The document discusses how to help children cope with loss through death or other traumatic events. It emphasizes the importance of strengthening the caregiver-child relationship, providing stability through routines, and allowing children to communicate about their feelings. Specific techniques mentioned for facilitating communication include memory boxes, life story activities, feeling wheels, drawings, and storybooks about death. The document stresses that even very young children can be affected by trauma and loss, so caregivers should normalize feelings, address fears, and involve children in rituals to recognize the loss.

1. How to thrive despite
adversity of loss –
responding to a bereaved
child
Angela Hough-Maxwell

2. Resilience
Everyday care
Consistent caregiver
Positive attachment
Self esteem
intelligence, cuteness
Hope for future
Ability to thrive despite
adversity
Suffering leads to
greater consciousness

3. Types of loss
• Death of : parent, grandparent, sibling,
child, cousin etc.
• Death of pet
• Divorce
• Loss of limb
• Loss of functioning- intellectual/ physical
etc.
• Loss of home/ income/ safety/ innocence

4. Statistics of HIV in South Africa
• 5.3 million adults and children live with HIV/AIDS
• 1.1 million children under the age of 17 have
become orphans as a result of AIDS
• 21.5 percent of the population ages 15-49 is HIV
positive
• 2.9 million women ages 15-49 are HIV positive
• 230,000 children under the age of 14 are HIV
positive
• In 2003 alone, 370,000 adults and children died
of AIDS
• UNAIDS 2004 Report on the Global AIDS Epidemic, Joint United Nations Programme on
HIV/AIDS

5. Global view of HIV infection

6. • Nearly 75% of South Africans experienced
at least one traumatic event during their
lifetimes. The most frequent type of
trauma reported involved a close other
(unexpected death of a loved one),
witnessing trauma, threat to one’s own life,
criminal victimization, and intimate partner
abuse (Williams et al, 2007 – South
African Stress and Health Study)

7. …is to bring hope and healing to children, their caregivers,
families and other caring community members using play for
communication in communities affected by HIV, loss and poverty.
2 parts to our work:
1) Direct community work -Developing AB’s to support children in
communities and direct work with children (CG) and caregivers (FS)
2) Training team- Training strategic partners in skills for working with
children
Our mission at Dlalanathi

8. • http://www.youtube.com/watch?
v=dfjgWDSFjxM

9. Loss
Although we know that after such a loss the acute
state of mourning will subside, we also know we
shall remain inconsolable and will never find a
substitute. No matter what may fill the gap, even
if it be filled completely, it nevertheless remains
something else. And actually this is how it
should be. It is the only way of perpetuating that
love which we do not want to relinquish
Sigmund Freud

10. Reflection
• Think of your own loss….
• What feelings did you have?

11. Loss of parent
• A child loses someone they love & a sense of
security & sense of self.
• Grief & trauma
• Intensity of distress, even though they may lack
cognitive understanding of finality of death.
Variations according to:
• Manner of death, foreknowledge of death,
witnessing death, developmental stage,
cognitive and emotional maturity, quality of
relationship

12. Manifestations of grief
• Denial & shock & numbness
• Protest (persistent crying, rejection of efforts to comfort)
• Deep sadness & longing & emotional withdrawal
• Loneliness & Emptiness
• Questioning – Why me? Why now? What if?
• Anger, rage
• Fear – future, further loss or trauma, security
• Relief
• Feeling different, excluded, stigmatised
• Feelings same as adults but means of expressing
different: somatising, feel they’re to blame, can’t
concentrate, regression
• Intensification of normative developmental anxieties

13. Sad children do not always cry…..

14. Symtoms in children
Common behaviour changes include becoming
withdrawn, bed-wetting, lack of concentration, clinging,
bullying, telling lies and being aggressive, all of which
may indicate their upset state
Depression can disrupt sleep and appetite, and cause
the body to slow down.
Anxiety is also common during grieving, and can cause
a racing pulse, hot sweats, poor sleep and loss of
appetite.

