Death Studies Young Children's Grief: Parents ...

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Young Children's Grief: Parents' Understanding and Coping a

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Kari E. Bugge , Philip Darbyshire , Eline Grelland Røkholt , Karen Therese Sulheim a

Haugstvedt & Solvi Helseth

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Centre for Health Promotion , Akershus University Hospital , Lørenskog , Norway

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School of Nursing and Midwifery , University of Western Sydney , Sydney , Australia

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Faculty of Health, Institute of Nursing , Oslo and Akershus University College , Oslo , Norway Accepted author version posted online: 14 Jun 2013.Published online: 01 Aug 2013.

To cite this article: Kari E. Bugge , Philip Darbyshire , Eline Grelland Røkholt , Karen Therese Sulheim Haugstvedt & Solvi Helseth (2014) Young Children's Grief: Parents' Understanding and Coping, Death Studies, 38:1, 36-43, DOI: 10.1080/07481187.2012.718037 To link to this article: http://dx.doi.org/10.1080/07481187.2012.718037

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Death Studies, 38: 36–43, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 0748-1187 print=1091-7683 online DOI: 10.1080/07481187.2012.718037

Young Children’s Grief: Parents’ Understanding and Coping Kari E. Bugge Centre for Health Promotion, Akershus University Hospital, Lørenskog, Norway

Downloaded by [Flinders University of South Australia] at 15:44 20 February 2014

Philip Darbyshire School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia

Eline Grelland Røkholt and Karen Therese Sulheim Haugstvedt Centre for Health Promotion, Akershus University Hospital, Lørenskog, Norway

Solvi Helseth Faculty of Health, Institute of Nursing, Oslo and Akershus University College, Oslo, Norway

The grief experiences of young children and the interactional dynamics between parents and children leading to healthy grieving remain comparatively underresearched. This article reports a qualitative evaluation of a Norwegian Bereavement Support Program where 8 parents described their young child’s grief reactions and coping and how these intersected with their own grief. Successful parental coping with their child’s grief involves understanding the child’s genuine concerns following the death and an intricately holistic balance between shielding and including, between informing and frightening, and between creating a new life while cherishing the old.

The death of a parent or sibling is one of the most traumatic and stressful events preschool children experience. Preschool children then depend on their parent(s) to deal with their own and their children’s grief and to establish a healthy new life for the family. Given their emerging verbal capacity, young children’s grief is more often expressed through behavior and bodily expressions and play rather than complex language. It is often difficult for parents, grieving themselves, to notice, understand, and respond appropriately to young children’s grief expressions and responses. Previous research has focused on children’s somatic grief reactions such as headaches, stomach aches, muscle tension, loss of appetite, insomnia, restlessness, Received 20 September 2011; accepted 12 July 2012. This project was funded by The Norwegian Extra Foundation, Health and Rehabilitation. Address correspondence to Kari E. Bugge, Centre for Health Promotion, Akershus University Hospital, PO: 70, N-1478 Lørenskog, Norway. E-mail: [email protected]

and fatigue (Sood, Razdan, Weller, & Weller, 2006). Cognitively, bereaved children may feel alone and different, afraid that they or others may become ill or die, and worry about separation from their remaining parent (Dowdney, 2000; Koehler, 2010). Bereaved children are more likely to exhibit conduct disorders and regress to infantile behavior than controls. Such grief reactions can lead to psychological and behavioral disturbances or complicated grief associated with long-lasting impairment (Melhem, Moritz, Walker, Shear, & Brent, 2007; Prigerson, 2008). The post-death family environment is an important predictor of children’s mental health (Tein, Sandler, Ayers, & Wolchik, 2006) and depressed surviving parents are the most powerful predictor of disturbances in preschool children’s behavior (Wolchik, Tein, Sandler, & Ayers, 2006). Bereaved children have new needs in their grief and require their parent’s help to recover and develop (Schmiege, Khoo, Sandler, Ayers, & Wolchik, 2006).


