How kids handle loss

Recovery is slow, but it is possible

January 23, 2004|By Larry Bingham | Larry Bingham,SUN STAFF

A car accident claims the lives of two young parents, but their two small children, who are with them, survive.

That scenario, which happened in Baltimore County this week, raises the question of how young children cope and recover from the sudden, violent loss of their parents.

"What we know is something like this is one of the most traumatic things that can happen to a child: A child losing a parent traumatically through death without any preparation is like a psychologic loss of the physical umbilical cord," said Dr. William Pollack, director of the Center for Men at McLean Hospital at Harvard University.

Pollack, author of Real Boys: Rescuing Our Sons from the Myths of Boyhood, said such loss is made even more difficult in children younger than 13 because they "depend on their parents for safety and comfort, not just in the moment but in the world."

Despite that, Pollack and other child psychiatrists say children can - and have - come to accept traumatic losses.

"You never get over it," Pollack said. "A trauma like this never goes away, but the serious pain, the intense depression that can come after the shock wears off, the horrible pain and suffering, if there are caretakers who will be there ... slowly - this can take years - they can come back from it."

"Usually the biggest predictor of difficulty adjusting is dependency on the person who died," said Dr. Holly Prigerson, associate professor of psychology and epidemiology at Yale Medical School. She said studies of children who lost their parents in World War II found that how well children adjusted afterward was influenced greatly by "how good the substitute parenting was."

Prigerson said the key to helping children recover from a traumatic loss is making them feel safe and secure.

"The first thing to do after any traumatic event is to make sure the kids are in a safe environment. That means safe physically and psychologically," said Dr. Peter Salpekar of the department of psychiatry at the Children's National Medical Center in Washington.

Salpekar said children who suffer trauma are "going through a lot of shock and a lot of fear." Children under 6 may regress and have problems sleeping. They may become fussy, they may not eat, and they may have separation issues. Older, school-age children may have some of these reactions, as well as questions of guilt. They also may become distracted or preoccupied with issues of danger and safety. Adolescents may become numb, may behave less responsibly than usual; their grades may drop, and in the worst-case scenario they may become fatalistic and get depressed.

"So in any kind of situation like this, number one, you have to have a safe environment with consistency and similarity, and the other thing to do is provide extra emotional support."

Psychiatrists say the treatment for children who have suffered trauma and traumatic loss varies because children react to trauma in so many different ways.

Children who have witnessed traumatic events have a higher likelihood of developing Post Traumatic Stress Disorder, according to a study by the National Center for Post Traumatic Stress Disorder, but the likelihood of developing the disorder depends on the severity of the event, the parental reaction to the event and the physical proximity to the event.

"Witnessing violence can be nearly as traumatic as experiencing violence," Salpekar said. "You still have the same feelings of vulnerabiity and lack of safety."

How children respond to traumatic events, and how they recover, depends not only on what they saw but on the "resiliency factor," which Pollack defines as "the capacity to regain hope and the capacity to review the world and realize bad things can happen but one can find some meaning still in life and go on."

Prigerson said one thing she has learned in her studies of grief and bereavement is that people benefit from being around others who have suffered a similar loss. "In that context, the siblings are going to be important to each other and potentially very helpful."

Psychiatrists have studied how trauma affects children in war-torn areas such as Kosovo and in inner-city Chicago, where children witness other forms of violence. "What we find that's most amazing is some kids, with the right kinds of support, are resilient," Pollack said. "They are able to function. They always maintain the pain, but they are able to isolate it and find happiness in their lives."

Resiliency is something being researched now, Pollack said.

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