How to support children through grief and bereavement

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When it comes to casual conversation, death understandably very rarely comes up as a subject that we jump at the chance of openly discussing.

Yet, it appears the coronavirus pandemic has made us all more aware of our own mortality and the mortality of those around us. Research by Dying Matters, a campaign group working to create an open culture around death and dying, found that nearly a quarter of UK adults (24%) say that the pandemic has made them more likely to have casual conversations with family and friends about preferences around their death.

While adults are potentially seeing the pandemic as a way to be more open about death, be that from coronavirus or other illnesses, one group is continually overlooked: children. Figures from Child Bereavement UK show that a child loses a parent every 22 minutes in the UK, equating to around 111 children being bereaved of a parent every single day.

During the pandemic and beyond, children have not just lost parents; they are also having to deal with grandparents, family friends, teachers and even siblings dying. Campaign groups and charities are working to help identify bereaved children and offer them the support they need, whether the bereavement is due to coronavirus or any other type of illness or injury. It’s now becoming apparent that we need a shift in public discourse, education systems and possibly even legislation in order to help bereaved children feel acknowledged and safe.

The current situation

The Childhood Bereavement Network analyses data from sources like the Office for National Statistics and uses its own research to estimate that 1 in 29 five to 16-year-olds has been bereaved of a parent or sibling – equating to a child in every average school class. “Unfortunately, there are no official figures on how many children are bereaved of a parent,” says Di Stubbs, a bereavement practitioner for charity Winston’s Wish. “A study has shown that 78% of children in the UK say they have experienced a ‘significant bereavement,’ showing that our children are very aware and affected by the mortality of those around them.”

Charities like Winston’s Wish were seeing many children before the pandemic to help support them through bereavements, alongside working with adults who know bereaved children to offer advice on how to best help young people during periods of grief. While children were facing countless bereavements before coronavirus, the pandemic has undoubtedly exacerbated the situation. “COVID emphasised our natural assumptions,” says Di. “The children we work with fall into many different groups. We are dealing with children who have been bereaved due to coronavirus. We are also dealing with children who have experienced a loved one die due to other reasons over lockdown, as the same amount of people are still dying from health conditions like heart attacks and strokes.”

There’s also another group of children that is now finding grief to be an issue. “Children who were bereaved before the pandemic are now finding that the current situation has really highlighted these intense emotions,” explains Di. “Suddenly, everyone is talking about death and bereavement all the time. Even for children who are not grieving, many have been quite suddenly exposed to the fragility of life and are having to respond to a new world.”

children bereavement

Navigating a new world

Coronavirus, and the lockdowns implemented to curb the spread of the disease, have caused confusion for many children around dying. “All of the rituals surrounding death, like funerals, were suddenly not there anymore,” says Di Stubbs. “We saw extremely sad situations, like shielding grandparents trying to comfort children over the death of a parent, whose only option was to do this through a window as no contact was allowed.”

Roseleen Cowie, regional lead at charity Child Bereavement UK, echoes this sentiment. “The effects of the pandemic have caused further pain for children going through a bereavement,” she says. “Without the usual rituals, children cannot say goodbye when someone dies, which has added to the difficulty. This is superimposed on the grieving, resulting in an additional loss and some people expressing their grief more deeply than may have been expected.”

Shelley Gilbert MBE, founder of specialist bereavement service Grief Encounter, stresses the importance of supporting bereaved people during and after the pandemic. “COVID has stolen things away from most of us, some bigger than others,” she says. “If someone special dies for young people, they are gone forever, and we need to think about how we support children throughout this period.”

Understanding children’s grief

Children grieve in a similar way to adults, but with some noticeable differences. According to the experts, ‘puddle jumping’ is to be expected. “Puddle jumping is the process by which children move in and out of their grief,” explains Roseleen Cowie. “A child may be very upset one moment and perfectly alright the next. Being aware of that is really helpful for people, especially in schools, as you can then appreciate that this is the way that children grieve.”

Puddle jumping tends to be different to how adults experience dealing with grief. “Adults tend to wade through grief, but children do this much faster; cycling in and out of grief and oscillating much faster than adults,” Di Stubbs explains. However, in many ways, the features of grief in children and adults are very similar, if not the same. “We can’t expect children to grieve differently to adults,” says Di. “All that anyone can do when they are bereaved is experience whatever intense emotions they are feeling. Eventually, we all grow around grief, allowing ourselves to experience new adventures and have fun.”

children bereavement

Talking to children about death

Undoubtedly, the consensus from experts is that children need to talk about death. “We recommend people use words like ‘dying,’ ‘dead’ and ‘death’ around children so that they have a clear understanding of what this is, as they won’t understand euphemisms,” explains Roseleen Cowie. Di Stubbs notes that language is particularly important, as phrases like ‘heart attack’ won’t make sense to some children, who may instead become distressed at the thought of a loved one being attacked, rather than understanding this to be a medical term.

Another expert who stresses the importance of using the right language is Nima Patel. A qualified primary school teacher and conscious parenting coach, she began her business, Mindful Champs, to encourage the practice of mindfulness between parents and children. Her latest project, a grief journal for children, encourages them to express themselves in whatever ways they can after a bereavement. “In 2017, my father suddenly died,” Nima discloses. “Seeing people lose loved ones during the pandemic, I wanted to create a toolkit for children and young people that I never had,” she says.

