One of the most challenging things to understand about grief is that healthy grieving is painful.  There are many different faces of grief. You can't judge what is going on inside a child by what you see on the outside. A child's grief, or pain, can only be understood by knowing what the child was like before the death.  Although most children have within them the ability to heal, some may need or want additional help.

Hiding Grief - Mimi Mahon

What to say to a grieving child/teen - Darcie Sims

Responding honestly to questions - Mimi Mahon

"Sometimes we just don't know what to do or what to say..." - Darcie Sims

Delayed Grief Responses - Hope Edelman

WHAT HELPS - HOW TO PROVIDE SUPPORT

As a relative or family friend, you can provide much needed support to a grieving family.  It is important, however, that you provide the support that the family needs, rather than the support you think the family should have. 

"When someone has died..." - Mimi Mahon

Keys to Good Support:  

1. Rather than make assumptions, check things out.  Ask open ended questions and listen to the responses.
2. Seek to understand rather than judge.  See Honesty and Forgiveness.  
3. Become a very good listener.  Being a good listener is one of the most important ways you can support any grieving child/teen.  The challenge for relatives and friends is that you may also be grieving and may have a difficult time really listening to what the child/teen needs to say without your own reactions taking over the conversation.  Be honest  about when you can be a good listener and when you can not (which is understandable when you are hurting, too).  A good listener is some one who: 
   

• Is honest about their own ability to simply listen - you will do a child/teen more harm than good if you pretend to be a good listener.  The child/teen needs your honesty now more than ever.
• Understands that the role of a good listener (which is different than the role of a parent/guardian) is to simply listen with empathy not sympathy.  Most children/teens will shut down communications with overly sympathetic people.
• Refrains from judging what a child/teen is sharing, knowing that the child/teen is doing the best they can with what they currently know and have.  Remember that every one grieves differently.
• Understands that there is rarely a need to fix anything - grieving children, teens and adults are not broken people; they are people who are hurting.  This hurt is a necessary and healthy part of the grieving process.  What they need is a safe harbor to share some of their pain.  Good listeners are among the safest harbors.

HOW TO TELL IF ADDITIONAL HELP IS NEEDED 
   

As a relative or friend of a grieving family, you may notice changes in the children/teens' behaviors.  If these behaviors include any of those listed below, you may want to share this information with the child/teen's parent/guardian.

Warning Signs - Mimi Mahon
   

RED FLAGS - Signs that a grieving child/teen needs immediate help

Some behaviors in grieving children/teens are red flags, or emergencies.  Immediate help is needed if a child/teen is:

• Hurting himself
• Hurting someone else
• Damaging property

Hurting one's self or someone else includes:

• Self injury
• Having more "accidents" or getting hurt more than usual
• Saying that she wants to die
• Threatening to hurt someone else
• Treating other people badly, so much so that she is losing friends

If you are the child/teen's parent or guardian, immediately contact your child/teen's health care provider or school counselor for bereavement support referrals.  If you are a relative or family friend, share this information with the child/teen's parent or guardian.
 

YELLOW FLAGS - Signs that a grieving child/teen might need more support

A yellow flag is just like a yellow light: it means caution.  Note: - As a relative or family friend, these yellow flag behaviors may be difficult to observe because you do not know what is happening when you are not around.  If you are in the position to observe any of these yellow flag behaviors, then you may want to share this information with the child/teen's parent or guardian.  Be sensitive to the situation and do not use this list as an opportunity to "help" where your "help" is not wanted or asked for.

• Asks for help: The child/teen indicates he wants additional help.
• Never speaks about the person who died:  The child/teen chooses never to talk about the person who died, even when others bring it up.  The child/teen perceives that she has no one with whom to speak.
• Expresses excessive anger:  When someone dies, children/teens (and adults) often feel angry and/or frustrated.  That's okay and healthy.  Too much anger or frustration, however, can cause a child/teen to feel overwhelmed or out of control, and that can be unhealthy.
• Has physical symptoms that do not have an obvious physical cause:  Children/teens who are grieving, like adults, might have physical symptoms, such as headaches or stomach aches.  This is normal.  If these symptoms persist, the parent or guardian may want to take the child/teen to a health care provider.  If nothing physical is found to be wrong, and a child/teen continues to have physical symptoms, the parent or guardian may want to consider getting additional help. 
• Significantly changes social interactions:  Some children/teens do not interact with friends and family as they did before the death.  A period of withdrawal is normal and healthy.  If the withdrawal persists and the child/teen does not resume some activities outside of school, the parent or guardian may want to talk with her.  This isolation may be a sign of needing additional help.
• Has dramatic changes in academic performance: Many children/teens' grades change during the year in which the death occurs.  If the grade changes continue into the following academic year, or other changes in performance continue for months, the parent or guardian may want to consider that the child/teen might benefit from more help. 
• Is overachieving:  We tend not to recognize a dramatic increase in performance or participation as a sign of grief because it looks like things are "going well."  Significant changes occur for a reason.  It's important to try to understand the reasons for any dramatic change, regardless of whether it is perceived as positive or negative.
• Guilt: Almost all children/teens feel guilt or regret about something related to the death.  "I didn't get to say goodbye."  "We had a huge fight."  Many children/teens need information about why the death was not their fault.  Guilt is the one emotion it's important to ask about:  "Most children feel guilt about something related to their mom's death.  Do you?" 
• Fear and worry:  New fears often emerge after a death.  A child/teen might be afraid that someone else will die, or worry that he will get sick, or be left alone.  When fear and worry keep a child/teen from doing what she wants to do, she might benefit from other help.
• Anxiety:   Most children/teens will be anxious after someone dies.  For many, the anxiety decreases within months.  For some, anxiety persists, causing behavioral changes, and might interfere with a child/teen's interactions with others.