Recently I lost my best friend and the love of my life, Lola “Bear” Works. She weighed 58 pounds and was a happy, spontaneous Golden Labrador-Retriever Mix. She was diagnosed on June 16th, 2020, with Histiocytic Sarcoma and underwent chemotherapy at the Oncology Department of Blue Pearl in Atlanta, GA. Histiocytic Sarcoma is an extremely rare and aggressive cancer that mostly affects middle-aged dogs. Lola was an atypical patient because she was only 4 years old.
Chemotherapy (specifically Lomustine (CCNU)) was victorious in this instance of battle with cancer but it was destructive towards Lola's liver. Lola was diagnosed with liver failure on November 18th and she left me on December 2nd, 2022. As I continue to grieve the loss of my love, and with it being Mental Health Awareness Month, I think this would be an ideal time to speak on Grief and Bereavement in the pediatric population.
Developmental age and cognitive ability are directly tied to how children comprehend death and dying. One crucial thing to remember is that children are concrete thinkers, meaning they are very literal. An innocent statement like, "Daddy went away" or "Mommy went to sleep" would be viewed as truth. It is in everyone’s best interest to choose words wisely and have simple explanations. Let us approach this conversation with three different age groups in mind: young children, older school-age kids, and adolescents.
Young children (Ages 0-6) have “magical thinking” and a limited vocabulary. Magical thinking means children link their last interaction to the outcome. For example, “I yelled at momma and she died.” Their last interaction with their mom was yelling and now she is dead. This child can believe they caused the death of their mother. Can you imagine that guilt? It is imperative for the adult to firmly say, “It is not your fault your mother died. She died from a bad heart.” This may need to be repeated.
Children cannot always express themselves verbally. For example, a typical two-year-old has 50 words and can put two words together (thank you). They may not be able to express that they have noticed a change in their environment or that they are upset. What is normally seen is regression. For example, a child who was potty trained is now having accidents or using “baby talk.” They are trying to control or rebel against what is in their power to control.
For older school-age children (ages 6-12), Grief can vary greatly. At this age, they do have a concept of death and grief will be individualized. You may see differences in focus, worsening grades, aggression, and even withdrawal. It is important to entertain an open conversation about feelings. Tell them how you are doing. Comfort them and reassure them that they will be ok. Make sure the school, teachers, and counselors are also aware so more eyes are paying attention to any changes in behavior.
Adolescents (age > 12), their world is their friends. Adults may not know how much they are grieving because they may be only disclosing their feelings to their friends. Encourage them to share, journal, provide self-care, and even go to counseling. Be mindful, counseling does not have to be the last option.
A counselor can help guide and navigate your child in ways you cannot.
There are some red flags that require emergent referrals at any age they are:
- panic attacks
- prolonged grief (over 1 year)
- Suicidal thoughts and/or attempts
Any child experiencing any of the above should be seen as soon as possibly by a pediatrician. If a child has thoughts or has attempted suicide they should be seen at your nearest emergency room as soon as possible. Additional resources are available at The National Suicide Prevention Lifeline. Call 1-800-273-8255 or you can text GO to 74174 to reach a trained Crisis Counselor.
Parents are sometimes leery about going to the emergency room, which I can understand. However, Emergency Rooms have Doctors, Nurses, Social Workers, and Psychiatry staff who are trained to handle issues like these.
On occasion I work as a contract physician. Recently, I saw a courageous 13-year-old male who told his parents he wanted to end his life. Parents sought advice from the nursing line, which correctly told them to take the child to the emergency room for a formal evaluation. The father said, “his plan was not strong enough”, and decided against seeking help. I suspect "Dad" was not comfortable with the idea of going to an ER. Luckily, his grandfather called for another appointment, saying the chief issue was eczema, but his main objective was to seek advice for his suicidal ideations. This adolescent was from a fractured home and his younger brother was recently killed; his grandfather noticed the thirteen-year-old's sudden behavior change. This slender, tall young man sat on the edge of the exam table with poor posture, limited eye contact, and a face devoid of emotion. He candidly told me he misses his friends and his brother. He stated that his grades are poor due to a lack of concentration and that he has had thoughts of hurting himself. This is not the first time but it is the “loudest.” He did have a plan but was unwilling to divulge that specific information due to embarrassment. I sincerely thanked him for his courage. This young man spoke to a total stranger, someone he may never see again, and asked for help.
I am working through my grief by allowing myself to cry, talking to other fur parents for support, asking for help when I need it, and engaging in processes that heal, for example, writing this blog article. It is important to know, "It is ok to not be ok" but support should be near.