15. Affective -cognitive processes
• Idealisation of dead parent
• Fantasising a reunion
• Self blame & guilt
• Attribution of omnipotent power “make
daddy come back!” or they did it to punish
child
• Denial

16. Kubler-Ross stages
• Shock & Denial
• Questioning & bargaining (Why me? Why
now? If only? If I am … ? )
• Anger (God, self, others, situation)
• Depression (loss of interest,
disconnection, loneliness, deep sadness)
• Acceptance (reinvest & continue)

18. What do children understand
Under five years:
•have little abstract sense of time or distance, so final and
forever mean nothing
•dead means less alive
•death is a sleep or a journey
•death and life are interchangeable
From five to eight years:
•death is a frightening person
•death is final
•death is often seen as the end result of violence and
aggression
•there's an intense interest in the rituals surrounding death
.

19. If a child is too young to
understand does death affect
them?
The infant or young child is always part of a relationship,
otherwise he/she could never survive. This relationship is
deeply involved in the loss and can affect the attachment
relationship- either family affected by trauma as well as
symptoms impacting on tolerance of caregiver (separation
anxiety, temper tantrums, sleep disorders) or primarily
disrupted through loss of primary caregiver(s).
No child is too young to be affected by trauma

21. So what can we do….
 Strengthen
relationships
between adults
and children
 Support
emotional
connections to a
new attachment
figure
 Everyday care &
routines to
establish sense of
safety

22. • Help talk about
death and why?
• Talk about the
loved one that
was lost (and
integrate into
ongoing sense
of self)
• Assist with
dealing with loss
• Normalise
feelings
• Encourage play
and
communication

23. • Increase
emotional
regulation
• Promote
adjustment in
daily life
• Rebuild positive
view of self.

27. Developmental Trauma
Disorder, Psychiatric Annals
35:5, May 2005

28. What helps
• Involve – in rituals – recognition of loss
• Answer questions as they come
• Allow to play & act out grief scenes
• Don’t rescue but walk with
• Find places of hopefulness, reasons to live
• Address fear & anxiety – advocacy, need security,
circles of care
• Good attachment & routines
• Opportunities to remember & say good bye
• Allow feeling anger – God, others, self, but don’t
condone acts of aggression
• Explain death & funeral (may need to repeat)

29. Helping children cope- A bereavement model
Schoeman, R., Killian, B. & Hough, A. 2000
RECOGNITION, REFLECTION, RITUALIZE, REORIENTATE
1. Creating a nurturing environment
7. Plan for adjustment 2. Active listening;
into new life helping the child to
tell his/her story
6. Repair self-esteem, resilience 3. Acknowledgement
building: I AM & validate feelings /
I HAVE give words to sorrow
I CAN
5. Provide and facilitate 4. Address fears and anxieties;
opportunities to say the child is not to blame and couldn’t have
good-bye prevented it, address daily concerns
RSBSC, Jewitt & Khanyile © 2005

30. Techniques to use
• Puppets & doll making
• Memory boxes or books & photo albums
• River of life/life-story
• Genogram
• Eco-map
• Stories, e.g.. When someone dies…, Felix book, Our Gran, etc.
• Making cards/letters/songs to say goodbye
• Having a ritual to say goodbye
• Clay for anger
• Clay unfinished business
• Feeling wheels
• Tree of life
• Drawings
• Doll making

31. Feeling Wheel
RSBSC, Jewitt & Khanyile © 2005

32. Drawing
• To facilitate conversation rather than used
for interpretation
• Can give us clues but not definitive
• Self soothing
• Tell coherent narrative (assists with
trauma)
• Engages senses and helps tell story
• Draw “what happened”

33. drawing

34. Body map /outline

35. Strengthen
relationships
between caregiver
& child
• Everyday care
• 3 dialogues: emotionally expressive; meaning
making; limit setting
• Routines
• Address fears & daily concerns
• Support family

36. Communication
• All our behaviour communicates to child
• Importance of consistent messages
• Simple, may not include all info but must
be honest
• E.g. Heart attack when parent committed
suicide.
• Surviving parent also sad but can contain
child

37. “We do not believe in ourselves
until someone reveals that deep
inside us something is valuable,
worth listening to, worthy of our
trust, sacred to our touch.”
e e cummings

38. Resources
• www.dlalanathi.org.za
• Khululeka trusthttp://www.khululeka.com/
• Bereavement uk
http://www.childbereavement.org.uk/
• OUR GRAN, by Susan Binion, illustrated
by
Kathy Haasdyk, published by the Union
Bible Institute in Hilton

39. • http://www.littleparachutes.com/subcategory.p
(list of children’s books re bereavement)