043: How to talk with children about death
16th July 2017 • Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive • Jen Lumanlan
00:00:00
00:46:28
Shownotes
The topic of today’s episode comes courtesy of my good friend Sarah, who fortunately hasn’t yet had any reason to use this knowledge, but asked me to do an episode on how to help children cope with illness, death, and grief, so she can be ready in case she ever needs it.
Dr. Atle Dyregrov joins us from Bergen, Norway. He graduated as a psychologist in 1980 and worked for five years in the Pediatrics department at Haukeland University Hostpital, helping families whose children had died. He also co-founded the Center for Crisis Psychology and served as its general manager for 25 years; he is now its academic director. He has worked particularly extensively with children who have experienced loss and trauma, as well as at the sites of major accidents and disasters both in Norway and abroad, and has written numerous books, book chapters, and research articles on children’s response to death and crises.
It turns out that this ended up being a very timely episode for me indeed: you’ll hear in the show that my mum died when I was young. Not even a week after I did this interview, my newly three-year-old daughter was playing with Legos in our living room when she asked – completely out of the blue – “Do you have a mama?” Having done this interview I was well-prepared for a short but straightforward conversation, and was able to shift what would likely have been a very uncomfortable situation for me into something where I felt much more confident in explaining how people’s bodies stop working when they die.
Subscribers to my newsletter will recall that we spent last week in Missouri visiting the very same Sarah who requested the episode, and I had given her a summary of the content and told her about my daughter’s question. A couple of days later Sarah and my daughter found a dead bug on a playground and Sarah said “I think it’s dead,” and my daughter responded “Did it’s body stop working?”. Sarah was taken aback…and amused…and was able to answer the question without losing her cool.
Listen to this episode – we’re all gonna need it at some point!
Dr. Atle Dyregrov's Book
Grief in children: A handbook for adults - Affiliate link
References
Abdelnoor, A., & Hollins, S. (2004). The effect of childhood bereavement on secondary school performance. Educational Psychology in Practice 20(1), 43-54.
Adams-Greenly, M., & & Moynihan, R.T. (1983). Helping the children of fatally ill parents. American Journal of Orthopsychiatry 53(2), 219-229.
Ayers, T.S., Wolchik, S.A., Sandler, I.N., Twohey, J.L., Weyer, J.L, Padgett-Jones, D., Weiss, L., Cole, E., & Kriege, G. (2013-2014). The family bereavement program: Description of a theory-based prevention program for parentally-bereaved children and adolescents. Omega 68(4), 293-314.
Baker, J.E., Sedney, M.A., & Gross, E. (1992). Psychological tasks for bereaved children. American Journal of Orthopsychiatry 62(1), 105-116.
Berg. L., Rostila, M., & Hjern, A. (2016). Parental death during childhood and depression in young adults – a national cohort study. Journal of Child Psychology and Psychiatry 57(9), 1092-1098.
Berg, L., Rostila, M., Saarela, J., & Hjern, A. (2014). Parental death during childhood and subsequent school performance. Pediatrics 133, 682-689.
Bugge, K.E., Darbyshire, P., Rokholt, E.G., Haugstvedt, K.T.S., & Helseth, S. (2014). Young children’s grief: Parents’ understanding and coping. Death Studies 38, 36-43.
Corr, C.A., & Balk, D.E. (2010). Children’s encounters with death, bereavement, and coping. New York, NY: Springer.
Dyregrov, A. (2008). Grief in children: A handbook for adults (2nd Ed.). London, U.K.: Jessica Kingsley.
Engarhos, P. (2012). The young child’s understanding of death: Early conversations and experiences with parents and caregivers. Unpublished doctoral dissertation. McGill University. Montreal, Canada.
Kristensen, P., Dyregrov, A., Dyregrov, K., & Heir, T. (2016). Media exposure and prolonged grief: A study of bereaved parents and siblings after the 2011 Utoya Island terror attack. Psychological Trauma: Theory, Research, Practice, and Policy 8(6), 661-667.
