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Featured this Month:

The Implications of Loss and Grief for Infants
Sunday, March 01, 2015 by Cynthia Waderlow MSE, LCSW
The Children’s Program has been privileged to work with bereaved children ranging in age from 3 to 19.   In addition to following research literature, we’ve been able to observe and learn about their grief responses according to developmental stages, and this is ongoing, as more young survivors share their experiences and questions about their losses.  We apply the model for relevant goals and outcomes, and to encourage the best support for each child to move through the grief process while maintaining or even enhancing development. Although there are some universal expectations for each developmental stage, every young person has unique inner resources and challenges, and the particular contexts of the child’s life also shape the individual needs and expressions of grief after the death of a parent or sibling. Because such losses do have developmental implications for children, we know that parent consultation and counseling for children provides much needed guidance and support.  Esther Shapiro, an authority on grieving families, states that “repair of our shattered selves following the death of a loved one depends both on our relationship resources and on the specific tools of our developmental moment “      (p. 87).  A wealth of information related to grief and family development can be found in her book, cited at the end of this article.

We concluded that a brief educational series touching on stages and tasks of child and adolescent development during significant bereavement would be useful. We know that severe losses can put individuals at risk for depression, and the rapid developmental stages of children and adolescents heighten the significance of depression’s impact.  Bereaved children and adults can struggle with the dilemma of staying frozen in time or moving forward and experiencing what they imagine as the unbearable pain of the past or the frightening emptiness of the future.  For children, the consequence of one year’s depressive response can be a delay in developmental time ( p. 119 ).  

After the death of a parent or sibling, no child will be the same as if the loss had not occurred.  But they may discover the resilience that can help them integrate loss and move forward, hopefully with increased empathy and compassion. The availability of attuned supports for the young is critical after a traumatic loss such as a suicide.  As surviving children grow, the conditions that encourage the formation of a world view that is not informed by a sense of abandonment and guilt include the quality of the image of the deceased loved one that the child has internalized, and the caregivers’ patience, presence and opportunities for the child to master the tasks of their developmental stage.   For each of the stages a child’s capacity for processing and understanding   the death, coping, and learning to use the image of the deceased loved one for comfort, inspiration and support is very different.  When we provide care for these children and adolescents our interventions can support their continued development even in the wake of a profound loss.

Infancy is one of the least understood periods where the impact of severe loss is considered.  Often, because the awareness and expression of young babies is primitive, we assume that they are minimally impacted.  But consider how infants do respond to all kinds of changes and emotional vibrations in the caregiving environment.  From the moment they come into the world, infants orient themselves through highly integrated sensorimotor, oral, psychosocial, and self-regulation though relational adaptation tasks.  Attachment patterns with the caregivers begin to form. They learn to trust and self-regulate through mutual interactions with the caregivers who provide consistency, healthy stimulation, affectionate communication, nutrition and nurturance.  This delicate balance is at risk for dysregulation after any devastating loss, and it is this surrounding, interactive world that is the context for infant development.   When the caretaking environment is disrupted by suicide, or any unexpected death, babies will not have concrete understanding of the death that would allow them to formally mourn, but the earliest capacity for meaning making regarding self and the world begins to form in relation to the bereaved caregiving environment.  The attachment literature suggests that young children are vulnerable if they are separated from the primary caretaker, and if stable, continuous caregiving is not provided from other adults.  But parents who survive the suicide of a spouse or another child face extraordinary challenges with energy and emotional responsiveness.  Shapiro,  comments that “grieving parents may find it all they can do to keep their own functioning intact and stable,” and “under the circumstances of bereavement, both the emotional and instrumental resources of parents are taxed to the limit” (p. 79).   So, for infants, as with any child, “the grieving  family’s ability to reestablish  stable equilibrium without restricting the ongoing development of its family members is especially crucial in determining the consequences of the death for its grieving children, who have so much of their development to complete” (p. 85).