Nima realised the importance of having honest and open dialogues with children around death by using language that they can understand. “Children will have so many questions around death, but adults often don’t know how to answer these,” she explains. “My aim is to help children develop language to express themselves, and encourage adults and children to voice their feelings. If emotions aren’t spoken about in the home on a daily basis, a lot of children don’t have the language needed for emotional events, like a bereavement.”

Many children may find they need professional support when they are bereaved, and adults and schools are able to refer children to charities like Child Bereavement UK, Grief Encounter and Winston’s Wish or to NHS services. The way in these organisations can support grieving children or adults who are concerned about bereaved children can take a multitude of forms, from offering helplines to one-on-one counselling sessions.

If you know a bereaved child, in addition to talking to them about their grief and emotions, another good way to help them express grief is through creativity. “Sometimes words are not enough to express our grief and this is where creativity comes in,” explains Shelley Gilbert MBE. “Being bereaved often means you haven’t the words to describe what you’re thinking or feeling. Old words have no meaning or take on new meanings and you’re learning words you’ve never heard before. Following the loss of someone special, we need a new language of grief.”

Creativity can come in many forms when expressing grief. Winston’s Wish encourages children to make memory jars or emotional first-aid kits, while there are also resources out there made specifically for grieving children, like Nima Patel’s Mindful Champs Grieving Journal. “We encourage activities like memory jars, flower releasing ceremonies and memorial trees in the journal to help children express their grief however they wish, be that verbal or non-verbal,” says Nima. Di Stubbs also recommends that books can be a great resource for children, including I Miss You: A First Look at Death and Goodbye Mousie to explain death to young children and Straight Talk about Death for Teenagers: How to Cope with Losing Someone You Love for teenagers. A further reading list is available at Winston’s Wish.

children bereavement

Assisting children with learning disabilities

For any child, dealing with grief can be tough, frightening and confusing. For children with learning disabilities, who may have acute difficulties expressing themselves, this can be a particularly hard time, especially during the pandemic. “We can’t emphasise enough the huge impact that the pandemic has had on children with learning disabilities,” says Tracey Hartley-Smith, a learning disability nurse and clinical lead at Cheshire and Wirral Partnership NHS Foundation Trust. “Coronavirus has impacted children’s opportunities for developing their social and communication skills hugely. We’ve seen through our work and heard from parents, carers and colleagues that children with learning disabilities have experienced heightened anxiety during this time.”

Tracey and her colleague, Dr. Jacqui Wood, a clinical psychologist at Cheshire and Wirral Partnership NHS Foundation Trust, have continued working with children with learning disabilities throughout the pandemic, including supporting them through grief and bereavement. “We encourage everyone interacting with a bereaved child to use the same, simple phrases when talking about death, as repetition is so important for consistency,” says Jacqui. “Visual aids, such as pictures or symbols, can often be helpful for sharing information with non-verbal young people, and helping them to express themselves,” she explains. Tracey adds that, as well as using the right language, “children with learning disabilities need to feel safe and loved, in whatever type of communication they use for this reassurance.”

Jacqui has recently published a guide specifically tailored for parents or carers of children with learning disabilities, which is accessible here. “Keep routines and boundaries, as they help establish predictability and security for children,” she advises. “Try to find opportunities to involve children in arrangements like funerals, to help develop their understanding of what has happened. Children with learning disabilities may also benefit from multi-sensory memory items, such as a piece of clothing from their loved one to touch and smell. This can help them learn to manage their expectations over time, so they adapt to remembering their loved one rather than physically seeing them,” she explains.

Jacqui also advises encouraging emotional regulation activities, be these for fun or relaxation. “Help children have fun during this difficult period by encouraging movement, whether that’s running around in the park or splashing about in the bath,” she says. “For calming sensory experiences, try dimming the lighting in your home, making a den to establish ‘quiet time’ or just comforting your child with regular hugs.”

children bereavement

Acknowledging and making memories

Above all, acknowledging that a child or teenager is grieving is incredibly important. Research by Dying Matters shows that 72% of those bereaved in the last five years would rather friends and colleagues said the wrong thing than nothing at all, and 62% say that being happy to listen was one of the top three most useful things someone did after they were bereaved.

“Above all, we should remember that love never dies,” says Shelley Gilbert MBE. “Lots of our work focuses on remembrance in difference ways, including remembering our loved ones as they were in the past and thinking about them in the present and future. When we make new memories, it can help to remember that our dead loved ones are with us in some way.”

When adults grieve, there is trauma and then a long road to acceptance. And, we should not assume that children and teenagers are any different. As Roseleen Cowie says: “When helping bereaved families, our ethos is that grief is a normal part of life: you can’t get over it or make it better, but you can learn to live with it.”

Complete Article HERE!

Death-friendly communities ease fear of aging and dying


Improving death-friendliness offers further opportunity to improve social inclusion. A death-friendly approach could lay the groundwork for people to stop fearing getting old or alienating those who have.