Renaud, S-J., Engarhos, P., Schleifer, M., & Talwar, V. (2015). Children’s earliest experiences with death: Circumstances, conversations, explanations, and parental satisfaction. Infant and Child Development 24, 157-174.
Yang, S., & Park, S. (2017). A sociocultural approach to children’s perceptions of death and loss. OMEGA. [Epublication ahead of print.] DOI: 10.1177/0030222817693138
Adams-Greenly, M., & & Moynihan, R.T. (1983). Helping the children of fatally ill parents. American Journal of Orthopsychiatry 53(2), 219-229.
Ayers, T.S., Wolchik, S.A., Sandler, I.N., Twohey, J.L., Weyer, J.L, Padgett-Jones, D., Weiss, L., Cole, E., & Kriege, G. (2013-2014). The family bereavement program: Description of a theory-based prevention program for parentally-bereaved children and adolescents. Omega 68(4), 293-314.
Baker, J.E., Sedney, M.A., & Gross, E. (1992). Psychological tasks for bereaved children. American Journal of Orthopsychiatry 62(1), 105-116.
Berg. L., Rostila, M., & Hjern, A. (2016). Parental death during childhood and depression in young adults – a national cohort study. Journal of Child Psychology and Psychiatry 57(9), 1092-1098.
Berg, L., Rostila, M., Saarela, J., & Hjern, A. (2014). Parental death during childhood and subsequent school performance. Pediatrics 133, 682-689.
Bugge, K.E., Darbyshire, P., Rokholt, E.G., Haugstvedt, K.T.S., & Helseth, S. (2014). Young children’s grief: Parents’ understanding and coping. Death Studies 38, 36-43.
Corr, C.A., & Balk, D.E. (2010). Children’s encounters with death, bereavement, and coping. New York, NY: Springer.
Dyregrov, A. (2008). Grief in children: A handbook for adults (2nd Ed.). London, U.K.: Jessica Kingsley.
Engarhos, P. (2012). The young child’s understanding of death: Early conversations and experiences with parents and caregivers. Unpublished doctoral dissertation. McGill University. Montreal, Canada.
Kristensen, P., Dyregrov, A., Dyregrov, K., & Heir, T. (2016). Media exposure and prolonged grief: A study of bereaved parents and siblings after the 2011 Utoya Island terror attack. Psychological Trauma: Theory, Research, Practice, and Policy 8(6), 661-667.
Renaud, S-J., Engarhos, P., Schleifer, M., & Talwar, V. (2015). Children’s earliest experiences with death: Circumstances, conversations, explanations, and parental satisfaction. Infant and Child Development 24, 157-174.
Yang, S., & Park, S. (2017). A sociocultural approach to children’s perceptions of death and loss. OMEGA. [Epublication ahead of print.] DOI: 10.1177/0030222817693138
Read Full Transcript
Transcript Jen: [00:37] Good morning and welcome to today’s episode of the Your Parenting Mojo podcast. This episode comes to us courtesy of my good friend Sarah, who fortunately hasn’t yet had any reason to use this knowledge, but she asked me to do an episode on how to help children cope with illness, death, and grief, so she can be ready in case she ever needs it. So my guest today is Dr. Atle Dyregrov, who joins us today from Bergen, Norway, and he’s actually the first knighted interviewee on the show, so we’re going to refer to him as Sir Dyregrov. He’s also a professor at the University of Bergen, Norway. He graduated as a psychologist in 1980 and worked for five years in the pediatrics department at Haukeland University Hospital, helping families whose children had died. He also co-founded the Center for Crisis Psychology and served as General Manager for 25 years and he’s now it’s Academic Director. Jen: [01:29] He’s worked particularly extensively with children who have experienced loss and trauma as well as at the sites of major accidents and disasters, both in Norway and abroad, and has written numerous books, book chapters and research articles on children’s response to death and crises. Welcome Dr. Dyregrov. Dr. Dyregrov: [01:45] Thank you. Jen: [01:46] Thank you. It’s such a pleasure to have you here. Now. Before we get started on this topic, I just want to have a little word with my listeners because some of the episodes that I do on the show are episodes that I do for them and some of them are closer to my heart and this is one that’s a little closer to my heart as well. It’s not really a secret, but it hasn’t come up yet in the course of doing the show that my own mom died when I was 10. In a way that was both sudden and unexpected and it was so long ago now that it’s not really a difficult thing for me to talk about anymore, but I kind of wanted to make sure that people are aware of it because it does impact the way that I talk about death and also the way that I think about it. Jen: [02:20] I’ve lived with it for so long now that I sort of think I’ve earned the right to have a bit of a dark sense of humor. I also use very frank language like death and dead rather than passing or lost, and whenever someone uses the word lost, when