Friday 30 September 2016

Dear David: How do we help our young son to cope with his sister's death?

Published 22/08/2016 | 02:30

Parents with toddler son. Photo posed
Parents with toddler son. Photo posed

Advice from the parenting expert on how to help a child deal with the death of his sister and on how to cope with a dramatic change in behaviour by an 11-year-old girl.

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Q. How do we help our three-year-old boy cope with the death of his baby sister (she died at just 11-weeks-old)?

His life has been out of sync for the last three months or more because we have been in and out of the hospital to her and often unavailable to him.

His behaviour has changed (toileting problems, screaming, shouting, hitting out, seeking reassurance) and we are not sure if he understands her death.

We parents are also trying to get through this difficult time and are not sure how much we should be telling him about all that has happened.

David replies: I can only imagine how difficult and, indeed, traumatic the last few months have been for your family. It is so hard for parents to be emotionally and physically available for their children when they themselves are struggling to cope with trauma. Your daughter sounds like she was very sick from birth and I'm sure you both were very distressed throughout this time.

Naturally, you yourself will be reeling from the emotional roller coaster since her birth. I am not sure how recent her death was, but, even if it was expected, I am sure it has come as a huge shock.

Be very patient with yourself in the coming months too. Grieving the death of a child is a long and slow process. There are no rights and wrongs in how you should do this. Nature will take its own course.

As you do process your own grief, you may find that you have greater capacity to take on board the emotional distress that your son seems to be experiencing. It is great that, even in the height of your own distress, you are able to pick up on it enough to be able to ask for help in helping him.

While, at age three, he may not understand death, he will still be attuned to the emotional temperature of your home. He will have been aware of, and affected by, the disruption to all of the usual routines while you have been tending to his sister.

The behaviours that you list do seem to be just his way of showing the level of distress that he is feeling. He has probably missed his usual closeness to both of you, since you have, naturally and appropriately, been distracted by caring for his sister.

During all of your time spent in the hospital, I can imagine he has been minded by several different people, some of whom he will have been closer to than others. Changes in care like this are very difficult for pre-schoolers and they lack the complexity of language to be able to articulate just how hard and upsetting it can be.

Hopefully, even if you are still quite traumatised yourselves, you will be able to resume some of your former stability and security at home for him. Your presence, and your minding of him directly, should help him to feel more secure and settled over time.

I am not sure how much you included him in the visits to the hospital and the funeral arrangements, but these are the practical experiences that he has had that explain what happened.

Your family has, no doubt, been rocked to its core by your daughter's birth, sickness and death in such a short period. If you are feeling it then your son will be feeling it too. He has been attuned to your distress, as well as his own. It is possible that he has regressed through it all. Perhaps responding to him as if he was a younger child might help.

Re-establishing a strong and secure relationship with your son can be achieved by lots of nurturing on your part. So, soothing, rocking, swaddling, singing, cuddling on the sofa or in bed, and other comforting actions will help.

You might want to revert to lots of simple games, rhymes or physical play that allow him and you to feel connected and glad to be in each other's company.

Don't worry too much about the abstract understanding of death that he may have. It is more important for him to feel connected to you and secure in the knowledge that you see him, want him and can mind him.

Talking and explaining about the trauma of the last few months can wait until he is older and you have been able to work through your own grief. For now, focus on reconnecting to him.

Our 11-year-old daughter has developed lots of rituals at night, and we don't know what to do

Q. We have an only child, aged 11. During the past six months she has become very challenging and angry in her tone and behaviour. She is also repetitive and ritualistic in her behaviour, especially at night, and will not sleep unless she has engaged in her routines (checking and rechecking the position of things like toothpaste, iPad charger, school bag and so on). She expresses a lot more anxiety generally. My husband works away from home and we seem to have lost control in dealing with the situation, and are at a loss as to how to help her.

David replies: Whenever I hear that a child's behaviour has changed significantly at a particular point in time, I wonder what it was that happened, or began to happen, in the child's life at that point.

Typically, when things change in children's lives (like changes in parents' work habits, changes in school, issues with friends and so on), it can create a lot of uncertainty for children. It can be hard to understand the emotional impact of these changes (for both the child and parent) and yet, the unpredictability of change can lead to a lot of anxiety.

Anxiety, in turn, can have a negative impact on behaviour, with some children acting out their upset and anxiety in provocative, challenging or disruptive behaviour.

In your daughter's situation, I wonder what, if anything, changed in her experience in the last six months that might help us to explain the change in her behaviour, when she started acting in a more angry way, challenging you more directly.

A couple of things come to mind. I'd be interested to know when your husband started to work away from home. Is that something that is a recent development, or has it always been the case? Similarly, are the anxieties new, or have they been there all along?

The ritualised and routined behaviours at night time, sound like they may be part of that general increase in anxiety. Have they only begun in the last six months too?

Your daughter may have become increasingly aware of these night-time rituals and may be very distressed by them. She may feel very out of control in terms of being unable to stop or reduce the rituals, with the compulsion to complete them being overwhelming. If that is the case, then it is also interesting that her potential feelings of being out of control seem to be mirrored in your own and her dad's experience of being out of control and unable to deal with the situation.

Indeed, there may be a strong enough element of compulsion in those behaviours to consider the possibility that your daughter has Obsessive Compulsive Disorder (OCD).

OCD would certainly fit with the increase in anxiety that you are seeing generally, since obsessions and compulsions are usually driven by anxiety and fear (that something bad will happen if the ritual is not completed 'properly').

Rather than focusing too much on her behaviour, I think you need to focus on her anxiety. She needs help to find ways to manage and regulate her anxiety, such that it doesn't lead to compulsive rituals, or leak out in challenging behaviour.

You can certainly help her with this, using empathy as a means to help her express the anxiety. You may struggle, though, to help her with the anxiety management element that is required.

In order to learn those kinds of anxiety-management skills, I do think that you should consider seeking professional help. Some expert support may also give you and her dad back your own confidence in understanding and being able to help your daughter.

If it is the case that your daughter has OCD, then I'd certainly recommend that you try to find a local clinical psychologist, who specialises in working with children and teenagers. Your local Child and Adolescent Mental Health Service (CAMHS) may be able to help too, but waiting lists can be long.

Cognitive Behaviour Therapy (CBT) is most effective in dealing with OCD, so do check what therapeutic model the psychologist employs.

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