YOUNG CHILDREN’S GRIEF

Grieving the loss of a spouse or a child affects parents in many ways, including intense emotional pain, lack of energy, lower stress tolerance, anger, and anxiety (Aho, Tarkka, Astedt-Kurki, & Kaunonen, 2006; Arnold, Gemma, & Cushman, 2005). Surviving caregivers report increased rates of depression, anxiety, post traumatic stress syndrome (PTSD) suicidal ideation, and functional impairment that affects their children (Melhem, Walker, Moritz, & Brent, 2008). Grieving parents face significant challenges in handling their children’s reactions as the child needs a loving, involved parent as a secure base during the preschool period (Moss, Cyr, Bureau, Tarabulsy, & DuboisComtois, 2005). For parents to meet young children’s needs while grieving they have to understand both what their child is trying to express and what information, support, and connectedness are important for bereaved children in coping with the situation. We know comparatively little about how parents manage these needs while they themselves are grieving. The impetus for this study arose from the work of our university hospital-based Bereavement Support Program Approach with children and families, where we focus on the grieving process and on preventive approaches to assisting family coping (Sandler et al., 2010). This program aims to prevent complicated grief, provide support and knowledge in the grieving process, and intervene early if the child or family’s grieving and everyday coping cause significant concern. Our program for preschool children involves parent and family meetings, a Bereavement Support Program for parenting in grief, and Bereavement Support Groups for preschoolers. Parents participating in this study attended the 10 meetings of our Bereavement Support Program. We use preschool and young child in this article to reflect the school commencement age in Norway where children start elementary or primary school at age 6. In our service we focus two central components that are central to a child’s coping (Libo & Griffith, 1996): belonging and competence. Belonging includes confidence, predictability, confirmation, and association within the family. Competence includes knowledge about the present situation, helpfulness and utility, being able to give and accept responsibility, and being able to meet and cope with hardship. Parents help their dependent young children encode and contextualize shared experiences by talking about them and exchanging thoughts and feelings. In co-constructing memories with their children, parents help them to develop narrative coherence (Kaplow, Saxe, Putnam, Pynoos, & Lieberman, 2006). In this study we sought insight into parents’ understanding of their child’s expressions of grief and into how they supported and were connected in their child’s coping.

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METHOD The study took a qualitative, phenomenological approach that values lived experience and appreciates the necessity of seeking the expressed perspectives, insights, and articulated accounts of those who use our bereavement services, in this case, parents themselves (Kvale & Brinkmann, 2009). Participants Of 12 parents who had recently used bereavement services, eight parents (five mothers, three fathers of eight young children (four girls and four boys) gave their written consent to participate after receiving an information letter about the research. Deaths included three young children and four spouses who died from different causes. The mean age of parents was 37 years at the time of the interview, and for children mean age was 4 years when death occurred and 5.4 years at the time of the interview. Procedure Health services ethics committees approved the study. Parental in-depth interviews comprised questions about their children’s grief reactions and coping, the parents’ own grief and its perceived connection to the child’s reactions and coping. Our interview guide, drawn from current literature and our program experience, raised issues such as noticing changes in the child, such as their reactions, behaviors, and attitude; parents’ understandings of support regarding the child’s grief; parents’ own grief reactions; parents’ concerns about the child’s current and future behavior and development; and child–parent interplay and activity changes post-loss. Each interview lasted for approximately 1 hr. Such interviews are guided conversations based on ‘‘focused but roomy’’ (Darbyshire, 2004, p. 19) questions that keep the interview on track while allowing parents to raise or explore other issues related to their or their child’s bereavement. The interviews were conducted in a quiet hospital room while the parent’s young child was involved in a play session in a nearby room. Analysis Kari E. Bugge conducted, recorded, and transcribed interviews and analyzed data using Kvale and Brinkmann’s (2009) three-step analytic approach. Following close reading of each interview to ascertain its essence and sense, Step 1 condensed meaning, conceptualizing, and organizing the interview texts into central themes using the participants’ own words. In Step 2, the researchers examined

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all participant accounts, determining common themes using everyday and phenomenological understanding to categorize meaning. Step 3 related theoretical propositions from our framework of coping and co-construction with parents to undertake final interpretation of the meaning of categorized text. At each stage of analysis, all members of the research team discussed, debated and refined themes.


RESULTS Four overall themes emerged: (a) children’s expressions of grief, (b) parents’ own grief affecting the child, (c) parents’ and children’s mirrored moods and needs, and (d) parents’ acknowledgement and support for children’s efforts in coping. Children’s Expressions of Grief Parents described children’s problems with falling asleep, waking during the night, being unable to sleep in their own beds, and having nightmares: She has always been difficult to get to bed, but now it is extreme. We [her mother or I] sit beside her bed, read for her and sing and after we have left the room, there is a lot of noise and she is still up for a long time. She also wakes in the night, 2 or 3 times.

