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Helping Children Navigate Grief and Loss

Dr. Raunak Khisty shares how to identify signs of grief in children, how to help children learn and manage grief, and when you should seek medical attention if your child is having a hard time processing grief.
Helping Children Navigate Grief and Loss
Raunak Khisty, MD
Dr. Khisty completed his Bachelor of Medicine and Bachelor of Surgery at the Krishna Institute of Medical Sciences in Karad, India. He went on to receive his Masters of Public Health in Epidemiology from The University of Texas Health Science Center School of Public Health located in Houston, TX. Dr. Khisty also completed a Psychiatry Residency and a Child and Adolescent Psychiatry Fellowship at Wake Forest University in Winston-Salem, NC. Dr Khisty is board certified in general psychiatry by the American Board of Psychiatry and Neurology. He is a member of several professional associations. As a Child and Adolescent Psychiatric Hospitalist, Dr. Khisty sees patients at Riverside Medical Center.

Kaleb Miller (Host):   Hello and thank you for joining us at the Riverside Healthcare Well Within Reach podcast series. My name is Kaleb Miller and I'm going to be your host today. Today we’re going to be talking about something that is really important, that is grief, specifically grief within children, adolescents. Today I'm going to be joined by Dr. Raunak Khisty. Dr. Khisty is a child and adolescent psychiatrist with Riverside Behavioral Medicine. We’re going to be talking a little bit today about navigating grief or loss with children. Dr. Khisty, thanks for joining me today.

Raunak Khisty, MD, M.P.H. (Guest):   Thank you for having me Kaleb.

Host:   So Dr. Khisty, why don’t you tell us a little bit about yourself and then your role as a child and adolescent psychiatrist here at Riverside Behavioral Medicine.

Dr. Khisty:   Sure. So I was trained as a psychiatrist. I did my residency in North Carolina. I went to medication school in India, actually, and then I also did a fellowship in child and adolescent psychiatry in North Carolina as well. I'm currently working at Riverside Medical Center on our inpatient child and adolescent units as psychiatry hospitalist.

Host:   Great. So you are, of course, seeing a wide variety of cases within children in our community. So obviously grief is something that all of us experience at some point in our life, grief and loss. We have to really manage this and walk through it, but children process this much differently than we do as adults. So what are some of the signs that parents or loved ones should be aware of when a child is experiencing grief or loss?

Dr. Khisty:   So I think it really depends on the age of the child. Because preschool aged children, school aged children, teenagers, they all respond differently to grief or to the death of a loved one or even a family pet. So for children who are really, really young, they may not be able to grasp the concept of death to start with, right. Around the time of eight years old is when children truly start understanding what death actually means or the finality of death, so to speak. Children below eight generally sometimes think, “Oh, grandpa went to heaven, but grandpa can come back or grandpa can give me a call.” So the concept of death has not finalized. In older children, that’s not the case. They know exactly what's going on.  They know that death is final. So they deal with grief a little bit more differently.

Host:   Right. So do you see any signs or unhealthy coping mechanisms that parents can recognize in their children that may be a sign of, “Hey, maybe there's something going on here?”

Dr. Khisty:   Absolutely. Especially after a person dies, you will see a lot of anger in children. Anger is okay. However, physical anger, I think, is where things get a little bit more dicey. Physical acting out, getting aggressive at school, getting aggressive at home, throwing things, breaking things, definitely unhealthy coping mechanisms. The other thing we also see is self-harming behaviors like cutting or harming oneself, voicing thoughts of suicide, voicing wishes to be dead, especially voicing wishes to be dead so that they can be with the deceased loved one. I think those are pretty big warning signs and unhealthy mechanisms really.

Host:   Yeah. So what are some of those main differences in the way maybe a child is going to process grief or loss compared to an adult? Then within those children, do you see a difference in the age groups of children? So obviously a toddler or a young child is going to process things differently than maybe a preteen or a teenager.

Dr. Khisty:   Absolutely. I think children between five to nine, they really are like preschool—Actually, let’s start with the preschool children. So preschool children really see death as being temporary or almost reversible. This kind of belief is even reinforced by cartoons, right. If you watch cartoon characters, they die and then they come back to life. So preschool children really don’t have an understanding or how death can be reversible. So for them, for the preschool children, that’s how they observe death as because it’s reversible, it’s temporary. They may not understand what's actually happened. However, school aged children start thinking about death more like adults. The younger kids, almost like between five to nine years old, school aged children will understand death. However, they think that it’s not going to going to happen to them or happen to anybody that they know. So for them, they handle grief a little bit more differently. A teenager will respond very differently because they completely understand what death means. Teenagers generally will respond with anger and aggression or even sadness.

