Grief in children

Grief in children: a handbook for adults

Atle Dyregrov
2nd edition, Jessica Kingsley Publishers, London, 2008. ISBN 9781843106128

"Atle Dyregrov has written about children and death with a calm and clear voice"

Explaining death, grief and loss to children and young people can be incredibly challenging especially for grieving parents and carers. Even health professionals, emergency workers, police and teachers working with children find talking about death, grief and loss with kids hard.

This became clear to me when a nurse asked AWCH for information about how to talk to children in her own family about their parent's serious illness. She wanted to talk with and prepare children at their level and in a supportive way. This was a critical time in their lives.

Grief in children: a handbook for adults, is an accessible book for parents, carers, family and professionals. It is for people who want to prepare, care for and support children living through grief, loss or trauma when someone is dying or has died. Circumstances covered vary from anticipated to sudden and traumatic death. 

Children and adolescents at different age levels have different understandings about death and grief. So how do we help children through their grief journey? 

Atle Dyregrov has written about children and death with a calm and clear voice. This is valuable in western culture where people often find it difficult to know how to talk about death. This book gives information about children and how they might think about death based on their age, sex and developmental stage. Useful examples have been drawn from family life experiences. In this second edition, more children's voices are included with children's questions and reactions. There is also more material on traumatic deaths. Atle Dyregrov has listened to what children have said about what is helpful and supportive.

To view contents link to the book, Grief in children: a handbook for adults. The chapter Guidelines for taking care of children’s needs, explores open and direct communication. There is information on death following an illness, making the loss real and giving time for understanding to grow. Children need information, adolescents may want to have websites to look at. 

The section Handling death in a playgroup and at school, is an inevitable situation for teachers and this book will help to do this well. Find help with mental preparation and planning before a death or other critical event occurs. Atle Dyregrov includes information on terminal illness of a child, although the general focus of the book is on sudden death.

This handbook overviews crisis or grief therapy for children and bereavement groups for children, caring for oneself and peer support.

Grief in children, draws on the author’s experience as a clinical psychologist, author and director of the Center for Crisis Psychology in Bergen, Norway.  His extensive experience and research underpins this book, yet the tone is informative and very readable. The case studies bring experience and understanding to the topic. Concerned adults will find a good overview and helpful information for what can be a hard task involving raw emotions.  

For children’s healthcare facilities valuing patient and family centered care, Grief in children will be a good addition to the bookshelf. It is also an accessible reference book for early childhood educators, teachers, school counselors, pastoral carers, libraries and families.

If you found this blog informative you might also like to read our blog G is for Grief and Grandma.

More information

Crisis support

Kidshelpline  Call 1800 55 1800

Hey teachers there's also the Kids helpline @ School program

Lifeline  Call  13 11 14

Resources and links

Australian Centre for Grief and Bereavement

Australian Child & Adolescent Trauma, Loss and Grief Network 

National Centre for Childhood Grief

Parent and carer information

Raising Children Network

Better Health Channel  

Kidsmatter

Women's and Children's Health Network, SA

AWCH books to borrow...

Do you have a resource that has been helpful? We'd love to hear from you.

Jillian Rattray

AWCH librarian

Email: Jillian@awch.com.au
AWCH Library

M – is for Moment of panic and Mum’s sleeping on the floor

Moment of panic

A brown blob appeared momentarily in my peripheral vision and disappeared, I stopped. Continuing on, the motion of my swinging hair caused the reappearance of the brown blob. Standing still, I sensed a slight weight, something was there… and it was starting to move.

A moment of panic ensued and with a hasty flick, the small huntsman spider dropped to the floor, scuttling across tiles, sinking low into a groove, not daring to move. This young Huntsman with brown translucent legs, had been taken from familiar surroundings and catapulted into a strange environment – my bathroom. 

Mum’s sleeping on the floor

This reminded me of a different kind of fear, not of spiders but of fear and children in hospital. I’d just read an article written in 1982 about one parent’s experience* with her seven-year old in hospital. Her sick boy, Sam, was in a ward with other children also taken to hospital in an emergency. If I were to give her article a title I might call it, “Why I chose to camp on the hospital floor”.

Not long ago the expectation was that parents didn’t stay with their children in hospital and visiting hours were restricted (a paediatric nurse at a Sydney children's hospital recalls many tears as visiting time on Sunday afternoons finished). The impact on many children, especially young children was large. Following AWCH's recommendations, Australian hospitals began promoting family centered policies, parents were encouraged to stay. 

This parent’s experience is worth reading because she challenged expectations in a leading children’s hospital, her story was firstly published in the Age newspaper, then AWCH magazine, Interface*.

Fear and separation

The mum, Janet, gave a moving account of five nights with her son in hospital. She knew staying would be best. This was reinforced when on the first night, another child awoke screaming, a nurse rushed in and this panicked child grabbed her crying “Mummy come quick”. 

The child in a bed nearby had been taken from home, was sick and separated from his family. Hospital was a strange and frightening place. He had an intravenous drip and splint attached to his arm. Later, a two year old was screaming and inconsolable, her mother had gone home. The nurse had given sedation to stop crying. 