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Death looms larger than usual during a global pandemic. An age-friendly community works to make sure people are connected, healthy and active throughout their lives, but it doesn’t pay as much attention to the end of life.

What might a death-friendly community ensure?

In today’s context, the suggestion to become friendly with death may sound strange. But as scholars doing research on age-friendly communities, we wonder what it would mean for a community to be friendly towards death, dying, grief and bereavement.

There’s a lot we can learn from the palliative care movement: it considers death as meaningful and dying as a stage of life to be valued, supported and lived. Welcoming mortality might actually help us live better lives and support communities — rather than relying on medical systems — to care for people at the end of their lives.

 

The medicalization of death

Until the 1950s, most Canadians died in their homes. More recently, death has moved to hospitals, hospices, long-term care homes or other health-care institutions.

The societal implications of this shift are profound: fewer people witness death. The dying process has become less familiar and more frightening because we don’t get a chance to be part of it, until we face our own.

Fear of death, of aging and social inclusion

In western cultures, death is often associated with aging, and vice versa. And a fear of death contributes to a fear of aging. One study found that psychology students with death-anxiety were less willing to work with older adults in their practice. Another study found that worries about death and aging led to ageism. In other words, younger adults push older adults away because they don’t want to think about death.

A clear example of ageism being borne out of a fear of death can be seen through COVID-19; the disease gained the nickname “boomer remover” because it seemed to link aging with death.

Grandparents with masks seen pressing hands against window looking at granddaughter

The World Health Organization’s (WHO) framework for age-friendly communities includes “respect and social inclusion” as one of its eight focuses. The movement fights ageism via educational efforts and intergenerational activities.

Improving death-friendliness offers further opportunities to improve social inclusion. A death-friendly approach could lay the groundwork for people to stop fearing getting old or alienating those who have. Greater openness about mortality also creates more space for grief.

During COVID-19, it’s become clearer than ever that grief is both personal and collective. It’s especially relevant to older adults who outlive many of their peers and experience multiple losses.

The compassionate communities approach

The compassionate communities approach came from the fields of palliative care and critical public health. It focuses on community development related to end-of-life planning, bereavement support and improved understandings about aging, dying, death, loss and care.

The age-friendly and compassionate communities initiatives share several goals, but they don’t yet share practices. We think they should.

Originating with the WHO’s concept of healthy cities, the compassionate communities charter responds to criticisms that public health has fallen short in responding to death and loss. The charter makes recommendations for addressing death and grief in schools, workplaces, trade unions, places of worship, hospices and nursing homes, museums, art galleries and municipal governments. It also accounts for diverse experiences of death and dying — for instance, for those who are unhoused, imprisoned, refugees or experiencing other forms of social marginalization.

The charter calls not only for efforts to raise awareness and improve planning, but also for accountability related to death and grief. It highlights the need to review and test a city’s initiatives (for instance, review of local policy and planning, annual emergency services roundtable, public forums, art exhibits and more). Much like the age-friendly framework, the compassionate communities charter uses a best practice framework, adaptable to any city.

Multigenerational family, walking, holding hands on the beach.

Age-friendly initiatives could converge with the work of compassionate communities in their efforts to make a community a good place to live, age and, ultimately, die.
There’s a lot to like about the compassionate communities approach.

First, it comes from the community, rather than from medicine. It brings death back from the hospitals and into the public eye. It acknowledges that when one person dies, it affects a community. And it offers space and outlets for bereavement.

Second, the compassionate communities approach makes death a normal part of life whether by connecting school children with hospices, integrating end-of-life discussions into workplaces, providing bereavement supports or creating opportunities for creative expression about grief and mortality. This can demystify the dying process and lead to more productive conversations about death and grief.

Third, this approach acknowledges diverse settings and cultural contexts for responding to death. It doesn’t tell us what death rituals or grief practices should be. Instead, it holds space for a variety of approaches and experiences.

Age-friendly compassionate communities

We propose that age-friendly initiatives could converge with the work of compassionate communities in their efforts to make a community a good place to to live, age and, ultimately, die. We envision death-friendly communities including some, or all, of the elements mentioned above. One of the benefits of death-friendly communities is that there isn’t a one-size-fits-all model; they can vary across jurisdictions, allowing each community to imagine and create their own approach to death-friendliness.

Those who are working to build age-friendly communities should reflect on how people prepare for death in their cities: Where do people go to die? Where and how do people grieve? To what extent, and in which ways, does a community prepare for death and bereavement?

If age-friendly initiatives contend with mortality, anticipate diverse end-of-life needs, and seek to understand how communities can indeed become more death-friendly, they could make even more of a difference.

That’s an idea worth exploring.

Complete Article HERE!

Scientists Discover Oldest Known Human Grave in Africa

The unearthing of a tiny child suggests Africa’s Stone Age humans sometimes practiced funerary rites and had symbolic thoughts about death

A virtual reconstruction of the child’s remains found in Panga ya Saidi cave in Kenya

By Brian Handwerk

Modern humans might share little in common with the Stone Age hunter gatherers who, 78,000 years ago, curled a dead child into the fetal position and buried it in a shallow grave in a Kenyan cave. But the humanity of their grief, and the care they demonstrated for the child, can still be felt by looking at those tiny human remains, arrayed as if still sleeping. Scientists don’t know whether the child’s family or community connected its burial with thoughts of the afterlife. In a way, though, their actions guaranteed the child would have another life. Unimaginably far into their future, the child is not forgotten and it offers a fascinating glimpse into how some past humans coped with death.

