should continue periodically keeping in touch with the grieving family and remind them they are willing to help without forcing themselves on the bereaved. Grieving is very individualized. Some people grieve for a long time. Others take shorter time. So respect the individual differences.

What are tips for helping someone grieve?

Weller: Acknowledge their loss and sorrow. Do not tell them “I understand” because you don’t and it makes the grieving parent angry.

Encourage them to share their sorrow. Listen to them. Cry with them if you feel like crying.

Extend your help to them.

Encourage them to share their good memories about the deceased family member.

Encourage them not to hide their grief from other family members.

Do not tell them time will cure. Time will ease the pain in their soul, but there will be a permanent scar left behind.

What is the best advice for a parent or sibling going through this?

Weller: Let them know that their loss is very hard and the feelings they are going through are normal. Feelings of guilt about things they should or should not have done about the deceased are common. Sleep disturbance is very common and psychosomatic complaints are common.

Tell them you are a good listener and a confidant if they want to talk to you as a friend. Encourage them to talk to each other about their loss. Encourage them to share their memories of the deceased. If you as a friend notice that the children left are being neglected or the grieving parents are becoming dysfunctional or starting to abuse substances or alcohol to deal with their grief, make sure you help them get expert help immediately.

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