IV. The Grieving Child

Trauma overwhelms a persons sense of control, connection and meaning in life. It causes an individual to experience fear, helplessness and isolation. For this reason, any death may be traumatic for a child. The death of an elderly grandfather who was the source of nurturing, caregiving, and protection may be a traumatic event and source of grief for a grandchild while it ma be an expected moment of sorrow in the childs parents life. Violent death is experienced as a double trauma. There is the trauma of death and there is the violent trauma that caused the death.

This section explores the typical developmental stages of children and their reactions to trauma, and concludes with a look at how trauma reactions are related to grief reactions.

A. Development Stages Affect the Trauma and Grief

Reactions of Children

Reactions tend to mirror growth stages and focus on the level and nature of the primary needs at the time of the trauma as well as the ability to absorb information and remember. Children need to process their traumas and grief through each developmental stage. If the trauma and grief inhibit, delay, or cause a child to "skip" a developmental stage, there will be a need to go back and revisit that stage in light of the traumatic grief.

Children also process their grief more slowly than adults. This may be due to several aspects relating to their reactions to death. Children do not fully grasp the permanence of death. Children are unable to sustain conscious sadness for long periods of time. Children do not usually deny the trauma of death but they may deny the reality of the death. Further, they do not have an alternative reality that assures them of the possibility of finding new relationships to rely upon.

Children may become "stuck" in one phase of the mourning process for months or years at a time.

Denial of deaths permanence may result in dreams, daydreams and nightmares of the deceased, waiting for the deceaseds return, visions of reunification with the deceased, belief in reincarnations and paranormal behaviors (events that cannot be explained rationally or logically).

Anger and protest at death is often displaced on parents, peers, or adults in authority. Parents who have "failed to protect" children or are perceived to have been negligent in their duties may be the targets for rage. They may also become the focus of anger when they fail to exhibit open grief because children sometimes think that such failure means that the parents didnt care about the death. Children often manifest their anger at school or in the neighborhood because parents seem too busy to take notice.

Despair may be manifested through extraordinary self-blame and guilt by children over the death. Something they did caused someone else to die -- even if the supposed cause is rooted in everyday behaviors or childhood thoughts. Despair can also be a consequence of emotional numbing such that the child sees no reason to live when life has no joy or meaning.

Eventual resolution of grief in children is often impeded because they do not know how to think about or plan for a future. They do not know how to develop new relationships and establish connections with others.

B. Childhood Developmental Stages

1. Infants and Toddlers (Ages 0-2)

Infants have limited verbal capacity to express their needs or emotions. However, they exhibit significant physical distress if daily needs are not met. They also retain physical memories of traumatic events even though they may never be able to articulate these memories or retrieve clear images of the events. A physical memory (or "imprint") occurs when the body recalls sensory perceptions of traumatic events. Much later, unexplained physical pains can occur that are related to these physical memories.

Infants initially experience their mothers as extensions of themselves with no clear distinction between self and other. As they grow older, they may become more aware of differentiation but they still see their primary caretakers as existing solely to meet their needs.

Infants lack a sense of object permanence until around one year of age. When people leave the immediate presence of infants, infants fear that they are gone forever. As infants grow to two years old they begin to explore their own independence and autonomy. However, they need constant reassurance that their adult caregivers will be available when needed.

Death of a parent is experienced as a critical loss and leaves an infant fearful and anxious. It may also be experienced as absence -- the death is defined not by the existence of a parent who is now gone but by the nonexistence of a parent who should be there. Deaths of significant others may also be experienced as loss if the child retains a sensory or emotional memory of that persons presence. If the infant or toddler is exposed to the traumatic event that caused death, the exposure may leave the child numb and muted. It may impede the initial growth of autonomy and independent functioning.

The child will have little conscious understanding of the loss or trauma, but as the child grows older may put words to the event as they seek to understand their impressions.

2. Pre-School (Ages 2 to 6)

Children usually become verbal between two and four. Preschool children often talk well. They can tell about what they eat and toys they play with, but do not understand less tangible concepts. Death may be thought of as a different state but not permanent. Children often believe in and experience visitations from the dead person through ghosts, spirits or reincarnations.

They may not be able to discuss events or incidents in terms of time and space, because their understanding of those concepts are related only to concrete or personal concerns. If children are asked when something happened -- in terms of a month, day, or year, they may not be able to answer. But if they are asked whether an event happened before or after their birthdays, specific holidays, the beginning of school or other significant events, they are likely to provide a reasonable response.

The focus for children of this age is on their immediate life. Nonessential details, for them, are often forgotten or perhaps integrated with their own perception of important events.

