This Children's Mental Health Week, we want to equip you to help...
When the Worst Happens
The death of a child is an unthinkable tragedy. How do you support a family through the grieving process? Hospital chaplain Reverand Paul Nash gives some starting points.
‘Why does God not listen? The Bible tells us “Ask and you will receive”. Why did God take Violet? I just don’t understand. I’m so frustrated! Sometimes I just want to curl up in a ball and SCREAM! I don’t want to say this but I am very angry with God. I get upset when people say, “God knows best. He’ll help you through this hard time.” Well, God could have stopped it. Why didn’t he?’ (Froelich, 2000, cited in my book Supporting dying children and their families)
How do you feel when I tell you that as senior chaplain of a major children’s hospital service - where over 230 children die every year - I have only this to say in response to statements like the above: ‘I am so sorry for your loss’? I was teaching at a conference not long after I realised this, and an experienced hospice worker came and thanked me, because she had felt so guilty for so long for only having this to say. Her sense of relief was tangible. Most of the time when I am supporting a bereaved family, these are the only words that seem authentic. In saying anything else, I think I am in danger of overstepping or overstating.
One of my team spent some time with a boy called Tom recently, who was suffering from a brain tumour. As my colleague sat down in the chair alongside his bed, his first words to them were: ‘I’m scared’. At that moment the nurse entered the room to adjust his lines and treatment. Not unusually, in the hospital setting conversations and prayers may be interrupted, and the lack of privacy at times is particularly difficult for children and adolescents, who are often acutely self-conscious and nervous. After some exchanges about home and school, Tom’s mum gently asked him if there was something he wanted to ‘ask about God’.
He nodded and launched in, explaining his fear that he had done something to bring this suffering upon himself, that he might be to blame. My friend stated clearly that they did not believe in a God who made children suffer. Nor did they remotely believe that Tom had in any way brought this situation upon himself. God did not wake up on Monday and decide who was going to be sent to hospital that day. God loved every child, and certainly loved Tom as much as any other child. ‘Then why did he do this? Why didn’t he stop me from getting sick?’ The questions were fired back.
When people ask me, ‘Why? ’ I can only say, ‘ I don’t know
My colleague acknowledged to themselves and to Tom how difficult and unanswerable this question is. There are no easy answers, as they said to Tom.
A family’s grief
For many who have worked in the area of bereavement support, particularly in a Christian context, theological questions are inevitably raised. I find that the incarnation of Jesus is a good theological model to draw upon. This has led to models of practice around the ideas of presence, non-judgemental accompaniment and both, random and non-random acts of kindness. When Jesus wept on hearing about the death of Lazarus (John 11.35) he demonstrated a compassion for the loss and in my experience shedding a tear is not unprofessional, but demonstrates our shared humanity (as long as the focus does not then turn to us). If it is a child who has died I will inevitably assure the families and friends of their children’s safety and eternal security in a loving God’s heaven.
A challenge I face is how we might carry those whose faith might fail them without disempowering them. How do we pray ‘for’ a family but also ‘for them’, on behalf of them, when they feel they cannot or do not know how to pray. This Jesus style advocacy role is a great gift and potential relief from guilt, and assures a family of your coming alongside spiritually as well as practically. I encourage people to be real with God, and to express all of their emotions; the Psalms are an excellent example of that. The Held in Hope book Jesus still loves Joe reinforces that it is okay to have a range of emotions when we are bereaved.
When the loss is unexpected or particularly tragic we may often be asked the ‘why’ question. I usually find myself saying that I do not know. I express a belief in God who loves them and grieves over their loss too, and that my belief is that one day we will be reunited with our loved ones in heaven. However, despite the hope that there is in this, it is important not to celebrate too quickly. While it is true theologically that our loved one is in heaven and no longer suffering, it is important that we acknowledge our own feelings of loss and don’t feel bad about our grief.
A child’s grief
The traditional stages of grief are as follows: we first have feelings of denial, then anger or depression before moving on to the final stage of acceptance, and re-organisation. Latest thinking suggests that this is not a linear process with a beginning and an end but a spiral that we jump in and out of. We may miss stages or come back to them. I find the image of a child’s roundabout helpful, where you try to jump on and off while it is going around. This metaphor gives a more dynamic, open understanding of how we might expect children or families to respond.
When working alongside families with several children, it is important to understand bereavement in the wider context of loss and of child development theory. Sometimes the language that we use isn’t appropriate to a child’s stage of development. For example, young children take words very literally. So if we use the language of ‘going to sleep’ for death, then this is confusing. Usually when you go to sleep you wake up again, but Granny hasn’t – you can see where such thinking may lead.
