Interview with Erika Leeuwenburgh, LPC, co-author of Why Did You Die?

What is your experience in the field of grief counseling for children?

I worked for 20 years at a major medical center counseling families expecting the death of a loved one, surviving siblings of SIDS/SUDS (Sudden Infant Death Syndrome and Sudden Unexpected Death Syndrome), and people dying from life threatening illnesses or trauma. I worked with grieving children and adolescents both on a crisis intervention basis and for long term bereavement counseling/art therapy. 

Which (if any) of the activities in your book do you find to be universally necessary for any child who has lost a loved one?

Activity 18, “The Death Was Not Your Fault,” is necessary. It is important for every child to understand that his or her thoughts, feelings and actions were not the cause of death nor could they prevent death. Young children believe in magic while older children and adolescents might form fantasies, theories, and misconceptions that need to be clarified to alleviate feelings of guilt and anxiety.

Obviously, adults and children have different understandings and experiences with death. What methods can you suggest for an adult trying to help a child through the process of grieving?   

Adults should try to remain open and encourage the sharing of memories and spontaneous discussion about the deceased. Children wishing to visit the cemetery can benefit from having this special time and place for remembrance. Why Did You Die? facilitates communication, which is helpful for adults having a difficult time talking to children about death. Finally, the family can create a memorial by making a photo collage of the deceased, planting at the cemetery, or decorating a box and filling it with items belonging to the deceased. 

You outline various stages of grief that children as young as two years old may be going through. What can a parent do to help an especially young child express and cope with feelings of loss? 

The ability to share photographs of the deceased encourages the discussion of memories. A group of photographs of the young child and the deceased can be incorporated into a book highlighting their relationship. Read the book when the child requests it or ask if they want to look through it together.

A controversial issue is whether to include children in rituals for the deceased. This raises anxiety and questions for adults. Children benefit from being included in family rituals, as this decreases their sense of isolation and provides a concrete experience for the child’s greater understanding. I recommend including young children in the grieving group with the following prerequisites:

• The child wishes to participate. A child should not be forced to join but given the opportunity to know people are gathering to remember the loved one and what the rituals entail. They need to understand that people cry and express sadness because of loss. And the expression of feelings is acceptable. If there is an open casket, the adult needs to verbalize that the body has stopped working, death is irreversible, and people are saying good-bye. Young children may benefit from hearing verbal descriptions, such as, “Daddy is dead.  His body doesn’t work.” Following the service, verbal explanations and descriptions should be repeated. Children under the age of five often see death as reversible. 
• It is helpful for parents and children to have support from family and friends during this time.  A few designated people can care for the child during and after the funeral. Adults can engage young children in activities during the service such as coloring and playing with games and toys. 

Young children will spontaneously share feelings of loss.  It is helpful for adults to elaborate on the child’s expression; if a child says, “I miss Daddy,” the adult can encourage the child to describe their memories. 

Why is it necessary for children to confront their feelings of grief and loss? What can happen if these feelings are avoided?  

Children are no different than adults in their need to grieve and express feelings. The word “confront” has the connotation that control is taken away and something is imposed. We need to encourage the expression of feelings to decrease the child’s sense of isolation and increase his or her ability to communicate directly about the loss. Feelings of grief are intense and confusing for children and adults; when not addressed, they are expressed in indirect and uncontrolled ways. We need to tailor our approach to children’s needs and style of coping. They have limited resources, are overwhelmed, and should not feel alone in this painful experience.  If an adult believes the child is not expressing their feelings of grief they should, seek professional services. When feelings are neglected, especially in the case of children who lose their parents, children are at risk for emotional and behavioral problems which may develop into major psychological disorders. 

What behavioral changes can a parent or guardian expect from a child in mourning?

This is addressed in Why Do You Die? in the section ‘How Children Grieve.” Every child copes differently and there are no prescriptions. Some children become more tearful and sensitive while others disconnect from their loss. 

Is this workbook something you’d suggest a parent do with their child, or should the child do it on his or her own?  

Young children will benefit from having an adult spend time on the activities with them, as long as it does not become forced or a chore. As I mentioned previously, when an adult has difficulty initiating a discussion about the death, using the book together will facilitate communication. Older children can independently use the book as a journal and choose to share it with an adult if they want to.