Children at this age are actively engaged in discovering a larger world than the home or the immediate family. This role of discoverer is needed to achieve greater independence in physical abilities and relationships, but it is quite challenging. Children must learn that they can trust their environment and their relationships to stay somewhat stable if they are going to venture into new worlds. Trauma and loss interfere with the development of an understanding of trust and security.

The most common communication device for the preschool child is play. Playing remains a key form of communication for older children as well. It is a nonthreatening language which can mask direct confrontation with nonhreatening issues. But while playing is an important mode of communication for all children, it is extraordinarily important in pre-schoolers. Their verbal ability can be good, but their security remains more intact through "acting-out" than through language.

Fantasy is an integral part of play. It serves a useful purpose in providing children with an outlet for their fears, hopes and dreams. Fantasy involves magical thinking and vivid imaginings but such thoughts are grounded in observed reality. Lack of conceptual development means that young children cant extrapolate well from concrete to abstract thought. Hence, many of their fantasies involve mimicry, anthropomorphisms, and variations on perceived reality.

They may also believe that what they think about something can cause it to happen. Such egocentric thoughts may cause young children to believe that something they did or said caused the death of a love one. Children may use magical thinking to construct alternative realities when the world around them is painful. Most can distinguish concrete fact from fantasy but may have more difficulty understanding real versus imaginary causes for event. In todays world, sometimes they may become confused with what is "real" on television and what is real life.

3. School-Age Children (Ages 6-10)

School-age is marked by rapid cognitive and competency development. Children tend to be able to formulate and articulate concepts, as well as understand multidimensional ideas, even though they may not be able to independently identify such dimensions. For example, they usually have been exposed to death and have thoughts about it, but may still think of it as reversible. Death may be externalized in concrete fears and images of monsters, scary animals or people, or animated inanimate objects. Their thoughts also may be shaped by misperceptions and myths overheard from others or seen in the media.

Children become less egocentric and develop an ability to see things from another persons perspective. However, this ability may increase conflicted feelings about another persons death. The death of a sibling may cause a child to fear his or her own mortality, feel bad because the sibling is gone, feel angry with parents for their preoccupation with grieving to the exclusion of the surviving child, or feel guilty about wishing the sibling dead at some time.

School-age children relate much better to time and space. In part this occurs because they begin to develop relationships with other people and things outside of their own home. The fact that they must be at school at certain times and days gives them a more precise frame of reference. Weekdays now become distinguishable from weekends.

Children become increasingly able to sustain emotional affect but may find it difficult to tolerate the pain of grief for any length of time. Adults may view childrens natural need to sporadically distance themselves from sadness as an absence of grief. Children rarely forget their sorrow but visit and revisit in short, intense periods of time punctuated by a determination to distract themselves with other things.

As children grow older they often become more conscious of right and wrong. Things seem to be black or white. There is little room in their thoughts for the grays. If they think that they did something wrong, guilt may beoverwhelming. If they think that others have done something wrong, anger and blame characterize their attitudes toward those persons.

Play is an important part of communication for school-age children; however, they need to be able to explain the purpose of their play as they become more verbal. School-age children often create "savior" endings when they retell stories of trauma in an effort to reestablish a sense of safety and mastery over an event. As they grow older, they may become more interested in games or play that is governed by rules and conventions. This is a part of their developmental efforts to internalize control and become increasingly independent from adults.

4. Early Adolescence (10-13 for girls, 12-15 for boys)

This stage of development may well be one of the most awkward and difficult for most children. The abruptness of physical change along with the related emotional upheavals that accompany increasing needs for independence and greater feelings of insecurity are major sources of stress to children. More children in this age group talk about stress-related symptoms: nausea, headaches, sleep disturbances, frequent crying spells, and so on.

Preadolescence and adolescence brings with it a solid concept of death. But sudden death may undermine an emerging sense of autonomy at the same time as it may propel children into early adulthood. Death is not equated with imaginary monsters or incarnations but rather is perceived as a biological process. Fears about death may focus on the dying process and the consequences of the death for the living.

The emotional roller-coaster that a child deals with at this age is manifested in wide mood swings. Their own identity is not clearly established and their self-esteem is shaky. Bravado and aggressive behaviors may be used to disguise their vulnerabilities.

In early adolescence, children become more preoccupied with peer relationships and begin to distrust adult interpretations of the world.

There is a tendency to invest emotional intensity in all phases of their lives. Events are often perceived symbolically. Increased abilities to understand abstractions may result in introspective searches for the meaning of life and death.