The 2-and-a-half to 3-year-old toddler now dubbed Mtoto (‘child’ in Swahili) was found in a specially dug grave now recognized as the oldest known human burial in Africa. The team that discovered and analyzed the child published their findings in this week’s issue of Nature. Extensive forensic and microscopic analysis of the remains and grave suggest that the child was buried soon after death, likely wrapped tightly in a shroud, laid in a fetal position and even provided with some type of pillow. The care humans took in burying this child suggests that they attached some deeper meaning to the event beyond the need to dispose of a lifeless body.

When we start seeing behaviors where there is real interest in the dead, and they exceed the time and investment of resources needed for practical reasons, that’s when we start to see the symbolic mind,” says María Martinón-Torres, a co-author of the study and director of the National Research Centre on Human Evolution (CENIEH) in Burgos, Spain. “Thats what makes this so special. Were looking [at] a behavior that we consider ourselves so typical of humans—and unique—which is establishing a relationship with the dead.”

Panga ya Saidi cave, in the tropical uplands along the Kenyan coast, is a key site for delving into the lives of ancient humans. In 2013, excavations there revealed the side edge of a small pit, and researchers used a tube to retrieve a sediment sample for dating. The sample immediately revealed the presence of some degraded and unidentified bones. It wasn’t until four years later that scientists began to suspect they’d found more than a few random remains. They dug about ten feet below the cave floor and found a circular, shallow pit tightly filled with an array of bones. But this surprise was shortly followed by another—the bones were in such a state of decomposition that any attempts to touch or move them turned them to dust.

So the team extracted the entire pit, protected it with a plaster encasement and moved it to the National Museums of Kenya in Nairobi, and later to a specialized laboratory at CENIEH.

In the lab, scientists unleashed a toolbox of techniques and technologies to peer inside and analyze the bones and soils of the sediment block. Carefully excavating a bit of the block revealed two teeth whose familiar shape provided the first clue that the remains might represent a hominin burial. As the scientists delved further into the block they encountered more surprises. They found much of the well-preserved skull and face of the child, including some unerupted teeth still found within the mandible. These remains helped to ascertain that the team was exploring the remains of a very young member of our own species—Homo sapiens.

The group employed microtomography, a high-resolution X-ray based technique to determine that more bones were inside the block. But the bones were fragile and powdery; their low density made them very difficult to distinguish in images from the surrounding sediments. To solve this challenge, those cross-section scans were paired with software that sharpened them and eventually reconstructed 3-D images of the bones in the block. The image of a child, seemingly at rest, began to emerge.

Mtoto’s bones were articulated in nearly the same positions they would have been in life, anatomically connected at some points, with only small settling movements corresponding to those commonly seen as a body decomposes and flesh and muscle disappear. While the right ribs, on which the child was lying, are flattened, the spine and even rib cage curvature remain amazingly intact. This and other aspects of the skeleton’s condition provide a compelling line of evidence that the child had been buried soon after death, rapidly covered by soil and left to decompose peacefully in the grave. It stood in stark contrast to various animal bones of the same age found nearby—they had been broken, battered and scattered as a result of being left in the open.

The pit’s mix of sediment also differed in color and texture from surrounding sediments, revealing that it was dug and later filled in. And the dirt yielded still more clues. Geochemcial analysis of the soil showed elevated levels of calcium oxide and manganese oxide, chemical signals consistent with those expected to be produced by the purification of a body.

The child was lying on its right side, with knees drawn to its chest. The right clavicle (part of the shoulder) and the first and second ribs were rotated about 90 degrees, a state consistent with the upper body being wrapped or shrouded. The child may have been prepared and tightly wrapped with a shroud of large leaves or animal skins—an act that would make little sense for a body regarded as simply a lifeless corpse.

Finally, the position of the head suggests a tender touch. The first three cervical vertebrae, still attached to the base of the skull, were collapsed and rotated to a degree that suggests that the child was laid to rest with a pillow of biodegradable material under its head. When this pillow later decomposed, it appears that the head and vertebrae tilted accordingly.

Mtoto Drawing
An artist’s interpretation of Mtoto’s burial

Durham University archaeologist Paul Pettitt, an expert in Paleolithic funerary practices not involved with the research, called the study an exemplary exercise in modern forensic excavation and analysis. The totality of evidence seems to show that some person or persons cared for the child even after death. But what thoughts the ancient humans had about the dead is an intriguing question that may never be answered.

The point at which behaviors towards the dead becomes symbolic is when those actions convey a meaning to a wider audience, that would be recognized by other members of the community and may reflect a shared set of beliefs,” says Louise Humphrey, an archaeologist at the Centre for Human Evolution Research at the Natural History Museum, London. “Its not clear whether thats the case here, of course, because we dont know who attended the burial, whether it was the action of a single grief-stricken parent or an event for the larger community,” adds Humphrey, who wasn’t involved in the research.

