Pretty much all the honest truth telling there is in the world is done by children. --Oliver Wendell Holmes

These are warning signs which indicate that professional intervention may be needed. Please seek a therapist who specialized in grief and trauma.

Being a mother means a lot. It means being a friend, a supporter, a mentor, a teacher, and a student! On this day, I would be the student.

Just when I thought they had forgotten her, I was gently reminded that my children still remember, miss and love their sister. But they also force me to face some decisions which were not appropriate for our family. It is tough talking to your children about death.

You see, in all my insight and wisdom during Chey's death and memorial service, I felt it necessary to "protect" my children from the event. I thought it would permanently harm them if they saw or held a "dead baby." So they were excluded. But now I know that children need to grieve just as adults do. I didn't know that at the time of Cheyenne's death. After all, there is no text book to prepare you for the death of your beloved child. It can be difficult to share honestly and admit mistakes to your children. On this day, I had no choice.

While driving in the car, a song came on the radio. My ten-year-old, Cameron, said to me, "This song reminds me of Cheyenne, Mom. It makes me think of her because she's an angel."

With grateful eyes I thanked him for sharing that with me. I told him that song would remind me of her from that moment on. He assured me that he hadn't forgotten her- or the years of pain and tears which followed.

Well, when the song was finished and after careful thought, my predictable and discerning daughter, seven-year-old, Stevie Jo (in her
infinite wisdom) said, "Why didn't we get to say goodbye to our sister?"

I responded, "Honey, I am sorry, I didn't know what would be the right thing to do. I was afraid for you and the boys to see that your baby sister had died. I just didn't know what the right thing was."

Her response was the concrete proof to me that there are times when children know so much more than adults do.

She said with a stern voice and disciplining look in her eyes, "Mom, of course, the right thing to do would be to let us say goodbye to our sister. She is our sister and we should have been able to see her, hold her and say goodbye. That is the right thing."

My reply?

"Yes, Stevie Jo. That would have been the right thing. Now I know and I hope that you will forgive me."

Her loving response?

"Sure Mommy, but I love you anyway."

Depression is an illness that is no respecter of age. It can attack children as young as four or five as well as teens and adults. The symptoms of depression are different in children than they are in adults. They can include, but are not limited to, irritability, rage, physical complaints such as stomach aches, headaches, and dizziness; bedwetting, nightmares and aggressive behavior. 

If you suspect your child is depressed, it is vital that you get help for your child. Depression is an illness that is treatable and curable in most cases. There are five main categories of depression, each with different causes and factors. 

MANIC DEPRESSION (also known as bipolar I and bipolar II) is usually an inherited disease. Scientists have discovered this kind of depression usually runs in families and can be traced to previous generations. Manic depression cycles between very low depressive periods coupled with manic high episodes. These can overlap at times, thus making the diagnosis difficult. Usually behavior during manic high periods includes high excitability, rapid speech, hyperactivity and fearless behavior (thinks one can fly like Superman or be like a super hero). Some bipolar patients actually hear voices telling them what to do and how to behave. Children as young as five have been diagnosed with manic depression. This is the only form of depression that there is no known cure for. It can be controlled, however, most of the time with medication. If manic depression runs in your family and your child starts displaying some of the symptomatic behaviors, seek medical treatment as soon as possible. 

MAJOR DEPRESSION is not common among children, although it is possible a teen may experience this form of depression. This type of depression is the result of an imbalance in brain chemicals and it requires treatment of antidepressants. Teens who experience major depression will be focused on themselves and their problems. They will be moody, uncommunicative, either overeating or not eating, and they will seek relief from their emotional pain. This is when most teens will turn to using drugs or alcohol or both. Psychiatrist Oscar Bukstein of Western Psychiatric Institute and Clinic in Pittsburgh, PA, says, "Kids often don't turn to drugs unless they have a coexisting psychiatric disorder. Children with inherited predisposition's to low levels of serotonin and other brain chemicals have a high risk of becoming addicted to a great variety of drugs, including cocaine, heroin, and marijuana, in an attempt to medicate themselves." 

DYSTHYMIA is another classification. It means "low-grade" depression. The symptoms are not as pronounced as they are with major or manic depression. If your child is having difficulty staying focused in school, is moody, complains a lot about physical symptoms and what a "bum-deal" he's received from life, you may want to have him checked for dysthymia. This classification can be effectively cured with antidepressant medication. 

As with adults, it may take some experimenting to find the right medication to treat depression. The right antidepressant will improve the metabolism of neurotransmitter chemicals in the brain. This will, in turn, normalize a depressed child's moods that can interfere with the ability to learn and develop socially. Most antidepressants are designed for short-term usage, usually not longer than two years. Be sure to follow your doctor's instructions and advice. 