they actually mean someone died. I always think of a quote from that fabulous Oscar Wilde play The Importance of Being Earnest, where Jack Worthington says, “I have lost both of my parents,” and Lady Bracknell responds: “To lose one parent, Mr. Worthington, may be regarded as a misfortune. To lose both looks like carelessness.” So our goal today is to try and understand what children understand about death and how they experience grief and to give you some real tools you can use when you need to talk with them about it. So let’s get started. All right, Dr. Dyregrov. I thought we could begin on Canada. Easier end of the questions and work our way towards the harder ones. So death is everywhere around us, you know, it happens to all of us and our media is absolutely saturated with it, but we have such a hard time talking about it and particularly talking about it with children. So I’m wondering if you can tell us your thoughts on why this is and is it really because we’re afraid of saying the wrong thing and should we be afraid of that? Dr. Dyregrov: [03:31] I think that’s part of the reason, but I also think that we are afraid of it because it has to do with our own vulnerability; the thought that maybe we will die away from our children to be left alone. That’s a hard thing for parents to think about and talk about. So it is a difficult topic for everyone. And I think it’s that some of the reasons for why we hesitate when we speak with children. Jen: [04:01] And it just seems so strange to me that it’s, I mean it’s everywhere on TV and we watch it all the time, but even when we’re not talking with children, it’s such a taboo topic. Dr. Dyregrov: [04:14] Yeah. But it’s getting gradually better, I think it said when I started in the field in the early eighties, children were not allowed into the hospital if there was a sibling who was very ill, are much more open about it now than we were and that happens everywhere. But, but it’s been a general movement across the world that we are more open with more direct and our responses to children. So I think we’re on the right way. Jen: [04:46] Okay. Well that’s, that’s a good sign then. So I’m curious about what children understand about death. We were actually.. I was taking my daughter down to the car this morning so she could head off to daycare and she was talking about how the rosebuds on our tree outside our house had died. And I was curious about what her conception is of that. Does she know that dying is forever? Does she know they’re not going to come back into bloom again in two weeks? What do children in general understand about death and what are some of the transitions they go through in this understanding as they get older? Dr. Dyregrov: [05:19] Well, in the preschool age, they have a problem understanding that when we’re dead, it’s irreversible; they can’t turn it back. They will ask you, well, in 14 days he’d be back! They also have difficulties understanding that all life functions cease when we die and they don’t understand that death is universal, that everyone will die. Sometimes depending on their actual experience, there is a transition when they get towards between four and six years, usually they would grasp more of this. My own son was…my youngest son was four and a half when his best friend and her and his sister were killed in a traffic accident as well as the mother and when we were going, and I took him to also see the three dead ones then, and before he saw them, he was saying that in 14 days he’d be back; after the summer, he’d be back. Dr. Dyregrov: [06:18] He was sort of not grasping their irreversibility of it, and then when we had seen them and he had taken into concrete facts on the way back home, he said that now we can never do this, now we can never do this. So he sort of took a step because of his practical experience with death and you see that in many children, that they gradually come to grasp with this and they understand that when we’re dead we don’t think, and the hair doesn’t grow any longer but it depends on how much you’re exposed to death also. Jen: [06:56] So you talked about the irreversibility there and then also the body is still a functioning after death. So it would be pretty common then to think that someone might have been buried but still be breathing or something in a way. Dr. Dyregrov: [07:09] Yes, that’s exactly what happens. They wonder who will give a person water; what if they’re thirsty? So they have this sense that they go on living and they would feel pain. So when we explain. We have to be very concrete that might make them understand how the death is concrete than that we don’t feel anything and we don’t need the supplies we usually would have as persons. Jen: [07:34] Okay. And so I, I know you wrote a book on this topic, it’s called Grief and