Eight-year-old Anisa* lost her mother a year ago. Since she was close to her mother, Anisa went into a state of shock. Mostly she would remain silent, would not eat properly and almost every night she would scream during her sleep. Anisa obviously did not understand death and wanted to be with her mother because she believed that no one loved her the way her mother did.

Nine-year-old Talha’s* grandfather was his best friend. Living in a joint family setup, Talha was devastated when his dada died. When his grandfather was alive, Talha spent lots of time with him taking care of dada’s birds, eating their meals together and listening to bedtime stories. After his dada’s death, Talha* began to spend time near the bird cage or in his dada’s room. He would not let anyone touch his dada’s belongings. Eventually, Talha was unable to concentrate on his studies and his grades dropped in school.

When 12-year-old Affan* lost his only sibling in a road accident, the incident left an indelible impact on his mind. Without his elder brother, Affan became a recluse with frequent angry outbursts.

Qurrat Jibran, clinical psychologist and senior lecturer at the Department of Psychiatry at Ziauddin University explains that grief in children is different from adults. Children are unable to express their distress verbally but one can see changes manifest in behavioural and emotional responses that can vary depending upon the individual and the nature of the loss.

According to an article “Understanding Grief and Loss in Children” published by The American Counselling Association, grief is a never-ending process that takes time. When children lose a close relative, they may seem fine, at least initially, but some of them may gradually start exhibiting signs of grief.

Grief counselling can help children learn how to effectively deal with their emotions and heal from their pain

Elaborating on expressions of grief in children, Jibran says that a child may become irritable, overreact on trivial issues and begin to have difficulties with schoolwork. Other signs include angry outbursts, nightmares or sleep disorders, changes in eating patterns as well as loss of interest in activities that they were previously passionate about.

Children may also show disturbing behaviour towards people in their immediate surroundings. For example, when a child loses a close family member such as a grandparent or a single parent, they eventually become clingy with other family members. Since they develop feelings of insecurity, dependency on other members of the family may increase.

Jibran explains that as the sense of loss becomes strong in a child, he or she may show negative tendencies in behaviour. They feel responsible for the loss and express guilt about having misbehaved with or having missed certain opportunities to express affection toward the deceased individual. When 12-year-old Sarah* lost her father, it made her anxious and scared and she began to follow her mother everywhere in the house.

“Some children tend to become overprotective about their existing loved ones. This is why a child may start tagging along with their other parent who is still alive because of the fear that they may also die or abandon the child,” adds Jibran.

So what are the causes of intense grief in children? According to psychologists, in addition to life-changing events such as moving home or school or divorce, the loss of loved ones such as grandparents (especially if a child lives in a joint family), parent, sibling, best friend or pet can also lead to feelings of sadness and pain among children.

Jibran shares an example of an eight-year-old girl who lost her cat. She was very close to her pet and when the cat died, the little girl could not come to terms with her loss and often dreamt of cats.

According to Jibran, every child has different abilities to adapt and understand loss. A child younger than two years may cry over the absence of a familiar person, but they won’t understand much about death and slowly within days will find another diversion, someone else to become attached to.

A child aged between two and five years, on confronting death, may assume that the person will come back sometime later, although they may develop regressive behaviour such as bed-wetting, thumb-sucking or fear of being abandoned. While children over eight years and adolescents do understand death as a final destination, some of them may either become quiet and try to put up a brave face or they may become aggressive.

Shehzeel Hayat, a counsellor, emphasises that grown-ups should continue to act normal with children and go about the daily routine, giving time and space to children to come to terms with the loss.

At times, adults do not talk about death in front of children in order to protect them from sadness and pain. Hayat believes that it’s important for grown-ups to understand the feelings of a child who has lost his/her parent or a loved one. When you avoid talking about the tragic event to protect children from sadness, it can lead to children bottling up their emotions. If the child cannot vent or share his or her feelings or frustration, it can be detrimental for his or her personality in the long run.

Jibran feels that most adults generally do not know how to talk to a bereaved child. “People often don’t have a clue of what should be said and not said. For instance, when talking to a grieving child, especially to someone who is over eight-years-old, people say ‘I know what you are going through.” To which some kids abruptly reply, “How do you know? They were not your parents.” It is important to carefully choose your words while offering condolences to grieving children.

Several studies conducted by clinical psychologists and psychiatrists about complicated grief and bereavement issues, as well as post-traumatic stress disorder, trauma and mental disorders, reveal that grieving is normal and usually lasts between four and six months. But if the duration of grief persists beyond six months, professional help such as counselling or therapy is advised.

According to mental health experts, the techniques used between counselling and therapy are more or less the same. Counselling is a short-term treatment that focuses on helping kids deal with emotions in a healthy way while therapy is long-term treatment which involves kids battling with more difficult or chronic problems such as anxiety or addiction.

Unlike in developed countries where there are grief centres, Pakistan has no such facility. However, there are a few private organisations that provide therapy or counselling services to children.

Jibran, who has dealt with kids suffering from grief says that clinical psychologists try to ascertain the reason for the grief as well as study the child’s past.

In several cases where children developed depression and anxiety, they also showed aggressive behaviour such as breaking objects. Jibran adds that the home environment plays an instrumental role in developing coping mechanisms. If the environment is not favourable, children are likely to develop psychological problems like obsessive-compulsive disorder or phobias, eating disorders, as well as bad habits such as smoking and substance abuse.

A study published in the Journal of Paediatric Obesity in 2018 reveals that emotional eating is associated with intense grieving. Food, especially sugary items, make one feel good and happy for a short time, but the downside is that overeating can increase the risk of obesity in children.

Jibran believes that the best therapies for children are art and play. “Kids are asked to draw or colour objects,” she says. “The use of colour helps in understanding the feelings that a child is going through. The child is also given a few puzzles and toy blocks to play with. The selection of a toy such as a doll, balloon, toy telephone etc allows us to gain an insight into a child’s mind.” Other tools used by counsellors include story-telling sessions, talking or music therapy. All these techniques help kids to relax and channelise their emotions in a positive direction.

The healing process takes time depending on how extensive the therapy is. Jibran conducts two sessions per week. The difference can be seen after two months but depends from child to child. If there is a marked improvement in a child, the therapy is discontinued with mutual consent. Following the therapy, one can see a decline in irritable behaviour as well as increased emotional and mental stability.

Besides therapy, Hayat suggests that an immediate family member or the guardian should have an open conversation with the child, especially if the child is older than eight years of age. In addition, they must be engaged in recreational activities. Grown-ups must be patient with the bereaved child, listen intently to their concerns and not ignore them at all.

“We should realise that these kids are frightened and insecure. All they need from adults is love, care and support,” says Jibran.

**Names have been changed to protect the privacy of the children The writer is a freelance contributor*

Published in Dawn, EOS, February 2nd, 2020