REACTIVE DEPRESSION is what most children will experience. This depression occurs in response to a loss such as the divorce or separation of parents, being placed in new surroundings, attending a new school, being separated from loved ones such as grandparents, etc. This depression does not usually require medical treatment, although it may require some counseling sessions with a trained therapist. A child psychologist or trained counselor will be able to help your child develop coping skills and put everything in perspective. It is vital for you, as the parent, to encourage your child with praise and support. Assure your child that you will always love him. Work with the therapist to build a sense of security in your child. 

If left untreated, reactive depression can lead to the more serious forms of depression (such as dysthymia or major) where the brain chemicals become unbalanced and stay that way. 

OBSESSIVE-COMPULSIVE DISORDER is usually not referred to as a form of depression, but researchers have discovered the same neurotransmitters responsible for the behavior(s) are the same ones affected in depression. OCD is called the "doubting disease" and results in obsessive-compulsive behaviors such as washing hands repeatedly, brushing teeth until gums bleeds, taking numerous showers or baths, etc. This disorder got its name from its victims never being "sure enough" that what they've done has been done well enough. Usually the behaviors revolve around personal hygiene, but this is not exclusive. 

According to psychiatrist Judith Rappor of the National Institute of Mental Health, "...these abnormalities may be a neurological misfiring, a sort of hiccup, in the caudate nucleus buried deep within the basal ganglia [an area in the brain]. And there may be a genetic basis for the disease because OCD runs in families." This disorder can be treated with antidepressant medication, so seeking medical intervention is recommended. 

If you have a child experiencing depression, in whatever form, you can write to: American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Avenue NW, Washington, DC 20016 or call them at (202)-966-7300 for additional information regarding your child's specific diagnosis. 

Please, for your child's sake and your peace of mind, don't ignore the symptoms of depression. They probably won't go away on their own. And your child won't be able to "snap out of it" anymore than an adult can. You owe it to your child and to yourself to seek help. 
 
 

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Death is a Family-Community Issue
© 2000 by Joanne Cacciatore

When death hits a family, each person suffers the loss. The individuals are comforted but society fails to recognize that this also affects the family as a 'unit.' How the children are affected by the death, for example, and the manner in which they are supported, can determine not only how the child reconciles with the death in the long-term, but also, how the family relationships function as well.

Children approach issues of grief with the same skills they use to understand other problems. Children try to establish a sense of familiarity and 'normalcy' in their lives. "Their sense of understanding is influenced by previous experiences and by their current stage of cognitive development. They are in the process of developing their sense of self, as well as a sense of how that self exists in relation to others (in terms of level of independence and dependence). Thus, loss-related experiences in childhood have the potential to shape future meanings, relationships and sense of trust or vulnerability at a significant level," says Dr. Iileen Murray of Counseling for Loss.

There are some dangerous misunderstandings about children who experience death:

1. Children don't grieve. Dr. Alan Wolfelt said that if a child is old enough to love, then they are old enough to grieve. While children are very capable of appearing to be 'fine,' it may simply be a coping mechanism. Children have shorter attention spans and may display strange behavior patterns like crying one minute and laughing the next. It may seem like they don't really care. This is a natural reaction to an overwhelming emotion which many children have not yet felt. That kind of 'break' in the mourning is necessary to help them handle the grief they feel. Children do seem to possess a natural resilience, however, adults should never dismiss the fact that a child is grieving, months and even years after their parent, sibling, or grandparent has died.
   
   
2. Children cannot understand death or dying. While it isn't true that children cannot understand what death is, they will need to be told the story repeatedly in simple and honest terms. Younger ones may want to talk frequently, asking irrational questions and reliving the event repeatedly. This may be an attempt to establish the reality of the death, or it may be a part of the inability to understand abstract concepts such as "death is permanent." When a death occurs in a family, the surviving adults- the parents- are in such deep grief that they are often unable to provide the honest dialogue and support necessary to help the surviving children. This is why it is important that the community steps in to assist. For the family to emerge from grief in a healthy direction, the parents and surviving children must have support from the community.
   
   
3. Children forget loss quickly if we 'replace.' We begin to teach these very dangerous 'grief habits' at a very early age. The dog dies and we replace it with a new puppy. While it may seem to assuage the child's grief, we must realize that some losses are irreplaceable. The mere replacement of a pet fails, in lieu of allowing the child to grieve- even for a day or two, fails to prepare them for the more significant losses they will suffer which cannot be assuages by a trip to the pet store. Childhood brings with it many unique losses such as a family move, loss of a friend who moves away, divorce, loss of a teacher, or the death of a core family member. In presuming that a child's grief can be handled by helping them forget their love object and replacing it with a distraction, we surrender the opportunity to teach them coping skills that will be invaluable to them in the future.
   