Children: A Handbook for Adults and I found it very clearly written; the language is so concrete and it was so helpful to me in understanding ways to talk about this and you say in it that you should…or the parents should let the child experience the death in the same way that the family does and if there is a viewing of the body that the children should be allowed to see the body if they want to. That to me seems…I mean my mom was cremated so I didn’t have that option, but I’m just thinking about, you know, taking my three year old to see a body and it’s a very strange feeling for me and I’m not saying I wouldn’t do it, but it does feel strange. Dr. Dyregrov: [08:15] It does, but we’ve changed the culture in Norway when we started out, it was very uncommon to have children even participating in the funeral now children are included in rituals and we’ve also done a study where we’ve interviewed children about this and they say that children should not be left out. That should be part of this. And they argue for why it’s important for them because this is something you cannot undo later. It is something that helps them understand that death is real. It can contract the fantasies they have about what death is and it is also an opportunity for expressing. They can bring into the coffin, drawings; they can have written a farewell letter. And I’ve lots of practical experience with this now, and of course there’s been some children who struggled with the image, they see the dead person and it’s different than they thought it would be, so, so that create, can create a sort of, a traumatic image for them, but we can always help with that. But it’s very hard if a child who’s eight asks, where were I; did I get the chance to see? And we have to say no and we cannot undo that they’ve been kept out of this. So I really tell parents that the best thing is to include them, but I also say never force them. Parents must also feel comfortable with bringing the children along and it demands that adults prepare them, that they follow them through and give them explanations for what they see for also the adults’ reactions they may observe and then follow up afterwards with conversation about what they’ve been part of. Jen: [10:07] Yeah. It seems that that preparation is really key, right? I mean, if you don’t know what you’re going to see. And I, I’m actually not sure I’ve ever seen a dead body, so I don’t know how I would prepare someone, but I assume there are people you can talk to about that kind of thing. Um, and that you should have a conversation with the child in advance, right? About what they’re going to see. Dr. Dyregrov: [10:25] Definitely. It’s, it’s the difference between something that can be experienced traumatic, and what can be therapeutic for you lies in the preparation. Jen: [10:35] Okay. And so do you find that funeral homes are typically well equipped to have those kinds of conversations or how do you do it if you don’t feel comfortable doing it yourself? Dr. Dyregrov: [10:45] In Norway we see that the, I don’t know what it’s called, the funeral and the undertaker? Jen: [10:51] Yeah; same thing. Dr. Dyregrov: [10:52] They are the ones that often introduce this to the families and also try to get the parents to include children. And so it’s more the rule that children will be part than they are excluded. And the same… If there’s damage to the body due to accidents or suicide, they will. If parents can’t be that children shouldn’t be there, but when parents can be there, children can be, and I have helped some who struggled with images, but it’s very few compared to how many will take part in this, but there are cultural differences here and
Transcript Jen: [00:37] Good morning and welcome to today’s episode of the Your Parenting Mojo podcast. This episode comes to us courtesy of my good friend Sarah, who fortunately hasn’t yet had any reason to use this knowledge, but she asked me to do an episode on how to help children cope with illness, death, and grief, so she can be ready in case she ever needs it. So my guest today is Dr. Atle Dyregrov, who joins us today from Bergen, Norway, and he’s actually the first knighted interviewee on the show, so we’re going to refer to him as Sir Dyregrov. He’s also a professor at the University of Bergen, Norway. He graduated as a psychologist in 1980 and worked for five years in the pediatrics department at Haukeland University Hospital, helping families whose children had died. He also co-founded the Center for Crisis Psychology and served as General Manager for 25 years and he’s now it’s Academic Director. Jen: [01:29] He’s worked particularly extensively with children who have experienced loss and trauma as well as at the sites of major accidents and disasters, both in Norway and abroad, and has written numerous books, book