Most parents recalled their child being worried or fearful about illness and other potential deaths and trying, in a childlike way, to intervene (e.g., by scanning their parent’s face for signs of illness or by checking their baby sibling for any signs): She had a doctor play set and used the stethoscope very often on us, herself and on her brother when he was born. When she wakes in the night, she walks into his room, stops in front of his bed and lays her hand on his forehead. If he is warm, she will go back to her own bed. [Her other brother died of a heart failure.]

Another parent described her daughter’s fear of dying from a tumor: This summer, she didn’t dare to eat, because she was afraid of getting a tumor in her stomach. That is the way she thinks. If I eat, my stomach will grow and then it is a tumor. [Her sister died of an abdominal tumor.]

Any changes that could be associated with the death made the child feel unsafe. One child revealed her extreme fear when her mother had to go to hospital; ‘‘People die in hospital,’’ she told her father. Parents also recounted their child’s anxiety that their remaining parent would die or that they themselves would die. One

parent’s young son said, ‘‘When I get older and become a father, I will die.’’ He also asked, ‘‘When are you going to die, Mum?’’ Some parents ‘‘normalized’’ the child’s reactions: ‘‘My son does stutter, but I do not know if he would be like that even if his father had not died.’’ Some parents found their child’s reactions to be erratic, confusing, and painful to witness, especially when parents did not know how to help: Her level of aggression, it goes from calm and quiet to explosive in a second. I can’t see anything that ‘‘triggers’’ it. She is so angry, screaming, crying and hitting. It is the same when she is happy. She has no control. [She has] a lot of pain in the stomach. She is eating very little. This started after her brother died.

All parents reported that their child liked to see pictures and videos of the deceased: ‘‘He loves to see videos of his father, of him and his father together playing. He can’t remember it all, so he has put some fantasy into what he and his father did together.’’ Parents described how their children liked to talk about the deceased and to visit the graveyard: ‘‘She misses her mother and will ask me if we can visit the graveyard. She often brings something from her daily life or a memory from a holiday to her mother’s grave. It is very helpful to her.’’ Parents also explained how their child would mention the dead parent or sibling in everyday conversation or when meeting new people: ‘‘After her little brother was born, we met a woman who said to my daughter ‘what a beautiful brother you have.’ My daughter replied, ‘I have another one too.’ ’’ All parents whose child died described their children ‘‘keeping their dead sibling alive.’’ Some children used the dead sibling’s name during play, while others had a new invisible friend: ‘‘In her play, she walks him in the pram, is in hospital with him, and gives him food and so on. She has a doll that is the dead brother.’’ Parents also described how the child kept their dead sibling alive in their memory: ‘‘She was talking about who to invite to her birthday party, and she wanted to invite her dead sister as well. She also wanted to celebrate her dead sister’s birthday, and we did. She put the 8 candles on the cake.’’

Parents’ Own Grief Affecting the Child Parents described the struggle to establish a new family life without the deceased spouse or child. Parents had to establish security and predictability for their children while struggling with their own grief. Parents tried their best but found it hard to meet all the challenges: ‘‘I took a year off from work after my wife died. I had to establish



a new foundation for my family. I had to have time for grieving, both for me and my children.’’ Creating a new life post-death was not easy. One parent’s story will resonate with many: ‘‘Now, a year after he died, I have trouble. I can’t see any future. I have done the right things, moved, changed my job, but it has not helped. My life is not good and I do not dare to have fun, because it is so hard to get back to my daily life.’’ Parents had to find new ways to do previously ‘‘ordinary’’ things such as celebrate birthdays or have holidays: ‘‘Both I and my children were curious to see how life would be without their father. How should we celebrate birthdays, did we have to move to a cheaper house, and I think they wondered if I could manage all alone.’’ Parents with several children had less energy following the death, and often felt it impossible to respond to their children’s needs without being exhausted, physically and mentally. You try as best you can to be a good parent all the time. You do not want your children to suffer more than they already have done. I’m absolutely tired out. I have never been this tired before. There is no energy left. It is even hard to brush my teeth.