   
4. Children grieve the same way adults do. Children manifest grief in many different ways. Often unable to articulate emotions into words, they may express their grief in behavior changes if not afforded the opportunity to express it in other healthy ways. Their cognitive developmental stage guides their thought process. Their recollection of events may be distorted, however, the grief remains the same. Trepidation in children can be heightened by the drastic change in their parent's personality (due to grief) that seem out of character (not their "normal" selves). Children under stress often regress to an earlier stage of cognitive development. A four year old may experience enuresis (bed-wetting) and adolescents may become more emotional than usual. Coping mechanisms may seem strange to their parents; when a child is expressing sorrow one minute and engaged in joyous play the next, adults mistakenly presume the child is not in grief.

Recent work by J. William Worden and Phyllis Silverman, authors of Children Mourning, Mourning Children, studied 125 children at 4 months, 1 year and 2 years post-parental death, interviewed surviving parents, and used a matched controlled sample. Their work revealed that children often stayed attached to the deceased parent through conversations with them, dreams, keeping special items of memorial, and a spiritual sense that their parent remained with them. This coping strategy worked. It helped children make sense out of the death. Children who generally did best were those who experienced the fewest additional changes and disruptions in their lives. The authors did caution that for some children, problems didn't for several years after the death, so the first year is not an absolute indicator. Factors that appeared to influence healthy family mourning included good relationships between the child and both parents, plenty of nurturing and emotional support, and open and honest communication with the child about the death and its impact on the family.

The family in grief needs a lot of community intervention. They need to be supported by their family, friends, co-workers and peers, and the professionals in their lives. The child family members need to be included in the death experience, the funeral and memorial services; long term mourning needs to be facilitated for the entire family, as a unit and individually.

What do children and their parents need when a death occurs?

• Honest dialogue and open communication in simple terms
• Minimal change of lifestyle, traditions, residence etc. The golden rule of grief is not to make any major decision for the first 18 months
• Access to resources and information about support groups that can help
• Children need to see the adults in their lives modeling a grieving process; acknowledging how one feels and talking about the loved one
• Respect of individual differences (such as child's age, decedent's age, relationship to the decedent, etc.)
• The parents must be community supported so that the child family member is not be expected to become the caretaker of the parent/adult
• Children should be also be offered an alternate adult for talking and sharing. Children are sometimes hesitant to express their true grief with their parents.
• The family's cultures and traditions should be respected
• The community should help the family move toward the grief, instead of away from the grief, while being emotionally supported
• Family, friends, and co-workers should realize that grief over the death of a loved one is not a transitory experience. The family will experience grief episodes for years after the event. It is important they know they have someone to talk to when a 'bad day' happens, whether at school, work, or home.
• Encourage art therapy for children and writing therapy for adults in grief. These are highly effective self-help strategies that provide a healthy outlet for expression
• Offer practical things that help- take the children to the park for a day as a break in the grief and to give the parents some time- or take turns making or arranging meals for the family. That type of practical assistance is often the most appreciated.
• Never ignore the grieving family. Don't be reluctant to open discussion about the decedent with the children or the adults in the family.

While children don't necessarily grieve the way that adults do, often that grief can manifest itself in physical ways, indiscriminate of the age of the griever. Children and adults in grief experience a parade of physical symptoms ranging from insomnia or excessive sleeping, over-eating, anxiety, irritability, anger, hostility, apathy or too depressed to take any action at all, nervous tics, muscle tension, emotional outbursts, rage-like episodes, isolation from friends and family. Others may 'stuff' even the physical symptoms during the crisis and wait to fall apart for years. Protracted grief can result in many crises for a family. It is very important to help the children and their parents face their grief and participate, actively, in the process of mourning.

Remember that the reality of the death does not go away but the manner in which a family experiences death will change with time, hopefully maturing in ways that make it easier to bear. The traumatic loss of child family member will always be with these children. With time, love and understanding from the community the family can learn to carry the burdens of traumatic loss in ways that will make the family stronger.

When You Thought I Wasn't Looking When you thought I wasn't looking, I saw you hang my first painting on the refrigerator, and I wanted to paint another. When you thought I wasn't looking, I saw you feed a stray cat, and I knew it was good to be kind to animals. When you thought I wasn't looking, I saw you make my favorite cake just for me, and I knew that little things are special things. When you thought I wasn't looking, I heard you say a prayer, and I believed there is a God I could always talk to. When you thought I wasn't looking, I felt you kiss me good night, and I knew you loved me. When you thought I wasn't looking, I saw that you cared, and I wanted to be everything that I could be. When you thought I wasn't looking, I saw tears come from your eyes, and I learned that sometimes things hurt, but it is all right to cry

When I was three years old by Stevie Jo Cacciatore, 8 years old When I was three years old My mom had a baby Her name is Cheyenne. She is my only sister, but she died. My mom cried a lot of tears. It took a long time, but we feel better now. My mom's heart, and my heart is still broken though. My sister would be in kindergarten this year She would be five years old. I wish she were alive right now. I would love her, and play with her, and take care of her. All we can do now is miss her. Even though she is not with us, I love her and my mom loves her too. We keep her close in our heart. Love, Stevie Jo, Cheyenne's big sister