1 - Introduction (126 words)

The literature indicates that all children have reactions to grief, which have
differences compared to adults. As well as, the grief in children is associated to
developmental stage. So, depending on ages the grief can be expressed differently.
(Kubler-Ross, 1969; Lancaster, 2011).
It is important to resalt that exist limited research in this area about the reaction
and feelings of children, and also practical interventions on this type of situation which
the families and professionals can do to their children (Favazza & Munson, 2010). Thus,
this essay aimed to clarify and discuss specific points such as the experience of grief and
loss in a children of 10 years old, associating the five stages proposed by Elisabeth
Kubler-Ross, and discuss practical nursing strategies regarding the experience presented.

2 - Age Group: School-aged children, 9-11 years of age (411 words)
A study by Lancaster (2011) showed that in the United States, 25% to 33% of
adult cancer patients who are undergoing treatment, they have at least one child younger
than 18 years at home. According to Favazza & Munson (2010), the perception of
children about grief and loss is strongly different from that perceived by an adult. So, this
essay present an experience of grief and loss of a school-aged children called David J.,
10 years old, who lost his mother one month ago due to breast cancer.
Five months ago the mother of David was doing the clinical treatment for breast
cancer, but the cancer was advanced and invaded other parts of the body. Since this period
of treatment, David had been suffering from the lack of maternal presence and also lack
of the father who spent most of him time caring wife. When the mother of David dead,
he was surrounded by adults, including his father, in the midst of their own grief. It is
valuable to note that the surviving parent is probably uncertain and confused regarding
how to react and respond in an appropriate manner to their children (Lancaster, 2011).
Normally, adults and parents try to protect children from this type of situation, but
it is inevitably that children face the challenge of coping with loss. Since, it is expected
that all children will experience of loss, often overwhelming emotions related to grief
(Heath et al., 2008). The father of David was trying to react normally and he had daily
conversations about death with David, but was really difficult to him talk about that with
David, who perceived it and also tried to help his father.
According to DAntonio (2011), school-age children are the age group most able
to speak openly about death and dying. During the last month, David have read books
which his mother used to read to him and he told that his mother was in the heaven
watching over them. Also at school and especially at home, the appearance of him was of
sadness, anger and depression; so he was presenting reduced cognitive function and
school performance. The behaviours of David are examples of grief reaction in school-
age group (DAntonio, 2011). Furthermore, the literature shows that school-age children
are real thinkers, since this age group begin to use logic, and have a strong sense of
equality. So, children can control new achievements and accomplishments, with help
from their family and professionals (Lancaster, 2011).




3 Theorist (409 words)
Elisabeth Kbler-Ross (1926 2004) is the prominent authoress of the best-
selling On Death and Dying (1969) and others books. Also, Elisabeth presented many
lectures and workshops throughout her life about grief and loss. The theorist established
five stages of grief, which include denial, anger, bargaining, depression, and acceptance.
Moreover, during her studies was discussed about the responses to grief and loss,
since these responses are not the same among people, because each individual have a
typical response, in other words, do not exist a standard of grief and loss, however, there
are responses which many people have. According to Lancaster (2011), in spite to
children grieve, the reaction of them may not be appropriate into one of the five stages
proposed by Elisabeth Kbler-Ross. On the other hand, the theorist consider that children
may feel a large deal of feelings and reactions such as remorse and guilt which can be
associated to some stage of grief.
It is important to understand that the five stages may not be continuous, so children
and other persons may be at different stages of grief. Firstly, the denial stage shows a life
without sense, shocking and oppressive; because the death has not been accepted and
particularly the children do not understand all proportions of death.
In addition, the anger stage is important to the healing course, but the anger has
not limit and can extend to any person. Children can feel guilt and responsible for the
death; they can enter a state of despair as well and hold the anger for prolonged time.
Additionally, bargaining stage is the request for a chore or promise of anything to see
well the loved one.
The depression stage is the empty feelings that appear, does not as a mental illness,
but it left a significant feeling of sadness. In the case of children, it is appropriate assist
them and give some practical intervention if necessary. Finally, the acceptance is when
the grieve person recognise the reality and can remember memories of the dead person
without oppression, and so the person learn to live with these remembrance.
The experiences of grief and loss in school-aged children indicates more anxiety
and evident symptoms such as depression and somatic complaints. As well as, it is
observed prolonged anger stage and the responsible for the death of the person.
Furthermore, some aspects like maturity, spiritual and developmental levels; may
contribute to children go through different stages of grief (Lancaster, 2011).

