Raising Children in Families
Affected by Loss
Joann O’Leary, PhD
CEED, University of MN
MNAEYC/MNSACA
February 10, 2012
A child can live through anything, so
long as he or she is told the truth and is
allowed to share with loved ones the
natural feelings people have when they
are suffering. Eda LeShan
• This presentation focuses on
pregnancy and infant loss but
children’s grief responses transfer to
other losses
Children Suffer Many Kinds of
Losses
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Adoption
Divorce
Deployment
Moving to a new home
Changing Day Care
Foster placement
Death of parent or sibling
Foster/Adopted Children
 Suffer from multiple losses that are ongoing. i.e. – loss of birth
family, loss of home/environment, loss of support, loss of
security, etc.
• Faced with unique loss experiences and attachment issues that
can represent significant developmental and/or
emotional/behavioral issues that can impact the process of
creating healthy attachments and bonding resulting in at
risk/complicated, chronic, disenfranchised, delayed or
unresolved grief
 Suffering multiple losses, both physical and symbolic can
result in bereavement overload, described as a shut down or
“auto pilot.”
In 1916 Sophia Fahs, a Unitarian educator, editor,
author and minister, with a special interest in the
religious education of children, wrote an article for
Parent Magazine titled, “What are our children’s
thoughts about death?” She describes a scene in her
home after her baby daughter Gertrude had died.
Her other three children were all under four years of
age.
“Before the funeral, a special service was held
for the three other children in the family and for
those of their child friends who cared to come. In
a bassinet draped with white dotted Swiss over
which were twined sweet peas, the baby’s body
lay. Simply and kindly the pastor talked and
prayed with the little group of hushed children,
and together they sang a child’s song.”
Why Include Children
Before the baby had come into the world, the
sisters and brother had shared the joyous
knowledge of her expected birth, and after she
went, they shared also with their parents the
trust that all was well with the child” (Hunter, pp
91-92).
Statistics Around Perinatal Loss
• 25 % of all pregnancies end in loss in the form
of miscarriage, stillbirth or neonatal death
• African American women experience loss 2x
more frequently than European Am Women
• Miscarriage occurs in 1 of 5 pregnancies
• MN has one of the lowest infant mortality rates
in the nation yet in the Am Indian population
babies die at a rate of two to three times higher
than the white population (America Indian Infant
Mortality Review Project 2005-2007)
Statistics Regarding Sibling Death
• Just under 2 million children age 18 and under
living in the United States have experienced
the death of a sibling.
• 26, 000 stillbirths in U.S. in a year
• 19,000 Newborn deaths
• Close to half of these families have other
children.
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The parent they knew before the loss
Sibling relationship
Loss of security
Sense of guilt
Will I die too?
Loss of attention
Loss of normality
Parental communication: If the parent can
tolerate the pain the child will learn to as well
Death is Hard to Talk About
• Death isn’t nice
• Death makes us uncomfortable
• Emotional pain of a grieving person can be
frightening
• Death forces us to look at our own mortality
• We cannot fix death
• Often looks like depression
• There are no easy answers
• We don’t know what to say or do
The Families Perception of Loss is
influenced by:
• Traditions around loss and death, personal beliefs,
extent and nature of family support, especially
pregnancy loss
• Even families that share a common cultural/tribal
heritage may have different customs as the result of
their own experiences and levels of assimilation
• Cultural expressions vary according to education,
socio-economic factors, ethnic affiliations and
acculturation process
Parental Concerns in Telling the
Children
• Children are too young to understand
• In the depth of their own pain they don’t want their
children to feel the same
• They don’t know how
• But…parents need to share why they are sad and be
okay crying with them and in front of them
Long illness or quick, unexpected
death
– A long illness may mean the child is more
prepared for the death, but also means that
attention has been devoted to sick sibling for
a period of time
– An unexpected death can be especially
frightening, leaves child feeling vulnerable,
family in deep state of shock, disbelief
At the Time of Loss Assess:
• Degree to which a child was involved or
excluded.
– A child who has been involved in the process
of the sibling’s illness and/or dying will have a
better opportunity to grieve, express feelings,
gain information
– A child who is excluded from the process feels
left out, does not understand what is
happening, may feel less important in family
Why Children Need to Know
• I remember lots of the miscarriages as a
toddler/preschooler and my Mom often
feeling sad and alone. I was frightened
and often overwhelmed. I still need to hear
that what happened was not my fault and I
couldn't fix it or make my Mom feel better.
Children Need
• Children understand
grief within
developmental
stages
• Grief is not linear
• Grief is unique
• Grief work helps us
to achieve
reconciliation and
healing with loss
• There is no right or
What Helps
• Open, honest communication
• Reassurance that:
– family is a safe place to share feelings
– their parents will be there for them
• Someone to
– Listen to their fears, fantasies, and questions
– Validate their individual thoughts and feelings
• Safe ways to express their inner feelings
– Play
– Art
– Books
Explore
• What parents have shared thus far with the child
• Is there stress between parents concerning the loss or
conflict with extended family
• What are their feelings about crying in front of the
child
• Present them with options, not directives
• Support what would be meaningful to them and then
help them to make those experiences happen
“It was the best of times, it was the
worst of times...”
