Grief in pediatric

1. GRIEF
PRESENTED BY:
MRS. PRECILLA B. THOPPIL
ASSOCIATE PROFESSOR

2. DEFINITION
It is a powerful emotional reaction to a separation or
loss like declining health, impending death, death of
loved ones or loss of valuable object.

3. MOURNING
It is the process by which grief is resolved. It is the societal
expression of post bereavement behavior and practices.

4. BEREAVEMENT
It means the state of being deprived of someone by
death and refers to being in the state of mourning.

5. CAUSES, INCIDENCE AND RISK FACTORS
• Relationship break – up
• Loss of health
• Loss of friendship
• Illness of loved one
• Death of pet

6. STAGES OF GRIEF
In 1969, psychiatrist Elisabeth Kubler Ross introduced, “five stages of grief” which
are as follows:
1. Denial: “This can’t happen to me”
2. Anger: “Why is this happening”?
3. Bargaining: “Make this not happen and in return I will..”
4. Depression: “I’m not sad to do anything”
5. Acceptance: “I’m at peace with what happened”.

7. STAGES OF CHILDREN’S GRIEF
1) Disorganization: The initial expressions of grief in children range from regression, temper
tantrums, lack of concentration and mood swings in older children.
2) Transition: Feelings of hopelessness, helplessness and despair follow stress and chaotic
behavior. Many children will exhibit true depression. More common are symptoms of
withdrawal, aggression and giving up in school.
3) Reorganization: When painful feelings are expressed, their emotional energy fades and
children feel better. During this stage children have more energy and motivation for moving
forward to resolve grief.

8. SYMPTOMS OF GRIEF
It can have physical, psychological and social signs.
1) Physical signs
• Insomnia
• Tight muscles of mainly chest and throat
• Interrupted sleep
• Lethargy
• Generalized weakness

9. 2, PSYCHOLOGICAL SIGNS
• Preoccupation with or ambivalence towards lost object
• Anger
• Fantasies that the object is not lost
• Guilt over inability to prevent loss

10. 3. SOCIAL SIGNS
• Withdrawal from usual social activities
• Decreased work productivity

11. FACTORS INFLUENCING GRIEF RESPONSE
1. The bereaved person was strongly dependent on the deceased
2. A love-hate relationship existed between the bereaved and the lost
3. The bereaved has experienced a number of recent losses
4. The loss is that of a child or young person
5. The bereaved person holds himself responsible for the loss

12. LENGTH OF GRIEF PROCESS
• The acute phase of normal grieving usually lasts 6-8
weeks and longer in older adults.

13. COMPLICATED OR DYSFUNCTIONAL GRIEF
• Chronic grief: It usually occurs when the relationship between the bereaved and deceased
had been extremely close and no friends or relatives are available to share the sorrow over
extended period of time.
• Hypertrophic grief: After sudden and unexpected death, bereavement reactions are
extraordinarily intense in hypertrophic grief. Hypertrophic grief frequently takes a long
term course.
• Delayed grief: Absent or inhibited grief when acute mourning is expected is referred to as
delayed grief. This pattern is marked by prolonged denial, anger and guilt.

14. GRIEF AND CHILDREN
Age of children Concept of death Way of expressing grief
Children below – 2 years of age They cannot understand death • Reduced activity,
• quietness,
• sleep problem,
• weight loss
Children between 1 – 6 years of age Assume that the loved ones is in deep
sleep. Think that death is temporary
and their loved one will get – up soon.
• Makes many queries like how will
the dead person eat?,
• difficulty in eating and sleeping,
• problems in bladder and bowel
control,
• fear of loneliness,
• temper tantrum.
Children between 6 – 9 years of age Death is frightening and final death is
thought of as a spirit or person or
ghost
• Ask specific questions
• Curious about death
• May develop fear about school
• Display aggressiveness in behavior
• Fear of loneliness or

15. Children between 9-13 years of age • They accept that death is
inescapable and no one
can change it.
• They are aware of death
• They accept that like my
loved one has died
everyone will die
• Anger, guilt, shame
• Enhanced anxiety about own
death
• Mood swings
• Changes in eating habit
• Sleeplessness
• Lack of interest in outdoor
activities
• Impulsive behavior
• Guilty feeling about being
alive himself or herself
Teenagers or adolescents They respond to death like adults do • Show denial
• They don’t display any fear or
emotion but internally they
are frightened and emotional
• May indulge in smoking,
drinking alcohol, drugs or
having unprotected sex.
• Can have suicidal thoughts

16. GRIEF MANAGEMENT IN CHILDREN
A. Helping a grieving preschooler (3-5 years):
• answer the child’s question honestly, and simply.
• Allow them to talk about loss, help them, share their fears and worries.
• Provide simple routines
• Give the child, affection and nurturing, attempt to connect with them
• Provide more opportunities for play
• Be patient with regressive behaviors, such as thumbsucking
• Provide opportunities for expression of painful emotions through play, creative outlets, and talk
• Teach them to recognize and name their feelings.

17. B. HELPING A GRIEVING ELEMENTARY SCHOOL AGE
CHILD (6-9 YEARS)
• Keep tasks simple. Try to keep the child busy in these simple task.
• Insist that children express their feelings in words, and not by acting out.
• Encourage them to let you know when they are worried or having a difficult
time.

18. C. HELPING GRIEVING PRE-TEENS AND EARLY
ADOLESCENCE
• Accept their mood swings and physical symptoms.
• Encourage them to honestly recognize their painful feeling and find positive outlets in
physical and creative activities
• Trying to understand the feelings behind the words and actions and respond with
empathy
• Be truthful and factual in explaining the loss
• Allow pre-teens to make choices that help in safe expression of feelings

19. D. HELPING TEENAGERS DURING GRIEVING.
• Although late teens grieve more like adults but they may not want to participate
in activities associated with a major loss. So respect teen’s position.
• Do not force the teens to participate in activities that he or she feels
uncomfortable while doing.
• Help them to find activities to express their grief.