Follow-Up Questions from HFA's Living With Grief: Children and Adolescents Teleconference

HFA’s teleconference features some of the best-known experts in the field of grief and loss. While the goal of the program is to share new insights and tangible ideas that can be put to use to help grieving children and adolescents, HFA strives to hear from professionals who are working with children every day. Prior to the 2008 broadcast, HFA solicited questions from Site Coordinators. Many of these questions were worked into the program, but as a follow-up we have included two more here, with answers from Dr. Kenneth J. Doka.

Question: What is the best way to tell a child that a loved one has died when it happens suddenly, or if there has been no discussion about death before the death occurred?

Dr. Doka: Simply, honestly without euphemisms. I would want to find a quiet area and make sure the child had a lot of support around. One book that can be useful in explaining death is What Does that Mean? A Dictionary of Death, Dying and Grief Terms for Grieving Children and Those Who Love Them by Smith and Johnson. This book identifies more than 70 important words, explains how to pronounce them and what they mean, and offers guidance about how to use these words and discuss these subjects with children.

Question: Do you have suggestions for other books that can be used to help children deal with grief?

Dr. Doka: Books can be very effective resources in helping children and adolescents learn more about grief. Bibliotherapy can be very useful but I always treat it as a prescriptive. Books have to be “prescribed” for a particular concern -- if not they can sometimes do as much harm as good. Also remember that the books used should be developmentally appropriate for the particular child. I think it is also important that the books are used in conjunction with counseling or other support.

Listed below are a few suggestions for books divided by reader level. These books are part of a more comprehensive list found in “Bibliographical Resources—Children, Adolescents, and Grief” by Charles Corr, in Living With Grief: Children and Adolescents, Kenneth J. Doka and Amy S. Tucci, Eds., published by Hospice Foundation of America, 2008.

Picture and Activity Books for Preschoolers and Beginning Readers

Carney, K. L. (1997-2001). Barklay and Eve Activity and Coloring Book Series. Dragonfly Publishing Company, Wethersfield, CT. This series currently has eight titles. Each book tells a story and offers drawings to color or blank spaces to draw pictures about a loss-related topic that adults may find difficult to discuss with children. In each book, two curious Portuguese water dogs learn lessons like: loss and sadness do happen; those events are not their fault; it is OK to have strong feelings as long as they are expressed in constructive ways; and “we can get through anything with the love and support of family and friends” (Book 1, p. 5).

De Paola, T. (1973; 1998). Nana Upstairs and Nana Downstairs. New York: Putnam. Tommy likes visiting “Nana Upstairs” (his great-grandmother). When told that she has died, he does not believe it until he sees her empty bed. A few nights later when Tommy sees a falling star, his mother suggests that perhaps it represents a kiss from Nana who is now “upstairs” in a new way. Later, an older Tommy repeats the experience and interpretation after the death of “Nana Downstairs” (his grandmother).

Storybooks and Other Texts for Primary School Readers

Alexander, A. K. (2002). A Mural for Mamita/Un Mural Para Mamita. Omaha, NE: Centering Corporation. A young girl, her family, and the whole neighborhood plan a fiesta to celebrate the life of her grandmother who has recently died after a long illness. Mamita was well known and greatly loved in the neighborhood as the proprietor of the local bodega or store. The girl’s special contribution to the celebration is a brilliant mural painted on the side of Mamita’s store. The text of this book appears in both English and Spanish.

Bunting, E. (1999). Rudi’s Pond. New York: Clarion. While Rudi is sick, his classmates send cards and make a big “GET WELL RUDI” banner for his hospital room. After Rudi dies, the children write poems and make a memorial pond in the schoolyard that attracts a beautiful hummingbird.

Literature for Adolescent Readers

Gignoux, J. H. (1998). Some Folk Say: Stories of Life, Death, and Beyond. New York: FoulkeTale Publishing. Here are 38 legends, retold in prose and poetry, that different cultures have used to come to terms with the reality of death and hopes for life beyond the grave. Brief comments from the author introduce each section and follow each story. The book is also enlivened by 8 dramatic illustrations. A treasury of global culture to stimulate the imagination and to use in working with children.

O’Toole, D. (1995). Facing Change: Falling Apart and Coming Together Again in the Teen Years. Burnsville, NC: Compassion Books. This little book is intended to help adolescents understand loss, grief, and change, and to think about how they might respond to those experiences.

Traisman, E. S. (1992). Fire in My Heart, Ice in My Veins: A Journal for Teenagers Experiencing a Loss. Omaha, NE: Centering Corporation. This book offers a journal framework for teenagers who have had a loss. A line or two of text on each page and many small drawings offer age-appropriate prompts for this purpose.

Evaluating Advice and Information in Grief

Dr. Kenneth J. Doka

Often, when we are in the midst of grief, we receive the advice of others. Sometimes it is solicited, other times it is simply offered. It may be from family, friends, or co-workers. We may even seek out the advice – eagerly reading an article or advice columnist in the paper, or surfing the Net for information.

Problems can arise when the advice seems troubling to us. Or we may be torn by conflicting suggestions – one person may advise tossing out all reminders and cleaning the closets while another recommends that we go slowly, making decisions after some thought and time.

How do we sift through all those different opinions? How do we make sense of the conflicting advice?

Remember Grief Is an Individual Experience

In the past decades, our understandings of grief have changed considerably. We no longer look at grief as a predictable set of stages. Rather we view grief as a highly individual process influenced by many factors such as our relationships with the person who died, the ways that we cope, the nature of the death, as well as a range of social, spiritual, psychological, cultural, and other factors. Some of us may respond to a death with deep and heartfelt emotion, while others may respond by focusing on work or other activities. We should be suspicious of any advice that tells us how we should feel and how we should grieve.