Many young children will suffer from separation anxiety, thinking that death is not permanent, or they will just seem to get on with it. For some children transferring concepts between insects or animals and humans is difficult, so using resources which clearly talk about what has happened can be important. Children can also be very matter of fact and repeat back to parents what they have been told: ‘Don’t be sad, Jack is happy now Mummy, he is in heaven and not feeling pain any more.’ It is also important to realise that each child will have their own particular response. They may believe what they have seen in video games and children’s television. One of my saddest experiences was to see a ten year-old boy speaking very firmly to his dead cousin, saying: ‘Come back to life, you can if you want to’.
Because of the importance of helping young children understand and process grief, one of the projects I have been involved in is the Held in Hope series of books, for three to seven year-old children, developed in partnership with Christian Education christianeducation.org.uk One book explores life-limiting conditions and another is about a bereaved sibling. Videos of the books narrated by Bear Grylls can be found on paediatricchaplaincy-network.org
As we know many children love to participate with creative activities. Many of our children’s workers have used the below in their bereavement support. Some of these have taken the shape of rituals facilitating discussion, expressions of grief and emotions. No matter how simple, they provide the opportunity for the child to engage with their feelings and responses. This seems to be true for adults as well! These sort of activities can be incorporated into a weekly group.
To help children express their feelings you can create your own feeling faces or equivalent. My favourite are face paddles – a bit lethal in the wrong hands but wonderfully visual when held up to the face, showing happy, sad, confused etc. We have also found a mood calendar really helpful, which you can flip over to demonstrate how you are feeling today. Pip Wilson’s blob resources can also be used in this way pipwilson.com
We sometimes make hearts with children and their families for them to write messages on. I also sometimes use small gold fabric hearts and invite people to come and put one on a picture as a sign of their love, and take away one with them as a sign of the love the person who has died had for them.
The ‘Footprints’ poem is one of my goto resources. It has been written for children in several different formats and I commend it to you as a resource to have at hand. Fortunately, there are now many good resources and networks to get some tried and tested resources and support, some are listed below. They in turn will also signpost you to additional resources and wisdom.
Memorial prayer tree
We have found that a tree is a beautiful and useful image for a memorial activity. At our annual memorial service, we offer family members a leaf and during the service the children can go to table around the cathedral to work with the team to write a message or prayer to the child that has died. This sort of activity can transfer into a school context as well and facilitating a memorial ritual at a local school if a child has died is something that churches may get involved in.
it is important that we acknowledge our own feelings of loss and don’t feel bad about our grief
Memorial picnic and walk
At our annual memorial walk and picnic, the children make badges with the name of the child they are coming to remember on, not their own name. We have made windmills, and allow the children to blow bubbles while their parents lay sunflowers at our memorial tree. This may be an alternative to a traditional All Souls type service which is not always very child friendly. We do ours at the National Memorial Arboretum where we have a riverside walk with some sculptures and benches, but it may be that a local park or wood or beach could be an alternative place to take a group.
Booklets and videos
The Held in Hope booklets have support suggestions at the back and give advice as to how parents and children’s workers might be able to use them. One version of the videos pauses and asks a question so the child can interact with it. They are really helpful to facilitate a conversation about bereavement and can be signposted to families. As always, watch the videos and read the books yourself first - they are obviously very moving. Although the focus is for three to seven year-olds the style may make them usable with a wider group, and they have been used in school assemblies and church small groups.
Ask, don’t assume: engage with what is asked and presented, don’t assume what is needed. Most of us have learnt this the hard way; we have been asked a question and assumed we understood, and then proceeded to give a long complicated and sometimes embarrassed explanation, only to find that’s not what they meant at all.
Be liberated: I once heard a bereaved parent say to a group of professionals: ‘Don’t worry about saying the wrong thing. It cannot be worse than what has already happened to us.’
Be brave - name the elephant: speak of the loss and of the person who has died. So many people don’t know what to say so say nothing.
Normalise it: don’t minimalise it, but loss is a dimension of life we encounter all the time. However, don’t think you have to have all the answers.
Don’t say ‘I know how you feel’: even if you have had a similar experience. We know we are tempted to say things like this out of a compassionate pastoral heart, but the truth is, we cannot possibly know how they feel in that moment, or in their circumstance.
Find out your local and national support organisations: Beyond the Horizon is one of ours in Birmingham and they offer an excellent bereavement support service to families and organisations beyondthehorizon.org.uk