Guidance and support helps children cope with grief

Lorna Manago first faced grief at age 8.

"Daddy has a disease in his brain," said Mom.

"I'll pray all day every day so he'll get better," said Lorna.

"Unless a miracle happens, he's going to get worse," said Mom.

For the next six years, Lorna helped watch over and nurse her father at home until he died from early-onset Alzheimer's disease.

In the year after, Lorna saw a counselor every week. But to fit in as a new high-school freshman, she ignored her great sadness and acted upbeat. She didn't mention her dad to classmates and she never cried.

"It was like bricks were on my lungs," she recalled. "It makes it harder and harder to breathe. You can't talk about it."

Whatever the cause — accident, illness, suicide — millions of children face the death, or anticipated death, of a beloved person in their lives.

Like adults, children grieve. That grief will last the rest of their lives. But guidance and support can help them cope in a healthy way.

A common instinct is to try to shield them from the hurt. Adults might not let a young child see the dying person or go to the funeral. They might not talk openly about the death. They might even lie about why the person died.

But there's no way to avoid it.

"The truth is, if a child loses someone who is dear, it's going to be painful," said Beverly Goldsmith, with Providence Hospice of Seattle.

Those feelings should not be minimized or denied. It's a matter of mental health.

Studies show that adults who were bereaved as children are at higher risk of depression, accidents and illnesses. They have less self-esteem and less optimism about the future.

"If we don't deal with them at the time, it's going to play out later," said Donna Schuurman, national director of the nonprofit Dougy Center in Portland. Two decades ago, the center, whose mission is to help youngsters and their families cope with grief, was the first to run peer-support groups for grieving children. It has since has trained about 140 programs around the world.

There's still tremendous work to do, said Schuurman. Too many adults and teachers don't understand how children respond to death and say things like "Shouldn't you be getting over it?"

In response, the Dougy Center and over a hundred other centers just started the National Alliance for Grieving Children and their Families. The alliance expects to roll out a $10 million education campaign a year from now.

The vision is to use celebrities who experienced grief and loss during childhood as spokespersons in public-service announcements on television, radio and on billboards. Their message will target families in need as well as professionals who encounter children dealing with the death of a sibling, friend or parent.

The alliance hopes the campaign will reach major cities in every state.

In the Seattle area, counseling and peer-support groups for grieving families and children are run through a few of the hospitals.

Last year, Safe Crossings, a therapeutic program sponsored by Providence Hospice of Seattle, which is part of Providence Health Systems, worked with 1,400 children, double the number of five years ago.

That growing demand is spurring new initiatives. This year, Providence Hospice has broadened its free services to include a summer picnic, an autumn nature walk and, possibly, a winter bonfire where families and children can express their grief over losing a loved one.

On the Oct. 28 Autumn Nature Walk in the Washington Park Arboretum people can bring a picture of their loved one and say something about that person. They'll make and decorate a musical instrument then walk together with the instruments through the Arboretum.

"We're doing it in response to the need that we're becoming aware of in our community," said Goldsmith, who coordinates Safe Crossings.

Another new program — a free weekend camp for grieving kids — was started by the philanthropic Moyer Foundation, founded by Mariners pitcher Jamie Moyer and his wife, Karen.

Camp Erin is named after Erin Metcalf, a softball player who died in 2000 at age 17 from liver cancer. The Woodinville teen met and grew close to the Moyer family through the Make-A-Wish Foundation.

"The whole reason we started it was to fulfill Erin's dream to help children," said Candice Douglass, spokeswoman for the foundation.

The mission is to help children in profound distress.

The first camp Erin was held last year in Snohomish County and expanded to King County last summer. The Moyer Foundation funds Providence Hospice in those locations to operate the camps because of its experience with grieving children.

Next year, the Moyer Foundation will open bereavement camps in Pierce County and Portland and, possibly, Phoenix.

Advice from the experts

Experts on grief and programs such as Camp Erin, Safe Crossings and others provide a good model on how to guide a child through the tangle of emotions that surround death and dying:

Use direct, honest language appropriate for the child's age.

Be willing to explore ideas and questions about death. It's not the answers that are important, but the loving atmosphere in which they're given.

Give children the opportunity to see and help the dying person even if it's hard or sad. Even young children can do something. One small child decided to assist her father, who was dying of cancer, by putting the toothpaste on his toothbrush.

Ask the child's preferences for when death occurs. Does she want to be wakened in the middle of the night or called out of school? Does he want to see the body, even if it looks different? One little girl's father and brothers died in a plane crash. She chose to see the bodies because it would be terrible not to say goodbye.

The night before her father died, Lorna helped her mother clip and polish his nails. Then the teenager sang him a favorite song: "I know he liked it because he tried to reach for my hand," she said.

Help children identify emotions such as sadness or anger or guilt, emotions that might feel like a stomach ache or headache.

Share books and stories. Kids learn about different kinds of feelings and what they are experiencing through characters in books about bereavement and loss, said Harrison.

Provide hands-on activities. Movement and play are therapeutic. At Children's Hospital, if parents give permission, dying patients and their siblings are encouraged to create art that leads to discussion and gifts that preserve memories.

"Many times children know they're dying before anyone says anything to them," said Cathy Harrison, a child life specialist. Patients often draw pictures of their families. They might leave themselves out or depict their body floating above. Sometimes, the patient gives himself wings. Such details provide an opening for gentle talk about death.

Two young sisters of a 6-month-old brother with fatal heart disease created a doll and comforter decorated with their handprints as a gift to the baby who died.

Providence Hospice runs grief groups in schools where children draw an outline of a body on a sheet of paper. Everyone writes their feelings on different body parts to help them get in touch with the physical experience of grief.

One colorful picture has the word "stress" between the eyebrows, "blank out silent" on the forehead, "pain" in the middle of a red cracked heart.

A participant once said "I don't feel anything at all in my body."

The others knew what to do. They drew a shield around the whole body with an orange marker.

"Sometimes, when you're grieving, you protect yourself from feeling anything," said Goldsmith.

Through it all, assure children they are not alone in their grief. Other kids have grieved a death and survived. One day, they will be stronger than it's possible to imagine now, strong enough to help another child.

Belated tears

This year — the second after her father's death — the bricks crushing Lorna Manago's emotions started to lift. She still couldn't cry. But she could talk about the death without gasping for breath.

In August, she attended Camp Erin with about 40 other grieving kids.

On the first day, a counselor asked each camper to recall favorite photos of their lost loved one. Right away, Lorna clearly saw her dad. There he was cradling her as a newborn and, again, in a cowboy hat.

"That activity killed me," said Lorna.

Her tears finally started and stayed much of the weekend.

The experience was "like a nasty spider bite," she said. But her mom Donna believes "It was good for her to get in touch with her feelings."

On the last day of camp, Lorna counseled a 16-year-old girl whose brother had died: "You will be able to breathe one day. It's not as far away as you think."

Marsha King: 206-464-2232 or mking@seattletimes.com