4 Analysis (1000 words combining theoretical principles, discuss and analyse
practical nursing strategies at least 5)
- Relate the theoretical principles of Elisabeth Kubler-Ross with the situation
of grief and loss in children of 9-11 years old.
Medical specialists, in adult oncology and hospice care, as well as pediatricians, need to
be aware and ask about children and how they are coping in the face of a parents terminal
illness. During this crisis, pediatric care providers can become an important source of
support and education to the child and their family. 1-3 (Lancaster, 2011)
An understanding of the relationship between and age and manifestations of grief in
children is crucial for practitioners to provide effective interventions to a grieving
child. (DAntonio, 2011)
Your own level of understanding and comfort discussing loss and grief will either enhance
or diminish your capacity to support others. (Favazza & Munson, 2010)
Many nurses felt a great lack of training in this area and had little instruction as to their
role in the face of such crisis. (Kubler-Ross, 1969).
Children are acutely aware and sensitive to adult responses, whether verbal or nonverbal.
You may be unaware or uncomfortable with the topic, thus limiting the childs
understanding and capacity to express loss and grief in healthy and helpful ways.
(Favazza & Munson, 2010)
Knowledge of how children perceive loss, especially death, at different chronological
ages and developmental stages helps teachers respond to childrens experiences in
healthy, helpful, and developmentally appropriate ways. (Favazza & Munson, 2010)
Although there is no one right way to grieve (Black, 2005), it is important to recognize
when a childs response is maladaptive or overly negative (i.e., acting out) and to help
him or her seek better ways to express grief associated with loss. (Favazza & Munson,
2010)
Discuss and analyse at least five strategies of practical nursing, such as,
helping children cope with grief (CHILD method: Consider, honesty, involve, listen,
and do it over and over again) (Davies, B., & Orloff, S., 2004)
Consider: Unique situation of the child, his/her developmental capacity to understand,
his/her concerns, thoughts, feelings, and relationship to his/her sibling.
Honesty: Use the d words: death, die, dying, realize that it is all right to not have all
the answers, avoid euphemisms, avoid words such as gone away or went on a trip, do not
explain to a child that the dead person is sleeping.
Involve: Let the child know what is happening; if possible, before the death occurs, give
the child factual knowledge about the cause of death especially the school-age child.
Involve the child in saying good-bye to the dying and deceased allow the child the
choice to participate in the funeral to the level at which he/she is comfortable.
Listen: Concentrate on discussing the stumbling block of the moment, let the child talk
through what is on his/her mind, let the child know that it is all right to not want to talk
to anyone anymore about the death for a while. Give the child outlets for expressing
his/her grief art, drawing, play, writing letters, poetry, stories, hammering. Be aware of
thoughts and fantasies children may have of being. Reunited with the person who has
died. Careful attention to any suggestion of suicidal risk, no matter what the age of the
child. Clarify that death is NOT the result of the childs action or thoughts; be attuned to
magical thinking involved in the childs explanation of the death and correct it to avoid
guilt and inappropriate grief reactions.
Give children a chance to talk about loss and grief, and make sure you not only listen and
are alert to changes in behaviors but also help them process the experience by using words
they can understand. (Favazza & Munson, 2010)

And do it over and over again: Appropriately share your grief; realize that children
cannot do grief work without permission and role models. Children need to see an honest
expression of emotions from adults. Keep in mind the developmental capacities of the
child and his/her age-related concerns and needs.
communication with children through play

non-directive play therapy with children

creative group work methods with children
Providing children with a variety of ways to promote self- expression is a natural
component of early childhood settings. It is common to find sociodramatic play, art,
puppets, and telephone play in early childhood settings to support self-expression
(Bredekamp & Copple, 2009). (Favazza & Munson, 2010)
Bredekamp, S., & Copple, C. (2009). Developmentally appropriate practice in early
childhood programs serving children from birth through age 8. Washington, DC: National
Association for the Education of Young Children
BOOKs -
The use of books and age-appropriate literature is an excellent intervention for children
of all ages, especially those of school age. The characters in stories can provide bereaved
children with role models of children who are coping with loss. In addition, when
reading together, adults can gain valuable insight into the thoughts and feelings of
a bereaved child (Corr, 2009) (DAntonio, 2011)
Corr, C.A. (2009). Siblings and child friends
in death-related literature for children.
Omega, 59, 51-68. doi:10.2190/OM.59.1.d