Poster was one of six from AWCH (SA)  issued by NAWCH, London, 1978

To go home or stay on the floor?

Sam’s mum, it had been suggested, should go home because her son was old enough that “he should be able to cope”. With an upright chair to sleep in, Janet stayed. At 3 am another nurse approached her with a strip of foam rubber and a towel, she “hit the floor with relief”. The next night she had a sleeping bag from home. Janet experienced some odd looks from hospital staff but she was pretty much ignored. This mum was courageous, doing what she thought was best for her child despite hospital protocol.

At home, Janet revisited scenes of children screaming for their parents. Her greatest affirmation came from Sam. Hugging her close, in a whispering voice he said: “thanks for staying with me in hospital mum”.

“thanks for staying with me in hospital mum”

AWCH helps children

AWCH “pioneers” were also courageous, working hard to change care for children and young people in hospital. They were part of a social movement, linking with international sister organisations. AWCH’s first benchmark policy, A recommended health care policy relating to children and their families, was published in Medical Journal of Australia, 1974. Your Child in Hospital (pamphlet),.a Joint effort of Division of Health Education and AWCH, was significant as the first Australian education of parents about sick children and hospital. Written between the lines was a reminder to health professionals of their role in caring for children. With great interest, ¼ million pamphlets were printed.

AWCH continues to produce policies, work with key stakeholders (CT scans - information for parents and carers), guide the provision and advocate for rights of children and young people in healthcare. 

AWCH Ward Grandparent scheme supports children and parents or carers in hospital. Volunteer grannies, recognise it isn't possible for parents or carers to always stay with their child. 

Your comments and impressions are welcome and can be added below.

Jillian Rattray

AWCH Librarian
http://library.awch.org.au

October 2016

The three little “P’s” - Playgroup and Peppa Pig

Children were excited when Peppa Pig Goes to Hospital was the story of the day at one Sydney play group. There were about 15 children, mainly two year olds and pre-schoolers, who sat on the story time mat. During playtime they couldn't wait to put bandages on their dolls or teddies and one boy carefully bandaged his dinosaur’s tail. Craft was a lot of fun with Humpty Dumpty, both before and after the accident, some children preferred the ambulance craft. It was a bustling morning but there was time for children to select a book from our display and have a quiet read. A few did this.  There were over twenty books to browse or borrow and several parents commented about the range of books available.

Before the story, children were told, ‘When we go to see a doctor or nurse we can take a special toy or book and we will have our mum or dad or person who cares with us’. Peppa pig’s hospital room had a bright rainbow and after the story I commented, ‘We can always play and draw pictures when visiting the doctors or in hospital’.

The playgroup was well equipped with hospital play kits including stethoscopes, bandages and toy thermometers. If any toy was short of a bandage, a box of bandaids was within reach. One little girl showed me green dots all over her baby’s head. She and her mother had carefully placed bandaids over the middle of the baby’s head covering the ‘dots’. This was clearly a topic the kids related to.

I was the first of several visitors for term three with the theme, 'people who care for us'. The playgroup leader introduced the topic talking about doctors and nurses and the children sang several action songs about being sick, including ‘humpty dumpty’.

When the doll, teddy and dinosaur play began a brochure was handed out, ‘Hospital preparation for pre-schoolers – time well spent’. In amongst the fun I was hoping to convey to the children that when we are sick or hurt, it is not because of something we have done. Also if we are sick, doctors and nurses are there to help us get better and Mums, dads or the person caring for us will be there to give us a hug.

Whilst the children played, parents were reminded that fear of the unknown is an issue for young children and that pre-schoolers need reassurance. When we think of going to hospital, we think about the role of health professionals and may not stop to think about the role of parents. My take home message for parents was that their role is really important too. Parents and carers help their children cope with fear by being calm. Playgroup parents laughed at this point, recognising this is something easier said than done. I showed them two books Help! My child is in hospital and Everybody stay calm.

Before my voice faded into the general hubbub, my final point was that it is important to be informed and not to be afraid to ask if something is not clear. Parents can ask the hospital what resources are available to help prepare. The AWCH website and Dr Angela MacKenzie have many helpful links for parents and carers who want to prepare their children in different medical situations. A special mention was given of the wonderful free app designed for and with young children, “Okee in medical imaging”.

A chat with staff at a local pre-school followed. It was not long after I had arrived when a teacher pointed out the hospital corner, put together because of a child's recent hospital stay. The staff borrowed books to read to their classes and enquired about books for children with special health needs or those who have sick parents.

 One of the most poignant reasons for preparing children for hospital came from a playgroup mum. She shared an experience as a three year old child. She recalled how her parents said she was going on holidays. It was devastating to find this was misheard and that instead, her parents had said she was going to hospital. This became a traumatic experience and hard to get over. I finished the morning with a greater certainty that preparation is time well spent*.

Perhaps the three little ‘ps’ stand for – preparation, playgroup and Peppa pig.

Jillian Rattray

AWCH librarian
http://Library.awch.org.au
July 2015

*Dr Angela MacKenzie encourages parents to do their “homework” and be prepared.