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consciousness of her and all the small things in her life.’’ Parents reported that they and their young child needed more physical contact and closeness after the loss and that sleeping together, sitting closer and giving each other hugs filled both parents’ and children’s needs: ‘‘Physically he [my son] has become closer. He gives me physical contact, puts his arms around me. It is good for me to have someone that gives me physical contact.’’ Parents noted that their preschool children were not merely demanding recipients of care and support but were valuable sources of support and well-being. Parents often commented that their children ‘‘helped them through it’’ at these times, both practically and emotionally and they genuinely appreciated their children’s care and concern. He [my son] was to go with my parents to a cabin, but he said he did not want to go, because I would be left alone at home. He does not want me to sit alone and he is right. He is the one driving me forward. It is one of the things I have noticed. The boys (5 and 11 years old) take responsibility, they help me more and they are more caring for each other and me. They work together to help me.

Parents found it hard to additionally fill the role of the dead parent because they lacked energy to take their child to activities, exacerbating their sense of loss. As one mother explained, ‘‘My husband did typical boys’ activities with him, and my boy misses it. It is not the same with me. I have no time or energy for that. I think this will influence his life.’’ Many parents experienced tension between being a ‘‘good parent’’ and actively grieving, becoming angry, anxious, upset and tearful: ‘‘I get angry with him [her son], and tell him I will leave him if he doesn’t stop. He is afraid of my anger. But of course I will never leave him.’’

Parents often described mirrored moods. For example, parents recalled their child’s intense anger but also acknowledged that the entire family had a lower level of tolerance for each other and experienced similar angers. Parents reported that their child’s anger often ended with the ‘‘release’’ of crying and then talking about the loss:

Parents’ and Children’s Mirrored Moods and Needs

Parents described a synergistic connectedness in grief reactions. If the parent had a bad day, the child often had a bad day.

Parents described children’s coping approaches they found easy to understand and support, especially where both parent and child experienced similar reactions and fulfilled each other’s needs. Parents also described children’s reactions that seemed comprehendible but were difficult to support. Here, parents may have experienced similar reactions to their child but struggled to cope with these in both themselves and their child. Parents described how the death had strengthened family bonds and connections, making them even more appreciative of their child(ren) and of the little things in life. As these parents commented: ‘‘It has been a lot of love. It has affected the children as well. We value our family and take life more seriously.’’ ‘‘I’m grateful that I have her [daughter]. I see her as a gift. I have a higher

In the family, we have lower tolerance than before. We are a lot angrier. We all get irritated. My child becomes extremely angry and slams the door to his room and then he starts to cry louder and louder until I walk to his room. In that situation, he often tells me it is unfair that he has lost his father.

After he had been through the bereavement support groups we had a meeting where he showed me what he had done. In one of his drawings he had told the group leader and she had scribed for him; ‘‘If my mother is happy, I’m happy. If my mother is sad, I’m sad.’’ I do understand it, but it was hard to read.

Some parents explained that they were restless and had trouble concentrating and noticed that their children had similar problems: I’m very restless, and my children are the same. In the kindergarten, they cannot play with the same toys for more than a short time before they start something

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new. I’m restless and have trouble concentrating. It is the same with my eldest daughter as well.


Parents found it difficult to manage children’s frequent sleep problems following the death. One parent called this ‘‘the new nightlife.’’ Most parents had sleeping problems themselves and some told of needing to have the child close at night. As this parent commented: ‘‘I did not want to be alone in the evening, so I let my son fall asleep on the sofa and then carried him to my bed when I go to sleep.’’ Parents’ Acknowledgement and Support for Children’s Efforts in Coping Most parents described a range of tough questions that their young children asked as they tried to understand what had happened to their loved one and to cope with a new present that had been indelibly touched by death. Parents recalled how their children talked and thought about what it means to be dead and wondered where the dead parent or sibling had gone. These are often the questions that parents readily anticipate yet find difficult to answer in ways that are truthful and yet meaningful for a young child. Several parents used heaven and angels. She asked a lot about where her dead brother was. We used the metaphor of heaven; that he was together with the angels, watching over us. This summer [2 years after her brother died], her grandmother died, and she was relieved because her brother did not have to be alone in heaven anymore.

Another parent highlighted young children’s literal understandings of death. In the hospital, after her sister died, she was walking around her sister’s deathbed. She wanted to see her [angel’s] wings. She gave her dead sister a hug and felt behind her back to touch the wings. She was satisfied, I think she could feel them [her scapulae] and they had started to grow.