Mtoto’s community was becoming increasingly more sophisticated. Surrounding soils in the cave from the same age as the grave are replete with an array of stone tools. The array of implements found suggests that Homo sapiens may have performed this burial during an era when they were gradually developing and using more advanced tool technologies.

Interestingly, the child wasn’t buried in some out of the way locale. It was buried at home. Panga ya Saidi cave is a key site inhabited by humans for some 78,000 years, until as recently as 500 years ago, and it also houses other, much younger burials. It remains a place of reverence for local humans to the present day, archaeologist Emmanuel K Ndiema of the National Museums in Kenya told reporters in a press conference unveiling the find.

The body was also found in a part of the cave that was frequently occupied by living humans. Martinón-Torres says this suggests a kind of relation between the dead and living, rather than the practical act of simply disposing of a corpse.

The bones were securely dated to 78,000 years ago. Though the date places Mtoto as the oldest human burial known in Africa, the child is not the oldest burial in the archaeological record. Burials of Homo sapiens at Qafzeh Cave, Israel, some 100,000 years ago, included pieces of red ocher, which was used to stain tools and may have been employed in some type of burial ritual. Iraq’s famed Shanidar Cave, which saw burials by Neanderthals, suggests another way in which Homo sapiens and Neanderthals may have been more similar than scientists once believed.

But evidence for funerary practices among Paleolithic humans and Neanderthals alike remains thin on the ground. That’s especially true in Africa, where it may be that scientists simply haven’t looked enough, as much of the continent has yet to be investigated. Climate works against African preservation as well, and different humans in different regions may have practiced different types of mortuary rituals as indeed they still do today.

Pettitt notes that the majority of humans who lived in Pleistocene—from 2.5 million to 11,700 years ago—Africa or Eurasia are archaeologically invisible. “They could have been tucked away in vegetation, floated off down rivers, placed on hills and high places…or simply left behind when the group moved on,” he notes.

If burial wasn’t standard Pleistocene practice, it begs the question why humans sometimes went to greater lengths to inter contemporaries like Mtoto. Pettitt leans towards the idea that such deaths were outside the norm.

The death of a child may have tended to spur humans to undergo the rigors and ritual of burial. A high ratio of child graves exist among the few Pleistocene sites that survive, including both of the earliest African burials, Panga ya Saidi and South Africa’s Border Cave, and many sites of Europe and Asia. Pettitt adds that among some hunter-gatherer societies the death of infants or children is viewed as unnatural and disturbingly out of the norm. “I wonder if these reflect the distinct treatment of dead infants that reflects societies emerging horror at such abnormalities?”

If Mtoto’s death caused exceptional grief, the child’s careful burial and the grave’s unlikely survival to the present day somehow create an equally exceptional connection between modern and ancient humans. In the physical world, ancient humans had to confront death too, and might such burials suggest that they also had symbolic thought about those that died?

“Somehow these types of funerary rites and burials are a way humans have to still connect with the dead,” says María Martinón-Torres. “Although they have died, they are still someone for the living.”

Complete Article HERE!

Helping Children Cope with Death

By Christine Carter

Not so long ago, a sweet child in my community—my kids’ buddy from preschool—was killed in an accident. For a full year, I descended into dark periods of deep grief. Fortunately, I also often rose to the occasion, cooking for their family and standing strong for mine. The kids describe that year as “the time when mommy cried a lot.” The horror and disbelief and deep loss when a child dies are truly unimaginable, truly indescribable.

There are a lot of families in Berkeley who are probably in that hard place right now. Two weeks ago today, a kindergartener dear to the Berkeley campus was killed in a traffic accident. He would have been six yesterday.

It is hard enough as parents to deal with our own strong feelings when children die. But how in the world do we also help our children cope with their grief?

The grieving process itself is very different for kids than it is for adults. Because kids’ capacity for sustained intense emotion is limited, they may experience bouts of sadness and anger but then go off to play or immerse themselves in activities. This can be confusing to parents, who misread the child’s ability to play and laugh as an indication that either the child is no longer grieving or doesn’t understand what has occurred. Neither is true; the behavior is a defense mechanism that protects kids from becoming overwhelmed.

Depending on age, kids understand death to varying degrees.

  • Infants under 3 may notice an absence in their immediate world, but most likely do not understand the difference between a temporary and permanent absence.
  • Preschool kids usually see death as reversible, temporary, and impersonal. Their deceased loved ones might return, just as cartoon characters on television miraculously recover. Most kids under 5 do not realize that everyone, including themselves, will eventually die.
  • Kids between 5 and 9 begin to see death as final and to understand that all living things die, but many still believe that it may just be possible to escape through ingenuity.
  • By age 9 or 10, most kids understand that death is final, permanent, and inevitable.

Grief also usually lasts longer for kids: parents will need to revisit and readdress the loss at different points in the child’s life, especially during important events (like birthdays and graduations). Because kids often have difficulty articulating their feelings, grief can manifest in a variety of conflicting ways, including emotional shock or apparent lack of feeling, explosive anger, acting out behavior, fears of abandonment or death, immature behavior, or repeatedly asking the same questions.

