Grief and Bereavement

Everyone grieves in his or her own unique way. The process of grieving is often long and painful for all who knew the child. This can include parents, siblings, relatives, friends, peers, teachers, nurses, neighbors, and anyone who understands the loss of a child.

What are the physical and emotional signs and symptoms of grief?

The emotional and physical expressions of grief are often the most obvious part of mourning. Everyone expresses sadness and loss in different ways. There are some common characteristics, however, that occur when one is experiencing great loss and sadness.

Crying, sorrow, and anger are common emotions when dealing with death. Often anger is misdirected causing conflicts with family members and marital relationships. Feelings of loneliness and desolation can be dangerous to some extent. If the living feel there's no point going on without their loved one, feelings of suicide can preoccupy their thoughts. These desperate feelings need immediate intervention. It may be normal to think about death and feel left behind when someone close dies, but it can overcome all other emotions and lead to suicide.

Appetite changes, eating more or much less, may occur. Sleep may increase or decrease to the point of exhaustion. Survivors may detach from all those around them, including surviving siblings and spouses. However, attachment to surviving siblings may become overbearing and unhealthy to both parent and sibling.

These strong emotional and physical symptoms of grief may not occur for all people who experience a loss. These symptoms may last as short as a week after the death or may last months or years.

What are the stages of grief?

The grieving process varies from person to person in terms of the order in which one experiences the stages of grief, as well as the time it takes to go through the stages of grief. People who are grieving don't necessarily progress in order. Some people may start with anger, while others may start with denial. The stages of grieving aren't necessarily a one time experience. However, each step helps with the healing process. Grief is usually divided into five stages:

• Denial. Denial is a stage where one can try to believe that the death hasn't occurred. One may feel numb, or in a state of shock. Denial is a protective emotion when a life event is too overwhelming to deal with all at once.

• Anger. Anger is a stage in which you're very upset and angry that this tragedy has happened in your family. One of the best ways of dealing with bursts of anger is to exercise or participate in another type of physical activity. Talking with family and friends, other parents who have lost a child, and the hospital staff, may also be helpful.

• Bargaining. Questioning God, asking "Why my child?" and "What did we do to deserve this?" are common questions in this stage. Guilt is a primary emotion during this stage. Searching for something that you personally did, which could have contributed to the death, is all part of bargaining. It's important to remember that there's nothing you or your child did which contributed to the death.

• Depression or sadness. This is a stage in which the death of a child can no longer be denied and parents and siblings may feel a profound sense of sadness. This is normal. It may be accompanied by physical changes such as trouble sleeping or excessive sleeping, changes in appetite, or difficulty with concentrating on simple daily activities. It's important to talk about depression with a health care professional such as a social worker, or counselor, or meet with a support group to help you cope with these feelings.

• Acceptance. Acceptance is the stage in which you've accepted death and are at a point where your child's death has been incorporated as part of your life. You've made an adjustment to the loss. This doesn't mean that you'll never feel other emotions, but usually families find that they're better able to manage their lives overall on reaching this stage. Some resolution has taken place with the child's death. This may include your religious and cultural beliefs and practices.

Sibling and peer bereavement

The impact of a child's death on their siblings is important to remember and address. Most young children can overcome the trauma of a sibling's death with the necessary support and time. Many children have strong feelings of guilt and blame when their sibling dies. Often the child who has died is idealized after his or her death, leaving feelings of inferiority and neglect for the surviving siblings. These siblings have often been surrounded by death, illness, and great sorrow from all family members, especially parents, during the dying child's experience. More often, the young siblings of a child with a terminal illness have been protected from some of the experiences associated with the death. They may not have been allowed to visit the dying child, prevented from participating in the religious or cultural rituals, and possibly, even prevented from attending the funeral. All of these experiences may help with closure and can make a sibling's survivor-guilt less burdensome.

For peers and classmates, the grief process may be experienced in a variety of ways. Many children may not have had an experience with anyone their age dying from an illness or accident. For any age group, review of our own mortality and purpose in life is evaluated. Young children may fear they will die soon also. They may also have feelings of guilt and blame, similar to the sibling's expression of grief. The peer of a dying child also needs time and emotional support to grieve over his or her loss of a friend, neighbor, and/or classmate. There are many support groups that include nonfamily members and peers in helping work through the grieving process.

Help is available

There are many support groups available that are experienced in helping families cope with a loss and work through their emotions associated with grieving. The phone book, hospitals, churches, and the Internet are all full of sources that are available to help.

It's important to understand that grieving is a normal response. Grieving, however, should be managed so that activities of daily living and relationships among the survivors are able to be maintained. Misdirected anger and feelings of guilt and blame can be very detrimental to a family and marriage. Seeking out support groups and professional help may make the grieving process more manageable and have less long-lasting effects.

No support group will be able to take away the hurt and sorrow, nor will they be able to magically end the grieving. Support groups will, however, help you understand your emotions, the loss, and meet others who have had similar experiences and what helped them through their toughest moments.

Follow-up care is also an important task for support groups. Often there's a lot of attention focused on the family in the first few months following the death, but there may be little support years down the road. Grief can recur years later. It may be triggered by a memory of the deceased, another child in the family, or by an anniversary or birthday associated with the deceased. Follow-up care in the bereavement process is important to be able to detect recurrence of grief and to manage long-lasting effects of grief. Follow-up care may take place over months to years.