Ideals and commitments are viewed as a sacred trust. Betrayal of promises, vows, or relationships is rarely tolerated even when being faithful to them may be harmful to the children who hold them.

Words mean a great deal to the preadolescent and the adolescent child. Stories, plays, poetry, and music lyrics often serve as a basis for expression -- both those written by others and those created by the child.

5. Adolescence (13-18)

Normally, adolescence tends to increase the motional upheaval of preadolescence. This adjustment period seems designed biologically to help us move to adulthood; however, the world is so complex that such growth still may seem to come too fast. Children often want independence but in reality are unable to work within such independence and hence may simultaneously want more guidance and structure in their lives. This may be particularly true if the child has been abused and feels out of control.

Their behavior tends to seem inconsistent. Adolescents often love and hate the same person at the same moment. Anger may manifest itself as rage, and sorrow may become suicidal. As a corollary to their need for independence they often have a great need for privacy and hence become very secretive. Confidences may be offered sporadically and may be peppered with untruthfulness when shared with adults.

The immediacy of death when it affects teenagers is in stark contrast to their desire to see death as a part of a far distant future. Sometimes their activities center around proving themselves more powerful than death. Involvement in risk-taking activities may be exacerbated by the loss of risk-inhibitions due to traumatization.

They often express themselves by acting out and through experimenting with new behaviors. Violence may be used as an expression of manhood by some young males. Substance use and violation of the law may be perceived as a statement against adult standards or as admission to the adult world.

Most adolescents are creative and energetic and want control over how those energies are channeled. They are likely to question adult authority and decision-making in which they are not active participants.

Their creativity increasingly is manifested through the creation of their own symbols, activities and words to express themselves. Slang, fashion fads, dance fads and alternative music styles are all examples of this need for creative expression.

C. Childrens Reactions to Trauma at Any Development Stage are Affected by the Impact of "Parent Loss"

1. Actual Loss of Parent(s)

A violent, traumatic event may cause the death of a parent. Children then must cope with the shock of the event but also with the sudden loss of one of the most important people in the world to them. Parents are normally the source of nurturing, care, and stability. They are the focus of a childs sense of security and protect their children from harm. If a parent suddenly dies, the child is left feeling scared and vulnerable. Infants and toddlers may only remember fleeting images or feelings associated with the parent, but they may experience the absence of a father or mother as a loss through adulthood. Some older children may regress to infant behaviors in an effort to recapture the time when they felt safe. However, many older children seem to accelerate their maturation process, taking on adult roles and behaviors.

Sometimes traumatic events separate parents from their children or cause them to abandon a child. If children cant understand why or how the separation ocurred, the loss of a parent under such circumstances harms childrens abilities to trust others, and also their self-esteem.

If a parent is the cause of the trauma, through accidental or criminal behavior, the loss of the parent may be complicated by feelings of alienation, betrayal, and even hate. Rage may become a dominant reaction toward the parent as well as others that the child views as conspirators with the parent. Children may blame themselves for their parents actions and carry a burden of guilt into adulthood.

2. Perceived Loss of Parent(s)

Children tend to look to significant adult figures in their lives for reassurance about their own reactions and to learn how to grieve. Parents and teachers are natural models of behavior. However, often parents and other significant adults in a childs life are unavailable to the child after a traumatic event because parents are so involved with other concerns. They may also be perceived to be unavailable because they dont understand childrens reactions, avoid or deny that such reactions are often intense and complex, or simply dont observe the reactions.

Parent loss may be experienced when parents become consumed with their own losses or reactions to a trauma. It is often difficult to cope with the impact of violence and to offer comfort to children at the same time. Some parents may even fall into behaviors in which they assume a childlike role while their children take on adult roles in their relationships.

3. Actual or Perceived Parent Loss Can be More Traumatic Than the Trauma Event Itself

Parent loss can affect how children later cope with adulthood. Since children tend to model their own behaviors on parent behaviors, parent loss may have an impact on a childs own parenting skills. It may have an impact on how the child deals with other adversities and how children cope with trauma when they are adults.

D. Child and Adult Grief Reactions are Exacerbated

by Violent Traumatic Loss

1. Intensity of Emotion Increases

Since most grief reactions are similar to trauma reactions, trauma and grief have a multiplier effect on emotional responses. Anger at the traumatic event or the perpetrators of the event are made more complex by grieving protest over loss. Fear or terror about the vulnerability of ones own life is complicated by the real knowledge of the death of others. Confusion about what happened, how it happened, or why it happened, mirrors confusion about the meaning of life and the meaning of death. There is also grief over the trauma, compounded by the grief over the consequent death.