One Size Does Not Fit All

Since grief is a highly individual process, it follows that we may find support and solace in our own different ways. Support groups are a wonderful example. Support groups can be highly useful – validating grief, offering support and respite, suggesting options as we cope with loss, allowing people to help others even in the midst of grief, and extending hope in a difficult time. Yet, support groups are not necessarily for everyone. Some may have adequate support among their circle of friends. Others may find effective, perhaps more private ways, to cope while still others may be too needy for the sharing environment of mutual support. In my support group, I emphasize that we can tell what helped us rather than what would help another. We need to be cautious whenever someone is insistent that this is what we must do!

There Is No Timetable to Grief


Grief is like a roller coaster – full of ups and downs, highs and lows. Like a roller coaster, for many of us, the early part of the journey may not be the most difficult. Here the shock of the loss and the support of friends cushion us. Generally, depending on the nature of loss, most of us resume prior roles. If we are not functioning in our major roles – work, school, or home – or if we are resorting to drugs or alcohol to cope, it may be time to seek additional help. In addition, if over a period of time, maybe even a year or two, we experience the lows as often and intensely as ever, we may also want assistance in assessing what seems to be complicating our grief.

Say Goodbye to Closure

We never get over a loss. We learn to live with it. For most of us, pain lessens over time and we function at least as we did prior to the loss. Yet, even years later, we may, at special occasions, deeply miss the person who died. For example, when my first grandchild was born, I missed sharing it with my parents – even though they had died a decade ago. Distrust any counsel that suggests or promises that elusive “closure.”

We Can Trust Ourselves

Perhaps our inner voice is our best source of advice. What helped us in the past? This is often good counsel for the present. Moreover, as we hear the recommendations of others – in print or elsewhere – we can ask the question, it may have worked for others, but does it sound right for me? We are likely to know that answer.

Dr. Kenneth J. Doka

When is Medication Appropriate for Grief? Dr. Kenneth Doka Shares his Thoughts

Dr. Kenneth J. Doka

A New York Times blog entry dated October 10 ("For Some Bereaved, Pain Pills Without End") reports that Columbia University researchers are studying anti-anxiety prescription drug use by the elderly. Although not specifically looking for trends in the treatment of bereavement, researchers inadvertently discovered that over half of the 33 Philadelphia-area doctors included in the study indicated they had prescribed potentially addictive anti-anxiety drugs specifically for bereavement. In addition, researchers interviewed 50 elderly long-term users of the drugs. Twenty percent said they were prescribed these drugs for bereavement, but then never ceased using the drugs, resulting in an average use of nine years.

As a professor of gerontology, certified thanatologist, certified counselor and minister, I am often asked if people who are grieving should receive medication for their grief.

My answer is never black and white, because the alternatives are really more nuanced. Whether grief or some other condition, it is medically irresponsible to prescribe any drug – antibiotics, pain relievers, psychotropic drugs -- without doing a full assessment of a patient and the situation. Medications should be used when grief is highly disabling, that is, when that patient (after the initial period of mourning) is not sleeping, eating, or able to function in his or her normal role, such as caring for children or going to work. And, if medication is prescribed, it should always be prescribed along with therapy, but never instead of therapy.

In the case of grief, the assessment should not be based on the nature of one’s loss but how the person is coping with a loss. If the measure of need is based on the nature of loss, why not give funeral directors the ability to write prescriptions?

Ken Doka, PhD, MDiv, is a senior consultant to HFA and a professor of gerontology at the College of New Rochelle in New York.

Eight Myths about Children, Adolescents, and Loss

Note: This article by Kenneth J. Doka, PhD, is featured in the Helping Young People issue of Journeys - A Newsletter to Help in Bereavement. Journeys is published monthly by Hospice Foundation of America.

Myth 1. Children do not grieve, or only grieve when they reach a certain age. Children grieve at any age. The way grief is manifested will vary, depending on the child’s age, development and experiences. It is important to remember that children may grieve in ways different from an adult.

Myth 2. The death of a loved one is the only major loss that children and adolescents experience. Children and adolescents experience a range of losses. The loss of a pet, dreams, separations by divorce or relocations, losses of friends or relationships, or losses due to illness or death can generate grief reactions.

Myth 3. It is better to shield children from loss. They are too young to experience tragedy. Although we’d like to protect children from loss, it is impossible. Exclusion can increase fears and breed feelings of resentment and helplessness. It may isolate the child or adolescent at a time when they need the support of adults most.We can support, teach and model our own ways of adapting to loss and include rather than exclude children and adolescents.

Myth 4. Children should not go to funerals or children should always attend funerals.
Children and adolescents should have the choice as to how they wish to participate in funeral rituals. They will need information about the funeral, options on how they may participate, and support from caring adults as they make their choice.

Myth 5. Children get over loss quickly.
No one gets over significant loss. Children, like adults, will learn to live with the loss and may revisit that loss at different points as they go through life.

Myth 6. Children are permanently scarred by early, significant loss.
Most people, including children, are resilient. While loss can affect development, solid support and strong continuity of care can assist children as they learn to live with loss.

Myth 7. Talking with children and adolescents is the most effective approach in dealing with loss.
While there is much value in openly communicating verbally with children and adolescents, there are approaches that allow the child or adolescent creative ways of expression. Play, art, dance, music, activity and ritual are examples of creative modes of expression that they may use to express grief and adapt to loss.

Myth 8. Helping children and adolescents deal with loss is the responsibility of the family.
Families do have a critical responsibility. But it is a responsibility shared with other individuals and organizations such as hospices, schools, faith communities, as well as the community at large. In times of significant loss it is important to remember that the ability of family members to support one another can be limited.