Host:   Right. So if I'm a parent of a child of really any age and I want to help my child get through this, how can a parent or loved one help with a child navigating grief or loss or experiencing this?

Dr. Khisty:   Absolutely. I think that’s a very good question because I think parents always struggle with this question about how do we handle children who are grieving. A child who is frightened of attending a funeral should not be forced to go. However, they should have a plan to honor the loved one in some way, such as lighting a candle, saying a prayer, making a scrapbook, reviewing photographs, telling stories so that you can help the child process their grief. They should be allowed to express feelings about their grief or loss in their own way. However, what happens a lot of times is after a loved one dies, their parents are also grieving, and they may not be available to provide that emotional support. In these situations, some other family member or friend who is close to the family can take on that role. Sometimes children do want to go to the funeral. What happens then? Because the parents themselves are grieving, funerals are very emotionally charged. So what we generally recommend is a family friend or a parent be with the child and walk them through what's happening and what's going to happen next in the funeral ceremony so to speak. If the child at any point wants to leave, I think the person should escort them out so that they don’t get more traumatized.

Host:   Yeah. You make a great point. Often when a child is experiencing grief, the parents or loved ones around them are also going to be processing through it themselves. So that’s a great point. So kind of moving forward from that, at what point do you as a parent or loved one say, “Maybe it’s time to seek professional help navigating this grief?”

Dr. Khisty:   Absolutely. I think when it’s an extended period of depression or when a child starts losing interest in things that they used to like to do, struggle with falling asleep, staying asleep, prolonged fear of being alone. A lot of times children will be like, “Oh my god, where’s my mom and dad? Are they dead like the other person died?” Acting much younger than their age because that will happen a lot or excessively imitating the dead person, believing that they're talking or seeing the dead person for an extended period of time, then repeated statements of wanting to join the dead person. I mean those are big warning signs. Now, to clarify, immediately after the death of a person, some of these things may be normal. It is normal to think, “Oh, I just saw somebody who looked like the dead person.” Or, “Oh, I hear their voice.” That is normal immediately after death. However, when it prolongs approximately two months or beyond, that’s when we want to do something about it.

Host:   Right. That’s about the time where someone would say maybe it’s time to give a clinician a call. So what kind of therapies or treatments or techniques can a clinician do to help relieve some of the burdens of grief for children?

Dr. Khisty:   So grief counselling is definitely strongly recommended. At Riverside Medical Center, we have our hospice program which also offers grief counselling not only to adults but also to children. I think that can be a very healthy way of processing your grief. I think children who also benefit from getting back into their routine, seeing that their parents are also getting back to their routines I think really helps. However, in certain situations when grief turns into depression, that’s when we also want to think about medication options.

Host:   Yeah. So it can turn into a more serious depression for these kids, but why is it so important to work through a child’s grief rather than ignoring it or just simply hoping it will go away over time?

Dr. Khisty:   Right. Because I think long term denial of death or avoidance of grief can be emotionally very unhealthy. Not only for our kids, but even for adults. It can later on lead to more severe problems related to not only depression but also mood instability and oppositional defined aggressive behaviors.

Host:   Yeah. So what kind of resources are there available maybe to our listeners who think maybe that this is something that their children are experiencing. What would you recommend?

Dr. Khisty:   So if your child is experiencing grief or is feeling depressed, I think the first and foremost thing to do is secure an appointment with our psychiatric specialist here are Riverside Medical Center. We also have a partial hospitalization program where the child comes in during the day during school hours for treatment and then they go back home. I think that’s a very good avenue as well. However, at any point if your child starts having thoughts of suicide, wanting to kill themselves, wanting to harm others, that’s when you want to bring them to the emergency room, and we may have to consider hospitalization at that point.

Host:   I know we also at Riverside Behavioral Medicine has a helpline as well that people can call. Do you have that number that parents can use?

Dr. Khisty:   Absolutely. The helpline is 844-442-2551. That’s our behavioral medicine helpline. Again, that number’s 844-442-2551.

Host:   Yeah. That’s a great tool to have on hand if that’s something that parents think that they would need. So Dr. Khisty, is there anything else you’d like to add as we wrap up our time together about grief and navigating it with children?

Dr. Khisty:   I think it is essential to validate their grief, especially after a person dies. Also, it is important to remember that children may temporarily become more infantile, need more attention. They may start wetting themselves at bedtime. A lot of times children, younger children, will frequently believe that they are the cause of somebody’s death. A young child may believe that a parent or a grandparent or a brother or a sister died because they had once wished bad on that person when they were angry. So I think that it’s important to realize that children respond differently to grief than adults do.

Host:   Absolutely. Dr. Khisty, thanks again for joining us today. Again, that behavioral medicine helpline for Riverside is 844-442-2551. Thanks for listening and joining with us today and we’ll see you next time.