Here are some more research-based ideas for helping kids cope with death:

Give them information. When asked what helps grieving kids most, Dr. Grace Christ from Columbia University says, “It is hard to overestimate the importance of giving children information at all stages.” Parents can help kids understand how and why a death occurred in simple, honest, age-appropriate terms.

Don’t tell half-truths. Saying things like “your uncle went on a trip” can prevent kids from developing effective coping strategies. Vague euphemisms (referring to death as “sleep” or “eternal rest”) are similarly problematic because they can be frightening and confusing.

Let kids talk about it. Repeatedly. Kids need to have opportunity to put their feelings into words. They may be anxious about the safety of other loved ones or themselves. Or they may be feeling guilty about times they weren’t nice to the deceased, or sad thinking about opportunities they missed to show affection. Kids will do better if they can express feelings like these to people who can provide the clarification and reassurance they need to heal. Encouraging other expressive outlets like drawing, painting and playing can also help.

Find ways to honor and remember the deceased. Research shows that instead of focusing on letting go and moving on, maintaining a link to the loved one can provide comfort and solace. The “continuing bonds” theory suggests we can move through grief by creating a new bond to the lost person. Activities might include putting together a memorial, gathering photos and creating a special album, or reliving memories together.

Read relevant books together. Books are often a wonderful way to help kids understand death. Kids may also project their feelings onto the story characters and engage in a dialogue in a non-threatening way.

Encourage death games. Kids will sometimes play “death games” in which they stage deaths, funerals, and other imaginative happenings. This type of game is a constructive way for kids to talk about death and work out anxieties in a relatively safe space.

Finally, we parents need to remember and honor our own need to grieve. I did better helping Fiona and Molly cope with our friend’s death once I had started to take care of myself and my own grief. I needed to allow myself (and my kids) some time away from our everyday activities to grieve and heal.

Grieving is an ongoing process, not an isolated event. My heart goes out to all those families who are in grief right now. If your family has dealt with a significant death, please help other families by adding your comments and suggestions (what are some good kid’s books for coping with death?) for how you healed below.

Complete Article HERE!

How Losing a Pet Can Make You Stronger

The process of acceptance and letting go builds the resilience necessary to navigate an array of life’s obstacles.

By Kerry Hannon

It’s been three months, and I still fight back tears when I’m reminded of the death of my Labrador retriever, Zena. The haunting image of finding her lying on the kitchen floor flashes back: her jaw clenched, eyes open and body lifeless but warm.

She was nearly 13, but there were no signs she was in distress when I left her 20 minutes earlier. Yet she was gone. I felt as if I let her down in some way. I wasn’t there for her.

When Zena was just a few months old, she curled up on the bed with my 88-year-old father, as I held his hand, and he softly exhaled his last breath. My younger brother, Jack, died unexpectedly three years ago. I clung to Zena for comfort.

My first experience with death was losing my turtles, Charlie and Tina, at 6. I’ve since lost friends, relatives, other dogs, cats, horses. Decades later, Zena’s death has sharply reminded me how aching grief is.

Our pets are a part of the everyday fabric of our lives in a way that few human relationships are. When you lose one that is close to you, something inside shifts.

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And yet the death of a family pet can remind us of how vulnerable, precarious and precious life is. It’s that process of acceptance and letting go that builds the resilience necessary to navigate an array of life’s obstacles. We hone an ability to adapt to the evanescence of our lives with grace and hope.

“We’re changed and transformed by the loss,” said Leigh Chethik, a clinical psychologist in Chicago. “It brings impermanence and death into an updated internal, emotional map. This loss can help us with whatever comes next, whatever future losses may be in store. We come to see that we can create a new understanding and attach to new dreams.” Below are some ways in which the loss of a beloved pet can be a catalyst for personal growth.

Embracing Your Loss

“The idea that grief can often be the price of love is helpful in developing resilience,” according to Jessica Harvey, a psychotherapist in Portland, Ore., who specializes in pet grief. “By focusing on the positive elements of having a pet as the cause of why the hurt is so powerful when they are gone, we can begin to heal.”

Pets occupy a unique role in our lives. “They are usually our ‘roommates,’ part of the household, and they are typically a source of pure warmth and positive experience,” Ms. Harvey said. “How we are able to manage the temporary reduction of joy and warmth from the missing roommate can be a significant practice in resilience.”

That loss, of course, can have a startling depth. “For adults in their upper-20s to mid-30s it’s like losing their innocence as a new adult and being catapulted into reality,” said Dani McVety, a veterinarian and a founder of Lap of Love Veterinary Hospice, a national network of veterinarians dedicated solely to end of life care. “Many times, people in this age range got their dog or cat at the very beginning of their adulthood. This pet has witnessed them go through college, boyfriends or girlfriends, marriage, children, career developments, and so on. This pet has been the one constant in their life through their biggest growth years.”

How we handle the death of a pet “shapes how we deal with love and loss, conjoined emotions,” said Kaleel Sakakeeny, a pet loss and bereavement counselor who is based in Boston.

