".. there is no right or wrong way to grieve. There is no pressure to move on. There is no shame in intensity or duration. Sadness, regret, confusion, yearning and all the experiences of grief become part of the narrative of love for the one who died." - Patrick O'Malley
Parental Behavior and Expressions of Grief
Grief is a normal response to any type of change or loss. When an infant dies, regardless of cause, parents may feel confused, lost, sad, out of touch, numb, guilty, angry, empty, alone, discouraged, depressed, helpless and fearful. The spectrum of emotions is not only intense, but one over which you have little control.
Initially, you may experience numbness and shock, i.e., sometimes feeling as if your child is still alive. There may be a strong desire to be reunited with your child, and sometimes auditory and visual sensations of hearing and seeing him or her. Physical symptoms at this time may include loss of appetite, sleep disturbances, aching arms, and signs of stress, such as headaches and high blood pressure. Psychological changes may include indecisiveness, inability to concentrate, and disorientation.
You may feel helpless and experience a sense of loss of control, which can lead to anger and depression. You may express feelings of guilt that you are somehow responsible for the child’s death. For example, you may believe that the death was due to your inability to carry a baby to term, to being carriers of a genetic defect, or because your actions may have in some way contributed to the death. While memories of your child will always remain with you, your sense of well-being will gradually return and you will be able to attend to the tasks of living.
Uniqueness of Grief
Everyone will grieve differently: mothers, fathers, grandparents, children, and other family members and caregivers. Some participants may think that others do not understand how they feel, or believe no one cares as much as they do. One parent may measure the partner’s expressions of grief against his or her own. Gender, role relationships and cultural background may contribute to differences in characteristics of parental grief. There is no right or wrong way to grieve.
Parental grief is often misunderstood. Misconceptions hinder understanding and acceptance. Among these misconceptions is the view of grief as an episode, rather than a lifelong continuous experience. Grief cannot be plotted on a timeline, with a beginning and end date, but rather is a timeless and boundless phenomenon that changes with time. Grief is also sometimes seen as a way of letting go, or detaching, rather than as a way to keep connected with the deceased child. Many people assume the goal is to reach some final resolution or acceptance; instead, grief tends to be a lifelong process. In addition, grief is sometimes avoided, whereas it is necessary for healing.
Healthy vs. Complicated Grief
Just as death is a part of life, grief and its accompanying pain are a part of healing. However, in some cases the grief process may go wrong.
Patterns of daily living can be dramatically altered by grief, which has the capacity to erode interest in self-care. Sleeping patterns, nutritional intake, ability to work, relationships with others and the ability to conduct self-care activities are all important aspects to be aware of.
The following behaviors are typical in the following weeks and months after a death. However, if you find yourself experiencing the following after several months, it may be necessary to look into additional mental health interventions, including grief therapy.
Inability to return to daily routine
Total lack of affect
Sensations of hearing and seeing the baby
Parental neglect or overprotection of siblings
Hostile aggressive behavior
Prolonged social withdrawal
Counseling Children About Death and Grief
The death of a brother or sister affects the surviving child in profound ways. Besides losing a sibling, they may experience a change in the relationship with parents and/or struggle to understand the concept of death, often for the first time.
A child often grieves deeply, although their grief differs from that of adults in expression, intensity and duration. Their ability to grieve is affected by the context of the death, their relationship with the baby who died, and their preexisting emotional and cognitive development.
Children’s emotional and behavioral responses to death may include regression to earlier developmental levels, physical symptoms, and a tendency to internalize the death as punishment for their own bad deeds. For example, children still in the magical thinking phase may believe they caused the death by wishing the sibling would ‘go away.’ Children often act out their feelings of loss through play, which becomes therapeutic, helping them to cope with the death.
Children’s Reactions to Death:
Anxiety and fear - Children may cling to parents or other adults, seeking reassurance that they are loved.
Anger and resentment - Children may be angry with their sibling for dying, and at God and their parents for not keeping the baby alive. They may be angry about not getting the attention they need during the crisis.
Guilt - Children often feel guilty because of what they may have said or done before the baby died, and for being alive when the baby is dead.
Shock - Children may not fully understand that the baby is not coming back; they may not show any emotion.
Sadness - Children’s activity may decrease; they may become quiet, cry, or daydream, without knowing why.
Role adjustment and regression - Children may return to earlier behavior for a short period of time, such as them sucking, using a bottle, and bed-wetting.
(Adapted from mcclain and shaefer, 1995.)
It is important to clear up any misconceptions about causality or blame, and to ease the child’s anxiety and fears. There are certain basic questions that most children will need to have answered:
1. What is death?
2. What made the baby die?
3. Where is the baby who died?
4. Can it happen to me?
5. Who will take care of me?
Children tend to be greatly affected by the reactions of adults in the environment, including the way the death is explained to them. Often parents, in an effort to protect their children from unnecessary pain or sadness, will discuss the death in a hushed voice, or in private. There is a better way, and parents should be encouraged to discuss the events with their children in age-appropriate ways. A health care professional can make suggestions and assist in developing the necessary communication skills.
The age of the child and the child’s feelings and expression of grief all will dictate the support needed from the parents and other caregivers. For example, young children will benefit from reassurance, being told they are loved and that the parent will not leave. Teens appreciate an honest discussion about feelings and circumstances surrounding the death.
Please see this helpful handout for further information about supporting children through loss:
Adapted from Bereavement Counseling for Sudden Infant Death Syndrome (SIDS) and Infant Mortality: Core Competencies for the Health Care Professional, (Mary McClain, RN, MS; Joan Arnold, RN, PhD; Evelyne Longchamp, RN, MA; Jodi Shaefer, RN, PhD; 2004).