chapters and research articles on children’s response to death and crises. Welcome Dr. Dyregrov. Dr. Dyregrov: [01:45] Thank you. Jen: [01:46] Thank you. It’s such a pleasure to have you here. Now. Before we get started on this topic, I just want to have a little word with my listeners because some of the episodes that I do on the show are episodes that I do for them and some of them are closer to my heart and this is one that’s a little closer to my heart as well. It’s not really a secret, but it hasn’t come up yet in the course of doing the show that my own mom died when I was 10. In a way that was both sudden and unexpected and it was so long ago now that it’s not really a difficult thing for me to talk about anymore, but I kind of wanted to make sure that people are aware of it because it does impact the way that I talk about death and also the way that I think about it. Jen: [02:20] I’ve lived with it for so long now that I sort of think I’ve earned the right to have a bit of a dark sense of humor. I also use very frank language like death and dead rather than passing or lost, and whenever someone uses the word lost, when they actually mean someone died. I always think of a quote from that fabulous Oscar Wilde play The Importance of Being Earnest, where Jack Worthington says, “I have lost both of my parents,” and Lady Bracknell responds: “To lose one parent, Mr. Worthington, may be regarded as a misfortune. To lose both looks like carelessness.” So our goal today is to try and understand what children understand about death and how they experience grief and to give you some real tools you can use when you need to talk with them about it. So let’s get started. All right, Dr. Dyregrov. I thought we could begin on Canada. Easier end of the questions and work our way towards the harder ones. So death is everywhere around us, you know, it happens to all of us and our media is absolutely saturated with it, but we have such a hard time talking about it and particularly talking about it with children. So I’m wondering if you can tell us your thoughts on why this is and is it really because we’re afraid of saying the wrong thing and should we be afraid of that? Dr. Dyregrov: [03:31] I think that’s part of the reason, but I also think that we are afraid of it because it has to do with our own vulnerability; the thought that maybe we will die away from our children to be left alone. That’s a hard thing for parents to think about and talk about. So it is a difficult topic for everyone. And I think it’s that some of the reasons for why we hesitate when we speak with children. Jen: [04:01] And it just seems so strange to me that it’s, I mean it’s everywhere on TV and we watch it all the time, but even when we’re not talking with children, it’s such a taboo topic. Dr. Dyregrov: [04:14] Yeah. But it’s getting gradually better, I think it said when I started in the field in the early eighties, children were not allowed into the hospital if there was a sibling who was very ill, are much more open about it now than we were and that happens everywhere. But, but it’s been a general movement across the world that we are more open with more direct and our responses to children. So I think we’re on the right way. Jen: [04:46] Okay. Well that’s, that’s a good sign then. So I’m curious about what children understand about death. We were actually.. I was taking my daughter down to the car this morning so she could head off to daycare and she was talking about how the rosebuds on our tree outside our house had died. And I was curious about what her conception is of that. Does she know that dying is forever? Does she know they’re not going to come back into bloom again in two weeks? What do children in general understand about death and what are some of the transitions they go through in this understanding as they get older? Dr. Dyregrov: [05:19] Well, in the preschool age, they have a problem understanding that when we’re dead, it’s irreversible; they can’t turn it back. They will ask you, well, in 14 days he’d be back! They also have difficulties understanding that all life functions cease when we die and they don’t understand that death is universal, that everyone will die. Sometimes depending on their actual experience, there is a transition when they get towards between four and six years, usually they would grasp more of this. My own son was…my youngest son was four and a half when his best friend and her and his sister were killed in a traffic accident as well as the mother and when we were going, and I took him to also see the three dead ones then, and before he saw them, he was saying that in 14 days he’d be back; after the summer, he’d be back. Dr. Dyregrov: [06:18] He was sort of not grasping their irreversibility of it, and then when we had seen them and he had taken into