From Grief, Building Confidence

But how does that growth happen? One study, “Post-Traumatic Growth Following the Loss of a Pet,” conducted by Wendy Packman and others, of the Pacific Graduate School of Psychology at Palo Alto University, found that after losing a beloved pet, many of the participants reported an improved ability to relate to others and feel empathy for their problems, an enhanced sense of personal strength, and a greater appreciation of life.

Lynn Harrington, who lives in The Plains, Va., lost her 15-year-old Norwich terrier, Hap, about a year ago. “For many months, I couldn’t shake the sadness,” Ms. Harrington said. “And during these sad times, I finally remembered a lesson I learned many years ago with the loss of my first dog: Animals that come into our lives are gifts to us and can never be replaced. However, another animal can come to us and help us heal our hearts.”

Shortly after that epiphany, a friend told her about a senior dog that needed a home, and a match was made. “There isn’t a day that I don’t think of Hap through a photo, a memory shared, or even some funny mannerism I see of him in my rescue dog,” Ms. Harrington said. “These moments remind me that I’m grateful for the animals in my life — they teach me about love and that I’m resilient even in times of great challenge or sadness.”

Remembrance itself — though photos and memorials — can be healing. “Grief is ongoing,” Ms. Packman said. “Remaining connected to your beloved pet after death can facilitate the bereaved’s ability to cope with loss and the accompanying changes in their lives. Our findings suggest that those who derive comfort from continuing bonds — holding onto possessions and creating memorials for their pet — may be more likely to experience post-traumatic growth.”

Life Lessons for Children …

For children, the loss of a pet can be “a dress rehearsal for losing a human family member,” Dr. Chethik said. “With the death of a pet, kids are often exposed to a new existential crisis or struggle: the idea of impermanence and mortality. Things we love and care for are not around forever. We can and will lose what and who we love. And we can’t go where we may typically go for comfort — to our pet.”

For children, this process can be hard to grasp. The death of a family pet can trigger a sense of grief in children that is deep and lingering and that can possibly lead to subsequent mental health issues, according to a new study by researchers at Massachusetts General Hospital.

“The impact can be traumatic,” wrote Katherine Crawford, the lead author of the paper. “We found this experience of pet death is often associated with elevated mental health symptoms in children, and that parents and physicians need to recognize and take those symptoms seriously, not simply brush them off.”

Dr. Chethik added: “A child needs to actively grieve and process the loss,” he said. “The attention, support, honesty, sharing and understanding the child receives during this time of grief will them create an emotional template for the human losses that will inevitably come their way.”

With support from parents and others, the loss of a pet can be a way for children to move forward. “Teaching children how to say goodbye and that the difficult emotions that accompany grief are OK to feel is a powerful lesson,” Ms. Harvey said. “Children learn that this painful experience does start to feel better eventually, and that other difficult situations in the future can as well.”

… And for Adults

I’ve reminded myself these past months not to rush the process. Grief slides from the heart in its own time. I’m still talking to Zena and reflexively looking for her when I wake up in the morning. Yet, I know that soon my husband and I will be ready for a next chapter with a new companion.

This is the second dog we’ve lost during our marriage. We’ve grappled with the sadness each time, but we both know from experience that the love and laughter a pet brings into our lives are worth it.

As Ms. Harrington said, “Just knowing I can move through that kind of pain and get to the other side really does translate into that lesson that even when things in other parts of my life seem dark, I just need to keep moving through it and the unexpected can happen, bringing joy or opportunity.”

Complete Article HERE!

More pregnant women died and stillbirths increased steeply during the pandemic, studies show.

A nurse helping a pregnant woman at a hospital in Paris last November.

By Apoorva Mandavilli

More pregnant women died, experienced complications or delivered stillborn babies during the pandemic than in previous years, according to an analysis of 40 studies in 17 countries published on Wednesday in the journal Lancet Global Health.

Pregnant women face a heightened risk of severe illness and death if infected with the coronavirus. But the researchers, in Turkey and the United Kingdom, wanted to assess collateral damage from the pandemic on pregnancy and delivery, and so excluded from their analysis those studies that focused only on pregnant women who were infected.

Reviewing data on more than six million pregnancies, the investigators found evidence that disruptions to health care systems and patients’ fear of becoming infected at clinics may have led to avoidable deaths of mothers and babies, especially in low- and middle-income countries.

Data from a dozen studies showed that the chances of a stillbirth increased by 28 percent. And the risk of women dying while pregnant or during childbirth increased by more than a third in two countries: Mexico and India. A subset of studies that assessed mental health showed that postpartum depression and anxiety were also heightened during the pandemic.

Nearly six times as many women needed surgery for ectopic pregnancies — in which a fertilized egg grows outside the uterus — during the pandemic than before. Ectopic pregnancies can be treated with medications if detected early, so the results suggest that the surgeries may have resulted from delays in care.

The analysis did not find differences in other conditions associated with pregnancy, like gestational diabetes or high blood pressure, or in the rates of cesarean sections or induced labor.

The rates of preterm birth also did not change significantly during the pandemic in low- and middle-income countries. But in high-income countries, preterm births fell by nearly 10 percent.

The drop may be a result of changes in health care delivery and in pregnant women’s behavior during the pandemic, the researchers said, indicating that the pandemic has exacerbated disparities between low- and high-income countries.