But Shapiro is encouraging.  She identifies a more balanced potential in bereaved parenting that suggests less of the trauma that can be experienced by children who are neglected under circumstances of profound loss.  Nor does she suppose a glossed- over perspective that assumes children will be fine with “good enough” caregiving.   Without minimizing the impact of severe loss on children, she observes that it is premature to predict that bereaved children will form insecure attachments and poor working models of self in relationship to the world. She stresses the importance of informed caregiving under circumstances of loss and bereavement.  She teaches that individual and shared grief responses in a family are sacred and not damaging; that the grief responses of the young should be protected from constraint and untruths or distortions about the death.  She teaches that a relationship with an image of the deceased loved one can support and influence a bereaved child throughout development.  She teaches that grief shapes, but can also deepen the developing person.   Grief is a powerful and consuming human experience, but one can find powerful human connections though shared grief, even with infants.  Grief is painful, but allows intimacy, sharing, closeness.  It wants to be expressed though memories and stories.  It wants to speak the name of the person who died.  Grief feels at home with sleeping, rocking, weeping, embracing. Shapiro emphasizes that for very young children an internalized image of the deceased person is created though received knowledge from the parent, siblings and grandparents over time. Infants can become familiar with photos and words that teach about the loved one, and this is a base for the stories and shared affection that surrounds the image of him or her.

Bereaved adults who are parenting infants can find healing benefits from the intimacy that babies offer.  However, the bereaved parent needs many resources and self-care to for ongoing, sustainable engagement with a developing infant’s needs.  The LOSS Program for Children and Youth would like to offer consultation and counseling to caregivers of children at all developmental stages so that family grief is manageable, emotional expression is unconstrained and an image of the loved one is taken in and held for comfort, coping and a sense of groundedness as the bereaved child relates to the world.  

Shapiro, Ester R. (1994) Grief as a Family Process: A Developmental Approach to Clinical Practice, New York: The Guilford Press.


Archives:

The Implications of Loss and Grief for Infants
Sunday, March 01, 2015 by Cynthia Waderlow MSE, LCSW
The Children’s Program has been privileged to work with bereaved children ranging in age from 3 to 19.   In addition to following research literature, we’ve been able to observe and learn about their grief responses according to developmental stages, and this is ongoing, as more young survivors share their experiences and questions about their losses.  We apply the model for relevant goals and outcomes, and to encourage the best support for each child to move through the grief process while maintaining or even enhancing development. Although there are some universal expectations for each developmental stage, every young person has unique inner resources and challenges, and the particular contexts of the child’s life also shape the individual needs and expressions of grief after the death of a parent or sibling. Because such losses do have developmental implications for children, we know that parent consultation and counseling for children provides much needed guidance and support.  Esther Shapiro, an authority on grieving families, states that “repair of our shattered selves following the death of a loved one depends both on our relationship resources and on the specific tools of our developmental moment “      (p. 87).  A wealth of information related to grief and family development can be found in her book, cited at the end of this article.

We concluded that a brief educational series touching on stages and tasks of child and adolescent development during significant bereavement would be useful. We know that severe losses can put individuals at risk for depression, and the rapid developmental stages of children and adolescents heighten the significance of depression’s impact.  Bereaved children and adults can struggle with the dilemma of staying frozen in time or moving forward and experiencing what they imagine as the unbearable pain of the past or the frightening emptiness of the future.  For children, the consequence of one year’s depressive response can be a delay in developmental time ( p. 119 ).  

After the death of a parent or sibling, no child will be the same as if the loss had not occurred.  But they may discover the resilience that can help them integrate loss and move forward, hopefully with increased empathy and compassion. The availability of attuned supports for the young is critical after a traumatic loss such as a suicide.  As surviving children grow, the conditions that encourage the formation of a world view that is not informed by a sense of abandonment and guilt include the quality of the image of the deceased loved one that the child has internalized, and the caregivers’ patience, presence and opportunities for the child to master the tasks of their developmental stage.   For each of the stages a child’s capacity for processing and understanding   the death, coping, and learning to use the image of the deceased loved one for comfort, inspiration and support is very different.  When we provide care for these children and adolescents our interventions can support their continued development even in the wake of a profound loss.