All parents reported that their children were eager to remember the dead sibling or parent and the fun and good times they had together. Some children were concerned that their parent would underestimate their grief because they were so young when the parent or sibling died. One parent explained, ‘‘She tells me all the time that she was not a baby when her sister lived. She does remember. She often looks at pictures of herself and her sister and laughs.’’ Some parents believed their child was ‘‘too young to remember’’ and assumed that because the child did not ask direct questions about the death, that they were unaware of or not thinking about it: ‘‘It [the illness] lasted only for a week. She had one of us parents at home with

her all the time. I don’t think she recognized the severity of the situation. She did not understand what was happening. I feel sorry for her.’’ Trying to constantly say and do the right thing by their children while judging how to find a balance between informing and overburdening a young child was an ongoing strain. Most had talked with their child throughout the process of the illness and death: We tried to inform him all the time. All we knew about treatment, tests and changes. We did not hold back information and we did answer any questions she had regarding her mother’s illness. It was quite brutal. Her hope that her mother would survive, I took it away from her by telling her the reality.

Some parents however, had not told their children about the severity of the situation: My husband was packing his things before going to the hospital and our son came in and asked, ‘‘Are you going to die now, Daddy?’’ We had not told him, because I didn’t know how to tell him. It was during his own birthday party that some of his cousins had told him that his father would die and where his grave would be and the whole story. It was painful to listen to him, but I was glad it was said. I confirmed his story.

Many parents reported that their child was present during the illness period and saw the loved one after death. Some reported that the child was present at the death scene. Some children kept a distance between themselves and the ill family member because of how they looked: ‘‘The children did not want to look at him, and I let them be.’’ ‘‘She was sitting on my lap when her brother died. She was scared, mostly because we cried.’’ Most parents thought it would be easier for the child in the future if they saw what happened with their dead family member. One parent recalled, ‘‘My son did see and experience everything around [the] death. I thought it would make it easier for him because it is how it is. You cannot cover it over.’’ Most difficult for parents were children’s responses that they could not understand or frame as possible grief reactions and their consequent feelings of inability to help their child.

DISCUSSION Post-death family environment and parental help to recover and develop are key factors necessary for a healthy grieving process in children (Schmiege et al., 2006). Present exploration of parental perceptions and coping with their preschool child’s grief extends previous work on both children’s expressions of grief



and their coping efforts, parental grief and its close connectedness with their child’s, and parents’ ability to acknowledge and support their child’s ways of coping. Results from this study extend awareness of the term positive parenting that is seen as a protective resource for bereaved children (Haine, Wolchik, Sandler, Millsap, & Ayers, 2006). Identifying the grieving young child’s needs while improving understanding of how parents struggle to meet these needs can help us in creating a better bereavement service both for young children themselves and for their parents by helping parents navigate the path between experiencing their own grief and doing the best for their grieving child while establishing a healthy new family life. Preschool children in our study expressed and coped with their grief both in positive ways but also in ways that their parents found difficult to understand or support and which had the potential to create long-lasting disturbances for the child. These examples of what Moreland and Dumas (2008) would class as asocial or antisocial coping were being emotionally out of control, developing eating problems, showing sleep disturbances, brooding over the death, being restless and overactive, and taking on too much responsibility for the well-being of parents and siblings. Children’s expressions of grief as highlighted in this study provide important information about the child’s grieving process. Children who had witnessed an illness or death were afraid that they themselves would become ill or die, or that other family member would die in the same way as the deceased. Trying to identify each child’s stressors or anxieties is challenging but important if we are to help the grieving preschooler. Failing this, the child may continue to overactively avoid painful memories and intrusive traumatic experiences, suppressing their own needs or perhaps becoming aggressive or withdrawn (Kaplow et al., 2006). Parents’ reflections on their preschool children’s grief reactions indicate that preschool children understand more about death and dying and often respond more meaningfully than traditional theories of child development may have suggested is possible (Corr & Balk, 2010). This study shows that preschool children actively and purposefully attempt to cope with grief. They seek security and care from parents while helping, supporting, and trying to stabilize their family. Such care, concern, and helpfulness supports previous work, for example, Thastrum et al.’s (2008) study of children aged 6–20 coping when a parent has cancer. Children used play activities, and talked about and looked at photos and films to create and maintain memories of the deceased. This process helps them understand the loss and maintain the relationship. Benchley (1996) remarked that ‘‘death ends only a life, not a relationship,’’ echoing the increased attention in the bereavement

