David J. Schonfeld, MD, FAAP, is Thelma and Jack Rubinstein Professor of Pediatrics. He also serves as director for the National Center for School Crisis and Bereavement, and in a similar capacity for Developmental and Behavioral Pediatrics at the Cincinnati Children's Hospital Medical Center. He responds here to questions about helping children who are grieving for a pet, close friend, or relative.
NAJP: Dr. Schonfeld, you recently conducted a free live webcast to help educators understand their role in helping children cope with grief. What brought this about?
DJS: The National Center for School Crisis and Bereavement, the New York Life Foundation, and Scholastic all share the goal of improving the capacity for school personnel to support children who are grieving. School is an ideal location to provide this ongoing support--children spend nearly half of their waking hours in school, teachers understand child development and are able to support children at times of stress, and teachers and other school personnel establish long-term relationships with children that can serve as a context to provide the needed support over time. In addition, students who are grieving often experience difficulties with attention, concentration, and learning that may impair their academics.
NAJP: What do you see as the educator's role in the death of a parent?
DJS: Teachers need to approach children who are grieving to acknowledge the loss (and express their sympathy), offer support and assistance, and check in periodically to help promote adjustment. Students may require, for a time period, academic supports (e.g., tutoring) and accommodations (e.g., additional time for tests or assignments). Teachers should anticipate and address grief triggers (e.g., before asking children to prepare a card for Father's Day, they should acknowledge that some children may not have a father who is alive or with whom they regularly communicate and suggest that they select another male role model in their life for the assignment or write a card in honor of their father even if he is no longer alive or reachable) and let students know that they can leave the room if they are feeling overwhelmed (e.g., after something in the lesson or classroom discussion triggers memories or feelings about their loss).
Teachers should also reach out to parents and seek their input about how to support their children and offer advice (e.g., around funeral attendance) and resources (e.g., bereavement support groups, referral to a school counselor or other mental health professional).
NAJP: Often children are confronted with unexpected death--say a car accident in which a parent is involved. How does that differ from a child who has seen mom or dad attempting to cope with cancer over the course of several years?
DJS: Unexpected losses are often associated with a period of initial shock and may be particularly overwhelming. They provide no opportunity for explanation prior to the death, no ability to put into place supports (e.g., when a parent is dying of cancer, hospice services may begin to work with the children to explain what is occurring and provide support), and may be associated with particularly high levels of guilt. Prolonged deaths often provide an opportunity for anticipatory grieving, where the individual can "practice" grieving while the individual is still alive, but then be reassured when feelings become overwhelming by the fact that the person is still alive. There are, though, challenges with prolonged illnesses. They often are particularly taxing to families in terms of money and energy. Individuals who are going through anticipatory grieving proceed at variable rates and the process is not linear--so one person may have reached acceptance and begun to detach personal ties (e.g., an adolescent may start spending more time outside of the home with peers or the surviving parent may spend more time at work) while others in the family become more directly involved with the parent who is dying (and then feel abandoned by the family member who is spending less time at home or with the individual who is dying)--and the same individual will vary in their level of attachment and involvement over time. …