Infancy is one of the least understood periods where the impact of severe loss is considered.  Often, because the awareness and expression of young babies is primitive, we assume that they are minimally impacted.  But consider how infants do respond to all kinds of changes and emotional vibrations in the caregiving environment.  From the moment they come into the world, infants orient themselves through highly integrated sensorimotor, oral, psychosocial, and self-regulation though relational adaptation tasks.  Attachment patterns with the caregivers begin to form. They learn to trust and self-regulate through mutual interactions with the caregivers who provide consistency, healthy stimulation, affectionate communication, nutrition and nurturance.  This delicate balance is at risk for dysregulation after any devastating loss, and it is this surrounding, interactive world that is the context for infant development.   When the caretaking environment is disrupted by suicide, or any unexpected death, babies will not have concrete understanding of the death that would allow them to formally mourn, but the earliest capacity for meaning making regarding self and the world begins to form in relation to the bereaved caregiving environment.  The attachment literature suggests that young children are vulnerable if they are separated from the primary caretaker, and if stable, continuous caregiving is not provided from other adults.  But parents who survive the suicide of a spouse or another child face extraordinary challenges with energy and emotional responsiveness.  Shapiro,  comments that “grieving parents may find it all they can do to keep their own functioning intact and stable,” and “under the circumstances of bereavement, both the emotional and instrumental resources of parents are taxed to the limit” (p. 79).   So, for infants, as with any child, “the grieving  family’s ability to reestablish  stable equilibrium without restricting the ongoing development of its family members is especially crucial in determining the consequences of the death for its grieving children, who have so much of their development to complete” (p. 85).

But Shapiro is encouraging.  She identifies a more balanced potential in bereaved parenting that suggests less of the trauma that can be experienced by children who are neglected under circumstances of profound loss.  Nor does she suppose a glossed- over perspective that assumes children will be fine with “good enough” caregiving.   Without minimizing the impact of severe loss on children, she observes that it is premature to predict that bereaved children will form insecure attachments and poor working models of self in relationship to the world. She stresses the importance of informed caregiving under circumstances of loss and bereavement.  She teaches that individual and shared grief responses in a family are sacred and not damaging; that the grief responses of the young should be protected from constraint and untruths or distortions about the death.  She teaches that a relationship with an image of the deceased loved one can support and influence a bereaved child throughout development.  She teaches that grief shapes, but can also deepen the developing person.   Grief is a powerful and consuming human experience, but one can find powerful human connections though shared grief, even with infants.  Grief is painful, but allows intimacy, sharing, closeness.  It wants to be expressed though memories and stories.  It wants to speak the name of the person who died.  Grief feels at home with sleeping, rocking, weeping, embracing. Shapiro emphasizes that for very young children an internalized image of the deceased person is created though received knowledge from the parent, siblings and grandparents over time. Infants can become familiar with photos and words that teach about the loved one, and this is a base for the stories and shared affection that surrounds the image of him or her.

Bereaved adults who are parenting infants can find healing benefits from the intimacy that babies offer.  However, the bereaved parent needs many resources and self-care to for ongoing, sustainable engagement with a developing infant’s needs.  The LOSS Program for Children and Youth would like to offer consultation and counseling to caregivers of children at all developmental stages so that family grief is manageable, emotional expression is unconstrained and an image of the loved one is taken in and held for comfort, coping and a sense of groundedness as the bereaved child relates to the world.  

Shapiro, Ester R. (1994) Grief as a Family Process: A Developmental Approach to Clinical Practice, New York: The Guilford Press.