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literature to the function of a continuing bond in relation to coping (Field, Gao, & Paderna, 2005). These young children were helping create a community of memory within the family around the deceased sibling or parent to show that they still ‘‘belonged’’ and that also helped their parents in creating their ‘‘new life.’’ These factors are important for resilience in preschool children’s coping with loss. To improve the child’s coping with grief, information is crucial. The way most of the young children in our study had been informed about illness, death, and dying seemed to have increased their pondering. Most parents had given their children concrete information during the illness and death but had relied on metaphors of heaven and angels to explain being dead. Adults are perhaps overly reliant on stage theories of development and often believe that preschoolers have little understanding of death and loss (Pearlman, Schwalbe, & Cloitre, 2010). Preschool children do not understand loss and death in the same way as adults do because they have limited knowledge and life experiences, but they are clearly aware of what is happening in their immediate world (Corr & Balk, 2010). Preschool children can certainly be literal in their understanding (Mendhekar & Lohia, 2010), which suggests that they need to be told directly about the permanence of death and that the loved one will not physically return. Emotionally, they will remain connected and hold their dead loved one close in their memories and even in their everyday experience and play. This is not pathological, but healthy. Parents experienced the greatest difficulty in coping with their young child when they could not understand asocial responses and were unsure whether the behaviors they observed were due to the child’s age, developmental stage, misbehavior, illness, or grief. Parents showed how understanding their child’s reactions did not always translate into successful coping. This has clear implications for the delivery of bereavement support programs. Parents’ desire to do the best for their child required an empathetic understanding of what was happening with their child and knowledge of how best to respond. Parents were, however, often relatively unaware of how their own moods, behaviors, and emotions affected their preschool child. Parents who had experienced the long-lasting illness of a spouse or child were exhausted when death came, lacking the energy to maintain secure routines at home and feeling depressed and overwhelmed by everyday tasks. For example, it is understandable that parents found sleep disturbances in their children both easy to understand yet difficult to manage, because grieving parents themselves frequently experience similar intractable problems (Cerel, Fristad, Verducci, Weller, & Weller, 2006). Parents were aware of the contemporary concerns around critical periods in early childhood and the popular conception that adverse early experiences could have


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serious adverse effects in later life. This added to parents’ worries around the correctness of their reactions and handling of their child’s grief as they sought to be ‘‘good enough’’ grieving parents. Some parents excelled in knowing what was best for their children, when to shield the child from unhelpful exposure, and how to reassure them. Others seemed unable to recognize what was frightening for the child during illness periods and after the death. As parents were struggling with their own grief while also trying to be ‘‘a good enough grieving parent,’’ it is not difficult to appreciate the challenges they faced in creating a new life with their young child at this time. Our study findings indicates that parental coping with their child’s grief involves understanding the child’s genuine concerns following the death and an intricately holistic balance between shielding and including, between informing and frightening, and between creating a new life while cherishing the old. Given these study findings, we suggest that parents can be supported in the following ways. Parents need help to understand the important elements of coping, belonging, and competence, and how these influence their young child’s reactions. This will help parents to present age-appropriate information and remain attuned and attached to their young child. Assessment interviews with parents are valuable where these focus on the relationship between the deceased and the child, the illness and death period and the child’s reactions and their own reactions and coping following the death. Parents can be helped to remember and cope with both positive and negative memories, to deal with anxiety and fear and to help the child relax and feel safe and secure. It is also supportive for parents to see the connection between a preschool child’s moods, behaviors, and reactions and those of the parent, especially when these are expressed differently. Parents benefit from support that helps them to re-establish a healthy family life and that enables them and their children to create communities of memory around the deceased child or spouse that connect both their past and future. This is a small-scale, qualitative study undertaken with parents from one program. Valuable future research foci would examine parents’ grief reactions, knowledge, skills, and embodied understandings, particularly in relation to grief in young children. Also valuable would be an examination of the parental factors that can lead to complicated grief and disturbed development or=and to resilience and healthy coping in the preschool child. REFERENCES Aho, A. L., Tarkka, M. T., Astedt-Kurki, P., & Kaunonen, M. (2006). Fathers’ grief after the death of a child. Issues in Mental Health Nursing, 27, 647–663. doi: 10.1080=01612840600643008

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