Counseling The Grieving Child

When a parent dies the impacted student is almost always devastated regardless of how he or she shows it, or what the pre-death relationship was like.

Common concerns of elementary students following a parent's death include:

• How did my mother/father die?
  
• What is death?
  
• Where did my mother/father go?
  
• Why do people have to die?
  
• What caused the death?
  
• How will my life be different?

With regard to the last question, keeping the child's routine as unchanged as possible is advisable, but in reality some changes are inevitable. Children should be fully informed about what is going to happen and given time to get used to the idea, e.g. change in sleeping arrangements, transportation to school, etc.

After a death, families may ask if children should attend the funeral or other rituals like viewings or memorial services. These difficult questions must be dealt with flexibly, depending on the child's developmental age and emotional maturity.

Some general guidelines are:

• Individualize the decision about attending the funeral; for most children, 6 years is a reasonable minimum age.
  
• Ask children if they wish to attend
  
• Prepare children beforehand for what to expect
  
• Designate a support person to stay with the child and take the child home whenever he or she asks to go

Children who have trouble expressing grief and moving ahead with the mourning process should be helped to discuss their feelings.

These questions are a good starting point:

• How have things changed since your mom (dad) died?
  
• Who do you talk to when you feel sad?
  
• Many children feel sad, upset, guilty, or even angry when someone they love dies.
  
• Do you have any of these feelings?
  
• Some children worry that something they did or said may have caused their parent's death. Do you worry about that?

Health professionals can further aid the grieving child by observing these general guidelines:

• Encourage adults and children to openly share feelings of sadness, guilt, and anger
  
• Make sure all teachers and day-care providers are notified
  
• Avoid assigning children adult roles in the family
  
• Allow children to grieve in their own way
  
• Maintain structure, routine, and rules
  
• Encourage children to express grief through play, drawings, writing, reading stories

Maintain memories through photographs, scrapbooks, parent's possessions, charitable donations, planting a tree, visiting the cemetery A mental health referral is indicted if any of these is present:

• Grief lasting more than six to eight months
  Significant depression, suicidal ideation, declining school performance, substance abuse, or serious behavioral difficulties
  Troubled relationship with deceased prior to death
  Witnessed or contributed to parents' death
  Surviving parent or caretaker emotionally unavailable

(Tellerman K. When a parent dies. Contemporary Pediatrics 1998; 15(9):145-153)

Comment: It takes more than reading this article for school personnel to help a student handle the death of a parent. A well-trained individual should coordinate the local campus efforts.