2. Duration of Grief May be Extended for Years

Grieving reactions following expected death may last for a year or two. Grief spasms -- when people are reminded of the death of someone whom they loved -- often are felt for a lifetime. Grieving reactions following an unexpeced death may be unresolved for five or ten years. The trauma of the loss must be dealt with before normal grieving may begin. This means an individual endures the crisis reaction of shock, disbelief, anger, fear, frustration, shame, guilt or grief in response to the trauma and may suffer long-term stress reactions due to the impact of the trauma. Often, in the process of coping with the trauma, people have little ability to face the finality and impact of death. Their abilities may be impeded because trauma issues are forced to be reexperienced repeatedly because of involvement in the criminal justice system, civil litigation, or reflections by the media. Grief may also be confusing because of the extent of losses. Someone loved has died, but the traumatic event may also have caused the survivor to suffer a loss of faith or trust in the world, a loss of innocence or belief in certain values, a loss of their own sense of identity or purpose, a loss of meaning of life. Each of these losses need to mourned and marked by conscious remembrance of what existed and now is gone. This grieving process is separate and different from the grief that will be experienced as one realizes the full impact of the loss of a loved one.

E. Trauma and Grief Patterns of Children are Similar

to Adults But Are Manifested Differently

1. Length of Grieving, Along With Acts of Mourning

and Remembrance, Extend Throughout the

Developmental Stages

As children mature, they should reprocess the impact of the trauma and loss in the context of their development. The loss of a father for a young toddler may be grieved over in terms of the loss of a loving caretaker. The loss of that father for the school-age child must be grieved over in terms of the absence of a teacher, an authority figure, as well as how the father would have been perceived by new friends and peers. The loss of the father for the preadolescent may take on new meaning in the absence of a model for sex roles or in the construction of the childs growing sense of identity. The loss of the father for the adolescent can affect his or her understanding of stability and the growth of independence. A young adult may grieve over the loss of the father in terms of a loving companion and source of friendship. The meaning of the traumatic event may change as well through development. Memories of a sudden trauma are reprocessed in activities and attitudes.

2. Grieving is Interrupted by Current Needs

or Events

Children must take time out from grieving to meet new challenges in life, cope with ongoing changes, establish new relationships, participate in school and to play.

3. Childrens Communication Styles Differ from

the Communication Styles of Adults

Children engage in activities to deal with trauma and grief. With young children, these activities involve spontaneous play, usually with objects or other children who are readily available. Older children and adolescents also engage in activities to express their reactions. These activities may include sports, drama, dance or song. Trauma or grief-related activities may be sporadic and repetitive.

4. Some Adults Have Spiritual Beliefs That Help

Them to Cope With Trauma and Grief

Children have not fully developed such beliefs, and trauma or grief intrude upon their conceptions of life and death.

F. Traumatic Grief Reactions

1. Loss and Death

The experiences and concepts of loss and death are closely intertwined. Death is often expressed as the loss of life. Someone who has died has been "lost" to his or her survivors. The end of relationships or certain times in life are often talked about through death imagery: divorce may be experienced as the death of a marriage; memories of the past may be thought of as old, faded or dead. Grief reactions are normal when anything has been lost. When someone or something is gone forever, the grief may seem overpowering. The concept of death for children may be more difficult to understand when there is no tangible or physical evidence of finality. It is also difficult for children to comprehend or accept the permanence of death.

2. Denial

Adults often react to notification of traumatic death with denial. They cant believe that someone they love is dead or that they died due to violence or trauma. Denial occurs because the death does not fit into the adults perspective of normal everyday life. Trauma may not be extraordinary -- violence and death happen routinely in todays world -- but traumatic death in a particular individuals life is extraordinary to that person.

Children lack the ability to deny trauma and death because they dont have a fully formed perspective of normal life. They live in a temporal world that is the present. What occurs today is reality even if it is an awful reality. If they have had little experience with loss or death, they have little experience in dealing with the emotions that accompany loss or death. They dont deny it, but they may be unable to sustain the sadness or the fears that they face.

Fantasy may be used to cope with those reactions and to escape from their intensity. Imaginary or magical thinking is a key source of emotional and mental processing. Children tend to replay the trauma or death through daydreams as well as nightdreams. They may not be as likely to experience intrusive thoughts or flashbacks about the event as adults. Rather, they let their minds wander into thoughts of the events and imagine ways to restore the past or to try to recreate relationships that might now exist but for the event. Sometimes fantasies are scarier than reality. Images of a loved one buried alive in a coffin, confusion over the state of sleep with death, concern over where the loved one is now are examples of sources of scary fantasies. On the other hand, younger children may create imaginary playmates or substitute parent figures in their dreams to help cope with their loneliness. Older children may idealize memories of the person who has died. Often dreams and fantasies focus on possible reunions. Some children may experience "visitations" by ghosts or spirits of the dead. Others may develop a belief in reincarnation of the deceased. Sometimes fantasy is used to explore alternative roles that they might have played in responding to the trauma or in preventing a death. antasy may also be used to imagine different endings to the traumatic event that could have happened and would have had more positive consequences.

