Column by Editor-in-Chief, Nancy W. Dickey, M.D.

My mother-in-law passed away last winter, two days before Christmas. A beloved grandmother and great-grandmother, her passing affected many generations simultaneously. There were details to deal with and questions to answer. Should the children be at the funeral? How should they be told of the death? How should we celebrate a holiday while grieving a loved one?

The answers to such questions and how each family deals with loss are, of course, deeply personal and dependent on circumstance, such as the age of the child, the death itself (sudden or the result of a chronic illness), and the child's feelings about attending the funeral. Although death can be an uncomfortable subject, even for adults, it is a subject with which our children need our help.

For children, like adults, grief presents itself in many ways. Your child may cry, get angry, withdraw and be quiet, deny the death, or even talk to the person who has died. There is no right reaction. Help your child understand this by sharing your feelings. Refraining from emotion around your child may inadvertently send a message that grieving is not okay. While avoiding demands for your child to verbalize his or her feelings, offers to talk or listen may be very helpful.

Straight Talk

Speak to your child about the death at his or her level. Use simple and concrete words like "died" and "buried," with explanations when needed. It is important not to dress death up in euphemisms that leave children unable to grasp the situation. A well-intentioned attempt to shield a child from death can create confusion. A child who is told that "Uncle Joe has gone up in the sky" or that "Grandma has gone to sleep" might very well be waiting for Uncle Joe to visit or Grandma to wake up after her long nap, never grasping or grieving the loss that has occurred.

It is likely your child will have questions. Be honest and direct in response. Keep answers simple, but make sure your child has the opportunity to ask for more information. It is okay if you don't have all the answers - none of us do. The important thing is to have open communication with your child about the loss. My own mother died of cancer when my oldest child was 5 years old. There were months leading up to the death when my children asked questions. They wanted to know why grandma had no hair and why she didn't feel like playing. My mother's decline gave us an opportunity for us to discuss and prepare for death before she was gone. Let your child know that death is a natural part of life. Many fantastic books are available that deal with this subject and can be of great help in starting this conversation. If, for whatever reason, you can't talk to your child about death, find someone who can. This may be an aunt, a close friend, a coach, a pastor, or a professional counselor.

Today, children see far more explicit details of death on television and in movies than we did growing up. For many school-aged children, initial impressions and ideas about death may come from these exposures. If a child is unable to ask questions, he or she may fill in the gaps with a vivid imagination, which can lead to far more disturbing visualizations than reality. If the only dead people a child can think of are crime victims, for example, seeing Grandpa looking peaceful in the casket may actually ease anxiety over death and dying.

Funerals and Rituals

Parents often ask whether it is appropriate to take children to funerals. The issue is not so much whether to take a child to a funeral but how to make sure your child is able to grieve and say good-bye to their loved one. This may involve the ritual of a funeral - or it may involve an alternative ritual. At my mother-in-law's funeral, the entire family, including the young children, came an hour before the funeral for a private viewing. This gave each child an opportunity to ask questions and to say good-bye in his or her own personal way. Although parents sometimes fear the open grief at funerals and viewings will scare their child, being with others who are grieving can make it easier for a child to do the same.

Memorials and Memories

Remembering a person who is no longer with us can be healing. Your child may want to:

· Draw a picture of a favorite memory

· Create a photo album

· Do something special at holidays to remember the person who has died, such as making their favorite food or singing their favorite song

If your child is old enough to understand what a funeral is, explain what to expect and ask your child how she or he feels about going. Prepare your child for the sadness and tears. If your child does not want to go, don't force the issue. If your child wants to attend, ask if there are remembrances - such as a photo or grandma's favorite flower - that your child would like to bring to the ceremony. If you feel you won't be able to provide the comfort your child may need while dealing with your own grief, ask a friend or relative to help during the ceremony.

Although children are resilient, their grief is not necessarily fleeting. You shouldn't expect your child to be back to normal the day after the funeral. Watch your child - and yourself. If sadness, withdrawal or other behavioral changes (such as loss of interest in activities or loss of appetite) seem to persist for more than three months after the loss, there may be issues of depression that need to be addressed.

It is hard to know how to comfort your child during moments when you are struggling to comfort yourself. Death is not easy for adults, and, understandably, not easy for children, either. But in death also comes an opportunity to share and cherish with our children. As we lose someone from our life, we can savor the life they shared with us. Although a cliche, in death we are able to celebrate life.

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