concrete facts on the way back home, he said that now we can never do this, now we can never do this. So he sort of took a step because of his practical experience with death and you see that in many children, that they gradually come to grasp with this and they understand that when we’re dead we don’t think, and the hair doesn’t grow any longer but it depends on how much you’re exposed to death also. Jen: [06:56] So you talked about the irreversibility there and then also the body is still a functioning after death. So it would be pretty common then to think that someone might have been buried but still be breathing or something in a way. Dr. Dyregrov: [07:09] Yes, that’s exactly what happens. They wonder who will give a person water; what if they’re thirsty? So they have this sense that they go on living and they would feel pain. So when we explain. We have to be very concrete that might make them understand how the death is concrete than that we don’t feel anything and we don’t need the supplies we usually would have as persons. Jen: [07:34] Okay. And so I, I know you wrote a book on this topic, it’s called Grief and Children: A Handbook for Adults and I found it very clearly written; the language is so concrete and it was so helpful to me in understanding ways to talk about this and you say in it that you should…or the parents should let the child experience the death in the same way that the family does and if there is a viewing of the body that the children should be allowed to see the body if they want to. That to me seems…I mean my mom was cremated so I didn’t have that option, but I’m just thinking about, you know, taking my three year old to see a body and it’s a very strange feeling for me and I’m not saying I wouldn’t do it, but it does feel strange. Dr. Dyregrov: [08:15] It does, but we’ve changed the culture in Norway when we started out, it was very uncommon to have children even participating in the funeral now children are included in rituals and we’ve also done a study where we’ve interviewed children about this and they say that children should not be left out. That should be part of this. And they argue for why it’s important for them because this is something you cannot undo later. It is something that helps them understand that death is real. It can contract the fantasies they have about what death is and it is also an opportunity for expressing. They can bring into the coffin, drawings; they can have written a farewell letter. And I’ve lots of practical experience with this now, and of course there’s been some children who struggled with the image, they see the dead person and it’s different than they thought it would be, so, so that create, can create a sort of, a traumatic image for them, but we can always help with that. But it’s very hard if a child who’s eight asks, where were I; did I get the chance to see? And we have to say no and we cannot undo that they’ve been kept out of this. So I really tell parents that the best thing is to include them, but I also say never force them. Parents must also feel comfortable with bringing the children along and it demands that adults prepare them, that they follow them through and give them explanations for what they see for also the adults’ reactions they may observe and then follow up afterwards with conversation about what they’ve been part of. Jen: [10:07] Yeah. It seems that that preparation is really key, right? I mean, if you don’t know what you’re going to see. And I, I’m actually not sure I’ve ever seen a dead body, so I don’t know how I would prepare someone, but I assume there are people you can talk to about that kind of thing. Um, and that you should have a conversation with the child in advance, right? About what they’re going to see. Dr. Dyregrov: [10:25] Definitely. It’s, it’s the difference between something that can be experienced traumatic, and what can be therapeutic for you lies in the preparation. Jen: [10:35] Okay. And so do you find that funeral homes are typically well equipped to have those kinds of conversations or how do you do it if you don’t feel comfortable doing it yourself? Dr. Dyregrov: [10:45] In Norway we see that the, I don’t know what it’s called, the funeral and the undertaker? Jen: [10:51] Yeah; same thing. Dr. Dyregrov: [10:52] They are the ones that often introduce this to the families and also try to get the parents to include children. And so it’s more the rule that children will be part than they are excluded. And the same… If there’s damage to the body due to accidents or suicide, they will. If parents can’t be that children shouldn’t be there, but when parents can be there, children can be, and I have helped some who struggled with images, but it’s very few compared to how many will take part in this, but there are cultural differences here and