Longterm reactions

Although many of the reactions that have been described so far will subside during the first weeks and months after the loss, a sense ofloss, longing and sadness can last for years, and to some extent for the rest of the child's life. This does not mean that the reactions will continue to be equally strong, but they can stay in the background of the child's life, especially if they have lost someone very close to them.

A very young child notices loss mostly through the changes in his daily routines; it is no longer Mummy who reads to him in the evening, it is Auntie who takes him to kindergarten, and so on:

A six-year-old child would cry terribly every evening. She said that she missed her brother so much. He used to come in and give her a hug, but now he couldn't any more. She also thought about how he would have helped her with her homework when she started school, and he wouldn't be able to do that either.

There may be many things in children's everyday life that remind them about the person who is no longer there. These reminders can, with no warning, suddenly fill them with sadness and they may cry without always knowing why. Adults can help children to put words to this sense of loss and can comfort them when they are very upset.

If the death or loss happened suddenly, unexpectedly or in a particularly traumatic way, the event can potentially influence different aspects of the child's development. It is well known that traumatic events of this nature can alter a child's character and the shaping of their personality, their readiness to meet the future (reduced belief in the future), their ability to regulate strong feelings, their choice of career and their relationships with others (fear of losing those who are dear to them). As long as the children have caring adults and good care, there is little reason to expect that they will grow up with a greater risk of developing long-term psychological problems. It should be noted, however, that there is an increased risk of developing depression in children who lose parents in childhood.

Among the risk factors which increase the likelihood ofa child having problems are:

• The child witnessed what happened (death, or violence before a divorce).

• The parents or the surviving parent develop or are already struggling with major problems (depression, post-traumatic disturbances and so on).

• The child experienced that he or she was in great danger.

• The child perceives strong reactions in the parent(s) without them being explained.

• The home circumstances are very negative for the child, with little warmth and friendly discipline (alcoholism, neglect).

• There is a high degree of denial of the events in the home, and a complete absence of open and direct talk about what has happened.

• There is development of serious behavioural disturbances or total change of personality.

During the preschool age, children learn to differentiate between different feeling states, something that continues during the primary school age, culminating in a deeper understanding of the origin of feelings and their consequences in adolescence. Traumatic situations will influence the tolerance for experiencing and differentiating feelings, interfering with the ability to feel compassion or empathy and expressing and tolerating strong feelings. Fear and anxiety can also lead to less exploration away from their security base (usually the mother or father) and children can become anxiously attached, depending on the reliability of their parents. Learning to regulate feelings is totally dependent on adult care-takers. A child initiates interaction sequences, but adults must be sensitive and answer the child's signals for him or her to make use ofthis contact in their development and learning.

Small children are protected by their lack of ability to see the long-term consequences ofa traumatic situation, and they understand danger to a lesser degree. As long as parents keep calm, young children can remain unconcerned. At the same time young children have less experience in interpreting an event, greater inclination for magical thinking and misunderstanding, and they are, to a lesser extent, able to reverse what happened in fantasy than older children. In addition, it is the younger children who are least included in conversations, who receive the least concrete information which can counteract fantasies, and are most easily overlooked following traumatic events. Such conditions makes it important to guide parents sensitively on how best to help their children.

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