3. Losses Caused by Death are Concretely Identified

in a Childs Life; Explanations About Death and

Loss are Often Interpreted Literally

Someone has died. If a child sees the person who is dead, they notice the absence of activity. However, the difference between life and death may not be otherwise obvious. Their concern about the physical aspect of death may be manifested through questions about how someone eats, breathes, or goes to the bathroom when s/he is dead. Since they dont comprehend deaths permanence, they may worry about what will happen to the person when they live again. Caregivers need to be alert to behaviors or casual comments that might indicate children have unspoken questions. Simple, straightforward answers or acknowledgments that the caregiver has similar questions is helpful to children.

Because childrens perspectives are tied to concrete, factual observations, it is particularly important to involve them in activities that acknowledge the mourning process and provide them with rituals and symbols that help to memorialize what has happened. Children sometimes think that adults dont care what happened to the deceased because adults do not involve the children in funeral arrangements or memorials and may be uncomfortable with demonstrating their own grief in front of children. Children often resent what they perceive as attempts to replace loved ones or to forget them. When the deceaseds clothes or property are removed quickly, children may see that as a betrayal of the deceased.

As children become more aware of the fact that the deceased will not return to their life, they also become more aware of the consequences of the death. They miss the behavior of the deceased -- habits, routines, activities that they had learned to expect in their lives. They may miss physical reminders of the deceased, particularly if adults have removed clothes, personal property, or photographs from the childs home or school. They also miss the deceased when they are not a part of their life. If a childs father has died, dinner time may be particularly traumatic because the father doesnt sit in his usual place. Children may long for opportunities to discuss ongoing life events with a person who has died but who served as an advisor or counselor for children during their life.

Loss may also be marked by increased expectations in a childs life, such as role changes or the need to become more mature. Sometimes these expectations are driven by childrens own interpretation of the death and their need to act or behave differently in order to become safer or to substitute their own life for the one that has been lost. Sometimes the expectations are defined by family or social connections. A grieving mother may turn to her son after the death of her husband and want him to assume the role of the "man in the family."

4. Trauma Reactions are Related to Grief Reactions

Traumatic death compounds grief but reactions to the trauma often take precedence over grief. There is shock and disbelief about the nature of the traumatic event. Emotional reactions such as anger, fear, frustration, guilt, shame and grief over the traumatic event prolong efforts to begin life again. Grief may be postponed over and over again, but it is also a part of the traumatic reaction. While there are common elements of grief -- just as there are comment elements of trauma reactions -- every child is different. Some reactions may be illustrated in the following.

a. Protest or Anger Over the Loss or Death

Anger may be directed at the person who died -- How could he do this to me? How could he leave me? It may be directed at parents or adult caretakers who failed to protect themselves or the child. It may be addressed to God or the supernatural -- Why did he have to die and someone else is still alive? Sometimes it is directed internally by children themselves as they worry about what they might have done to cause the death.

b. Sorrow and Sadness About the Loss or Death

Children need to know that crying is a normal way to express sadness. They need to know that feeling lethargic or uninterested in things around them is also a sign of their grief. Some children misbehave or withdraw from ordinary activities. It is often important to reassure children that it is okay to laugh and play, and that it doesnt mean they didnt love the person who died.

c. Guilt or Self-blame

Children often believe that their thoughts or feelings can cause things to happen. If they wish that someone was dead and then that person dies, they may feel their thoughts made death happen. They may feel that if they had been better people, God wouldnt have let this happen to them. They may have deep regrets and guilt over times when they were angry or behaved badly towards the deceased.

5. Children Face Additional Risks Which Increase

the Traumatic Grief Reaction

They may experience changes in the primary adult or adults who are responsible for their caretaking. They may be forced to relocate their home or to attend a different school because of the impact of the trauma. Sometimes they are sent away to homes of relatives or friends for a temporary time to give parents or significant adults a chance to organize their lives. Excluding children from transition activities and events adds to their sense of abandonment and isolation. Particular activities which children had enjoyed before the trauma may now cease because the person who died was the one responsible for promoting those activities or involving the children in those activities.

Back to Table of Contents