Written by Megan Bronson RN, MSN, CS and Samantha Price, MHDL, NCC, LPC on December 11, 2019
Burn trauma is fraught with loss and is unique for each family depending on who or what was lost and the circumstances of that family. These losses can include loss of a beloved family member, loss a family member’s ability to function and support the family in the way they did before the burn injury, loss of pre-burn appearance, loss of body parts, loss of pets, home, possessions, family relationships, loss of lifestyle, the many losses related to divorce, and so on.
The statements “Children are resilient” and “It is good they won’t remember this time” are both urban legends that probably developed to help adults feel better. There is some truth in both statements. However, the reality is that children are very good at walling off loss and trauma while appearing to be fine. They are able to go to school, play with friends, and be involved in activities while a part of them carries the pain of the loss outside of conscious awareness. They may not have clear memories but they do carry emotional and body memory of the loss and trauma.
Children do grieve and feel deeply about loss. They are able to move through grief and to reclaim life and their right to be a child when the loss is clearly acknowledged, their feelings are treated as normal and expected, and their grief is supported in appropriate ways over time.
PRINCIPLES FOR SUPPORTING GRIEF
The following are basic principles to keep in mind when working with and supporting oneself or another in the grieving process. It is important to consider the developmental stage of children and to give information in an age-appropriate way that they can understand and handle. These principles create a safe container for the healing process of grief.
Principle #1
The truth, spoken with care and compassion, catalyzes the emotional healing process.
Withholding or distorting truth complicates grief and feeds denial.
Therefore, support compassionate truth-telling.
Principle #2
People, including children, are doing the best they can with the tools they have to work with.
Acceptance is more helpful than judgment.
Therefore, avoid judgment.
Principle #3
There may be differing values, and even spiritual beliefs, within the same family.
Many families will have different values and belief systems than yours.
Recognize, respect, and honor difference. Children may be angry with God after loss and this anger needs to be allowed expression. God can handle our anger.
Principle #4
Facilitating saying good-bye supports closure and facilitates healing later on.
Interfering with the process of saying good-bye blocks healing in individuals and families.
Give children opportunities to say good-bye.
Principle #5
Feelings are neither right nor wrong, good or bad—neither are they necessarily logical.
Feelings need to be heard respectfully and without judgment. Listen to understand.
Feelings do not need to be interpreted or analyzed and they do not need to be fixed.
Show respect for and honor feelings.
Consider the developmental stage of the individual when traumatized: Inadequate or incomplete achievement of developmental tasks by the burned child or their siblings often occurs in the wake of trauma. It Is therefore essential to consider the developmental stage the person was in when the burn injury occurred as the developmental task of that stage may have been partially or inadequately mastered
Unresolved trauma and traumatic loss often present as:
Depression
Anxiety disorders
Obsessional thinking and compulsive behaviors, perfectionism
Alcohol and substance abuse and inappropriate dependence
Problems with intimacy
Sleep disturbance—difficulty falling asleep, staying asleep, early awakening
Eating disorders—anorexia, binging, bulimia, overeating
Psychosomatic illness—such as headaches, peptic ulcers, etc
Aggression, hostility, irritability, difficulty managing anger, controlling behaviors
Risk taking behaviors
Failure to emancipate, failure to take responsibility, running away, etc.
Regressive behavior such as thumb sucking and baby talk.
Recognizing fear and its roots in trauma:
It is the trapped fear that is at the root of post traumatic stress symptoms. Common fears of children after trauma are described by Lenore Terr, MD in Too Scared to Cry: How Trauma Effects Children and Ultimately Us All.
These common post trauma fears are:
Fear of another more frightening event
Fear of separation
Fear of death
Fear of helplessness
The mirror image of extreme rage is extreme passivity—both are fear based
It is often unresolved fear that unconsciously drives a trauma survivor’s life and the resolution of fear is therefore essential to recovery and healing.
Traumatic experiences have a profound effect on the developing child. These effects impact the child cognitively, emotionally, psychologically, and socially. Traumatic experiences any event in which the child experiences as life threatening to themselves or others can be defined as traumatic.
COMMON MANIFESTATIONS OF TRAUMA IN YOUNG CHILDREN: (APPROXIMATELY 2-6 YR.)
Generalized fear and anxiety
Nightmares, night terrors, fear of going to sleep or sleeping alone
Regressive behaviors,(bed-wetting, talking baby talk, thumb sucking, whining)
Repetitive trauma play, may have difficulty verbalizing about the trauma
Confusion and difficulty understanding that the trauma is over
Attachment anxiety, (clinging, excessive concern about parent leaving)
Physical symptoms, (stomachaches, headaches, other physical symptoms)
Personality changes, may be withdrawn and passive, or aggressive and reckless
School difficulty, such as difficulty concentrating may not want to go to school
Arguing, fighting, agitated, restless, quick to anger and become defensive
MANIFESTATIONS IN OLDER CHILDREN: (APPROXIMATELY 6-12 YR.)
Fears are more specific and related to the trauma
Sleep disturbance, (nightmares, fear of sleeping alone)
Obsessing about and talking about the trauma repeatedly, compulsive behaviors
Guilt related to not being able to control the trauma
Impaired ability to concentrate and learn
Changes in behavior, (such as withdrawn and isolating, or aggressive and reckless)
Feeling overwhelmed by and afraid of losing control of feelings
Concern for the safety of family members
Fear of death and sometimes a fear of spirits or ghosts
MANIFESTATIONS IN ADOLESCENTS: (APPROXIMATELY 12-18 YR.)
May include symptoms of older children, as well as adult symptoms
May be self conscious about feelings, fears, and being different
Aggressive, destructive, self destructive, risk taking, acting out behaviors, (substance abuse, sexual acting out, delinquent behavior, truancy, etc.)
Avoidance of interpersonal relationships, withdrawal, social isolation
Personality changes, depression, apathy, moodiness
Leaving school or leaving home, or fear of separating from family/parents
Pessimism, cynicism, plans of revenge
Failing grades, disinterest in school, friends, and previously enjoyed activities
The following behaviors are common after loss. It is when these behaviors persist for months after the loss that they are considered red flags and indicate the need for professional assessment and intervention.
RESOURCES FOR SUPPORTING CHILDREN THROUGH GRIEF
Kids grieve too and can handle loss and change when their healing process is supported over time. The grief of children will likely reemerge at each developmental stage. Supporting the child’s grief as he or she grows and develops through the teen years helps to keep them developmentally on track. Remember that the journey of grief is challenging and sometimes painful, however it is how adults and children heal and adjust after loss and major life change. Healing is grief’s purpose and function. Healing and recovery after loss are ultimately about reclaiming life and hope.
https://www.dougy.org/ - A national grief center for children since 1983 with a national directory of grief resources on their website, which can help you locate a children’s grief group in your area. Also offers many books for kids and teens after loss.
http://www.compassionbooks.com The world’s largest mail order service with resources on grief and loss for children and adults. Also offers many books for kids and teens.
http://www.selfesteemshop.com An excellent source of books for children about loss, trauma, and self-esteem.