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Charles Dickens
Twin births rose 70%
between 1980 and 2004
Triplet or higher order
multiple (HOM) births
increased more than 400%
during the 1980s and 1990s
(Martin et al. 2009)
4x the perinatal mortality
3x the neonatal morality
C-birth in over 80%
Twins are five times and
triplets are 15 times more
likely to die within 1 month
after birth. (Little, 2010)
Prenatal Grief
• Respect that unborn
children carry cellular
memory
– Implications for
survivors of multifetal
pregnancy
– Children who are
adopted
– Unwanted pregnancy
Infant
• Bowlby contended infants as young as 6
months experience mourning in the same ways
as adults
• Aware of presence, sudden change in physical
and emotional climate
• If the mother is grieving, the infant senses this
and respond with changes in behavior
• May have night terrors, colic, or general
distress; Need the words for feelings
• Separation anxiety can last a long time
Verbalize Emotions
• Adoption or Foster Placement: loss, fear,
abandonment, anger & pain
• Allow child to grieve and not “shush” his
cries
• Acknowledge the pain “It must be so hard
for you to leave your mother.”
• Ask the birth mother what kind of soap she
uses so they can retain some of those
same comforting smells.
Toddlers/Preschool
• Learning the world is
safe
• Can't conceptualize
death but express
sadness even when a pet
dies
• Grieve in spurts, throw
temper tantrums, rock
for comfort, revert to
earlier behaviors
• May have a strong
desire to control
Case: Day Care
• 2 ½ yr. old with emotional melt-downs,
aggression, defiant behavior
• No death in family or divorce but in a period of
two months the:
– Family had moved to a new home
– Girl no longer shared a bedroom with 5 yr. old sister
– Sister “graduated to Kindergarten” so no longer with
her
– Girl had transitioned out of toddler room
• Losses:
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Her home
Her old neighborhood and friends
Cozy, shared bedroom
Big sister at her day care
Old classroom environment, teachers and friends
Case: Death of a Parent
• Four year old in car accident where
mother died
• Remembers waking up in the dark, red
light flickering and hearing sirens
• Told no information other than her mother
went to heaven
• For months afterwards she screamed
every time she heard a siren
Case: Pregnancy Loss
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5 year old (1959)
Saw mother hemorrhage on the floor
Ran for help
Other than father, no one saw the baby
No explanation to the children
I think what he did was to just detach. If I don’t
love you I don’t have to be hurt
• As a adult: Writes science fiction, many about
survivor guilt : A boy on a mountain hiking trip
and he comes home and his younger brother
doesn’t. It’s always a younger brother who
doesn’t survive.
Case: Death of Younger Brother
• For years I always thought it was my fault
because he had a small form of epilepsy. I still
remember the day my dad was running down
the hall screaming. My parents would not let me
hold him, or see him so the last time I saw him
was when the paramedics were working on him.
• I never talked to anybody about it. My parents
never wanted to talk about it. They were the
type, “Let’s just not talk about it.”
• Sibling loss changes order in the family
• “It should have been me”
• Acting out, destructive behaviors OR
• May isolate themselves, become asocial and
emotionally insulated
Other Signs of Grief
• Physical pain, such as a headache or stomach ache
• Sleeping problems or bad dreams
• Eating problems (not eating or eating too much)
• Fear of being left alone
• Being very clingy (wanting to be near certain people)
or disengage
• Regression eg wetting bed, cognitive skills
Helping Preschoolers
• Discuss death in simple & direct terms
– The body stopped working
– It has a specific cause
– Pregnancy loss “The baby was too small to live
outside of mommy”
– It is irreversible
– Reassurance they are still safe
– Keep activities as routine as possible
To Help Children Help the
Parents
• Deal with their own grief. If they’re okay the kids
will be okay
• Encourage parents not to hide their tears or pain
from their children
• Be truthful, honest and consistent
• Remind the parents to tell their children that the
death was not their fault (magical thinking)
– We thought it was our fault that Freddie died.
• It’s not the child’s job to take care of the parent
Preventing Disenfranchised Grief
• Giving voice to an
experience liberates it from
disenfranchisement
(Quote from Embracing Laura)
• Children given the words for
what happened fair better as
it is not a secret in the family
• They saw mommy’s tummy
getting big and needed to
know the baby didn’t just go
away
You Can Help By:
• Encourage kids to show their feelings by letting them
write a letter, a story, a poem, or drawing
• Keeping parents informed of children’s activities
• Encourage parents to be lavish with their affection,
plenty of hugs
• Allow children to be involved in the funeral and other
family rituals
• Reassure the parents that the kids will be okay
When Parents Have Difficulty
• You may be the first to observe children acting
out the story in play or art work
• Discuss the child’s behavior and guide
supportive intervention “Have you noticed any changes in
your child’s behavior?”
