1. Loss and Grief for Children and Adolescents Graham Martin OAM, MD, FRANZCP, DPM g.martin@uq.edu.au

2. Personal reflections

3. Death and Children in 2007 Children may experience meaningful loss through death of  Grandparents, Parents or Siblings  Animals  Death on Television though the News, or more likely through programs is more frequent, but may have less impact.

4. Acute Loss Syndrome  Psychological and Somatic Symptoms  May appear immediately, or delayed  May be exaggerated or apparently absent  May appear to be a distorted aspect of one part of the syndrome  Is amenable to support, care, but needs to run its course

5. Symptoms  Somatic Distress - often in waves  A sense of unreality, with increased emotional distancing  Often an intense preoccupation with the image of the dead  Feelings of responsibility or guilt  Disconcerting loss of warmth in relationship, with irritability or anger  Changes in patterns of conduct  Traits of the deceased may appear in the behaviour of the child

6. Death of a mother  Universally accepted as more traumatic  Shock, disbelief, denial may be followed by episodes of panic  Regression  Compensation  Clinging to a mother substitute

7. Death of a father  All the previous symptoms may occur  Death of a father may be more difficult for a boy

8. Death of a sibling  Regret or Guilt may be prominent  Profiting from extra parental attention  Struggling with the reaction of parents  A ‘replacement’ child can have special problems

9. Grieving in Infancy  During the first 2 years there may be no true understanding of death  However, stages of loss (Bowlby, 1958) may appear:  Protest  Despair  Detachment  There may be later problems with attachment, or an inability to trust that others will ‘always’ be there

10. From age 3  May have more comprehension  May be able to discuss the death  May act out fears and fantasies  May not have concept of death as final; this may lead to anxieties over sleep  Separation anxiety is common, and dependency may be strong  Grief work through play

11. From about age 6  May accept that death is final  May have resulting fears around own finiteness  Personification of Death  Grief work more verbal

12. From about age 10  More emotionally mature with an understanding of the finiteness of death  Most of the intellectual tools to understand death and its context  Delayed or distorted reactions can occur

13. Distorted grief reactions  Overactivity with no sense of loss  Taking on traits of the deceased  A psychosomatic disorder  Alteration of relationships with friends and siblings  Hostility to certain people (eg professionals)  Withdrawal  Problems at school  Aggressive acting out  Depression with agitation

14. The Funeral  Whatever our core religious beliefs, some ceremony is necessary for us to celebrate a life and acknowledge the passing  All children should be present and take part in the mourning as far as they can