Music therapy and brief school-based grief counseling are two other interventions that
can be used in this age group (Rosner, Kruse, & Hagl, 2010). (DAntonio, 2011)
Rosner, R., Kruse, J., & Hagl, M. (2010). A
meta-analysis of interventions for bereaved
children and adolescents. Death Studies, 34,
99-136. doi:10.1080/07481180903492422

Focused storytelling that seeks to draw out grief-related feelings and concerns is
another strategy available to this age group (Scaletti & Hocking, 2010). (DAntonio,
2011)
Scaletti, R., & Hocking, C. (2010). Healing
through story telling: An integrated ap-
proach for children experiencing grief and
loss. New Zealand Journal of Occupational
Therapy, 57, 66-71.

helping family members share their grief with children.
Wass, Raup, and Sisler (2006) also reported that children typically did not discuss death
or grief with their friends or parents because the adults viewed the topic as unpleasant,
frightening, or unnecessary. (Favazza & Munson, 2010)
As Willis (2002) points out, parents may try to protect their children or discuss it in such
a way that may be more confusing than helpful by using phrases such as gone to sleep
or taking a long trip. (Favazza & Munson, 2010)
Both parents and children can share a sense of loss associated with transitional milestones
that do not occur in the typical time frame or never occur. (Favazza & Munson, 2010)
teachers and parents can assist children in very sensitive and healthy ways as they
experience loss and grief (Favazza & Munson, 2010).
The most important support for children who are experiencing a loss is a positive
relationship with an adult who is willing to support the childs grief process. (Favazza &
Munson, 2010)
As Wolfelt (2001) suggests, families should be encouraged to support children in dealing
with loss in ways that are developmentally appropriate and sensitive to familial and
cultural values. (Favazza & Munson, 2010)
Therefore, it is important to support children of this age in their desire to remain
close to the surviving caregiver while enhancing independence as much as possible.
5 - Conclusion (100 words)
Childrens understanding of death and loss changes as they develop. (Jeffreys, 2005;
Wolfelt, 1983) (Favazza & Munson, 2010)
No matter what the childs developmental stage, parental loss is always traumatic to a
child (McClatchy, Vonk, & Palardy, 2009). Children who are offered bereavement
support that includes ongoing informative discussion and conversation cope better
(Fearnley, 2010). However, the effectiveness of this support is contingent on the choice
of interventions that are anchored in, and crafted around, the childs stage of
development. (DAntonio, 2011)
Grief of children is dependent upon their age and is inuenced by factors, such as
culture, close ness of the lost family member or friend, and socioeconomic conditions.
(Lancaster, 2011)

McClatchy, I.S., Vonk, M.E., & Palardy, G.
(2009). The prevalence of childhood trau-
matic griefA comparison of violent/
sudden and expected loss. Omega, 59, 305-
323.
Fearnley, R. (2010). Death of a parent and
the childrens experience: Dont ig-
nore the elephant in the room. Journal
of Interprofessional Care, 24, 450-459.
doi:10.3109/13561820903274871
12. Kliegman RM. Grief and Bereavement. In:
Kleigman RM, Behrman RE, Jenson HB,
Stanton B, eds. Nelson Textbook of Pediat-
ric., 18 th ed. Philadelphia, PA, WB Saun-
ders; 2007. http://pt.scribd.com/doc/31473425/7279907-Pediatria-Nelson-Textbook-of-
Pediatrics-17th-Ed


11. Serwint JR. Separation, Loss and bereave-
ment. In: Kleigman RM, Behrman RE, Jen-
son HB, Stanton B, eds. Nelson Textbook of
Pediatrics. 18 th ed. Philadelphia, PA, WB
Saunders; 2007.
http://pt.scribd.com/doc/198286337/Nelson-Textbook-of-Pediatrics-19th-Part-1