• If an early pregnancy loss sometimes pictures of
fetal development can be useful
• Help build memories
– For the long term sibling relationship
– To continue the bond with the deceased
Support the Twin Relationship
Respect the Loss for the Surviving Baby
• Begins before birth with
each baby’s innate
sense of physical
proximity to the other
• Respecting the
experience of loss for
the surviving babies is
important
• Most surviving children
are thankful to have the
pictures
Other Cultures
• The belief of some African tribes is that the spirit
of the dead twin must be preserved in order to
ensure the wholeness of the survivor (Elniski, 1994).
• Yoruba twins from Nigeria carry a wooden image
representing their dead twin around their neck or
waist, which is said to give at once company to
the survivor and refuge for the spirit of his or her
dead twin.
Involving Siblings
• Support the children’s
story about their deceased
sibling
• Grief can be more intense
as parents realize what
they have missed in not
having all the babies.
Pregnancy After Loss: What we
know already
• Overprotective parenting style and poor parent/child affectional bonds
can impact on children’s later mental health (Armstrong & Hutti 1998,
Parker 1983, Shoebridge & Gowers 2000)
• Bereaved parents in their subsequent pregnancy after the death of a
baby often delay emotional attachment to their new baby for fear of
another loss, (Cote-Arsenault & Marshall 2000, Robertson & Kavanaugh
1998; O’Leary & Thorwick, 2006)
• Subsequent child called ‘replacement’ ‘vulnerable child,’ under influence
of ‘Ghost’ or 'penumbra baby' , may be subject to increased risk of
psychopathology including attachment disorders (Ainsfield & Richards
2000, Kempson, Conley & Murdock 2008, Powell 1995, Reid 2007,
Sabbini 1988,)
• When raising subsequent children, bereaved parents can be
overprotective (Lamb 2002, Pantke & Slade 2006; Warland, et.al.2010;
O’Leary & Warland, 2011)
Involving the Children in the New
Pregnancy
• Children can have the same fears as the
parents: “Is this baby going to die too?”
• Loss of innocence: “When the second baby
died we didn’t believe that a baby’s actually
going to live when they were born”
• May worry about the health of the mother.
• Need reassurance that the doctors are taking
good care of the baby and their mother
Children born after Loss
• Empathetic
• Strong connection and need to have a
continued relationship with deceased
sibling
• Understand the concept of death “Loss of
magical thinking”
– Child: They’re very comfortable with death.
They don’t go into the fear based stuff around
death, more into what happens spiritually to
people when they die (3 & 5 yr. old
subsequent girls)
Protective Parenting
• Understand they will be more protective parents: I check on the
kids in the middle of the night and always have…put my hand on their chest
or my finger under their nose to feel that they are breathing
• Acknowledge you understand their fear and provide
reassurance: “She’d tell me how her day was. She actually wrote something up
every day about what her day was like.”
Parent Suggestions
• You can’t focus on the negative, worrying about
what could be but focus on what is good today
• I keep myself in check by watching friends who I
think are doing a good job raising their kids and
haven’t had the same experience
• I practice teaching them to do things alone in
case I’m not there to help
What Families Need
From Teachers and Care Providers
• Put away all pre-stigmatized thoughts on the subject
and know that in the minds of these families and the
hearts of these families there’s a substantial and
significant loss that is always part of them that they
carried.
• Parents don’t always know what the best way is to
teach our kids about that loss and move forward. We
might not do every thing right and unless they have
support like I had from other parents in the same
situation it feels like it’s a secret that we have to carry
and one that stays quiet.
• Parents really need to know that people aren’t going
to sit in judgment of how they’re parenting their kids.
• Don’t know
everything
• Don’t know all the
answers
• Don’t need to know
what to say
• Won’t help everyone
• Aren’t perfect
• Can be open
• Can say no
• Have both
strengths and
weaknesses
• Believe the
family will
survive and
YOU WILL
make a
difference
NUTURE YOURSELF SO YOU
CAN SUPPORT & NUTURE THE
FAMILY
• Care providers must
grieve too. If your own
grief issues are
unresolved it may cause
difficulties.
• There is evidence
showing that people
working under major
stresses without relief are
at risk of physical as well
as emotional illness.
• Rely on peers to avoid
taking on the families
Resources
• www.plida.org for
updated bibliography
on grief issues with
children and parents
• http://cehd.umn.edu/c
eed/profdev/onlinecou
rses/htm
Adoption/Foster Care
• Axness, M. (1998). Painful lessons, loving bonds: The heart of open
adoption.
• http://DrMarcy@QuantumParenting.com
• Axness, M. (1998). What is written on the heart: Primal Issues in adoption.
• Ganz, S. Video: Unlocking the heart of adoption.
• Mann, J. & Kretchmar, M. (2006). A disorganized toddler in foster care:
Healing and change from an attachment theory perspective. Zero to Three,
26(5), 29-36.
• Resources by Michael Trout at the Infant-Parent Institute
• MTrout@infant-parent.com
• The Hope-Filled parent: Meditations for foster and adoptive parents of
children who have been harmed
• Breaking Peaces: Babies have their say about domestic violence
• Gentle transitions: A newborn baby’s point of view about adoption
• Multiple transitions: A young child’s point of view on foster care and
adoption
• Is anyone in there? Adopting a wounded child