Complete Article HERE!

Cancer, Religion and a ‘Good’ Death

It is hard to know how much my patient, caught in an eternal childhood, understood about his cancer.

By Mikkael A. Sekeres, M.D.

When I first met my patient, three years ago, he was about my age chronologically, but caught in an eternal childhood intellectually.

It may have been something he was born with, or an injury at birth that deprived his brain of oxygen for too long — I could never find out. But the man staring at me from the hospital bed would have been an apt playmate for my young son back home.

“How are you doing today, sir?” he asked as soon as I walked into his room. He was in his hospital gown, had thick glasses, and wore a necklace with a silver pendant around his neck. So polite. His mother, who sat by his bedside in a chair and had cared for him for almost half a century, had raised him alone, and raised him right.

We had just confirmed he had cancer and needed to start treatment urgently. I tried to assess what he understood about his diagnosis.

“Do you know why you’re here?” I asked him.

He smiled broadly, looking around the room. “Because I’m sick,” he answered. Of course. People go to hospitals when they’re ill.

I smiled back at him. “That’s absolutely right. Do you have any idea what sickness you have?”

Uncertainty descended over his face and he glanced quickly over to his mother.

“We were told he has leukemia,” she said. She held a pen that was poised over a lined notebook on which she had already written the word leukemia at the top of the page; I would see that notebook fill with questions and answers over the subsequent times they would visit the clinic. “What exactly is that?” she asked.

I described how leukemia arose and commandeered the factory of the bone marrow that makes the blood’s components for its own sinister purposes, devastating the blood counts, and how we would try to rein it in with chemotherapy.

“The chemotherapy kills the bad cells, but also unfortunately the good cells in the bone marrow, too, so we’ll need to support you through the treatment with red blood cell and platelet transfusions,” I told them both. I wasn’t sure how much of our conversation my patient grasped, but he recognized that his mother and I were having a serious conversation about his health and stayed respectfully quiet, even when I asked him if he had questions.

His mother shook her head. “That won’t work. We’re Jehovah’s Witnesses and can’t accept blood.”

As I’ve written about previously, members of this religious group believe it is wrong to receive the blood of another human being, and that doing so violates God’s law, even if it is potentially lifesaving. We compromised on a lower-dose treatment that was less likely to necessitate supportive transfusions, but also less likely than standard chemotherapy to be effective.

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“Is that OK with you?” my patient’s mother asked him. I liked how she included him in the decision-making, regardless of what he could comprehend.

“Sounds good to me!” He gave us both a wide smile.

We started the weeklong lower-dose treatment. And as luck would have it, or science, or perhaps it was divine intervention, the therapy worked, his blood counts normalized, and the leukemia evaporated.

I saw him monthly in my outpatient clinic as we continued his therapy, one week out of every month. He delighted in recounting a bus trip he took with his church, or his latest art trouvé from a flea market — necklaces with glass or metal pendants; copper bracelets; the occasional bolo tie.

“I bought three of these for five dollars,” my patient confided to me, proud of the shrewdness of his wheeling and dealing.

And each time I walked into the exam room to see him, he started our conversation by politely asking, “How’s your family doing? They doing OK?”

Over two years passed before the leukemia returned. We tried the only other therapy that might work without leveling his blood counts, this one targeting a genetic abnormality in his leukemia cells. But the leukemia raged back, shrugging off the fancy new drug as his platelets, which we couldn’t replace, continued to drop precipitously:

Half normal.

One-quarter normal.

One-10th normal.

One-20th normal.

He was going to die. I met with my patient and his mother and, to prepare, asked them about what kind of aggressive measures they might want at the end of life. With the backdrop of Covid-19 forcing us all to wear masks, it was hard to interpret their reactions to my questions. It also added to our general sense of helplessness to stop a merciless disease.

Would he want to be placed on a breathing machine?

“What do you think?” his mother asked him. He looked hesitantly at me and at her.

“That would be OK,” he answered.

What about chest compressions for a cardiac arrest?

Again his mother deferred to him. He shrugged his shoulders, unsure.

I turned to my patient’s mother, trying to engage her to help with these decisions. “I worry that he may not realize what stage the cancer has reached, and want to avoid his being treated aggressively as he gets sicker,” I began. “Maybe we could even keep him out of the hospital entirely and allow him to stay home, when there’s little chance …” My voice trailed off.

Her eyes above her mask locked with mine and turned serious. “We’re aware. But we’re not going to deprive him of hope at the end …” This time her voice trailed off, and she swallowed hard.

I nodded and turned back to my patient. “How do you think things are going with your leukemia?”

His mask crinkled as he smiled underneath it. “I think they’re going good!”

A few days later, my patient developed a headache, along with nausea and dizziness. His mother called 911 and he was rushed to the hospital, where he was found to have an intracranial hemorrhage, a result of the low platelets. He slipped into a coma and was placed on a ventilator, and died soon afterward, alone because of the limitations on visitors to the hospital during the pandemic.

At the end, he didn’t suffer much. And as a parent, I can’t say for certain that I would have the strength to care for a dying child at home.

Complete Article HERE!