Grade-Schoolers Their Lives Expand : Distressing Times Coping with death and depression (part 1)

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Q: How can I tell if my daughter is depressed and what can I do?
A: It can be difficult to know how seriously to take your child’s ups and downs. Get too involved when there is no need, and you interfere with her learning to handle difficult feelings; stay away when it’s serious and she may feel abandoned. Depression can show through a variety of behaviors and emotions, such as an increase in sadness or irritability and loss of interest in things such as friendships, hobbies, sports, or schoolwork. Physical complaints like stomachache, tiredness, or headache can also be an indicator of emotional difficulties. If you notice some or all of these signs for two weeks or more, seek help from a health professional, who may recommend specialist help. Your support at home plays a major part in your child’s recovery. Set aside extra time to talk together, and, when she shares her worries, take them seriously even if they seem out of proportion. Give your child support to do things she has enjoyed in the past. For example, run her a bubble bath, spend time cuddled up watching a funny TV show together, or have a favorite friend or relative drop in for just a few minutes to encourage her to socialize. These small pleasures can gradually lift her mood.

Draw your child’s attention to her successes. For example, comments such as, “Did you notice how you finished that puzzle so quickly today” help her think in the positive. Support your child to stick to her usual routine: Regular everyday tasks divide the day into small manageable periods, whereas unstructured time can seem impossible to get through. Going to school, although difficult, usually works well to keep up her learning and friendships.

Keep monitoring her behavior and emotions, and go to your doctor if things do not improve.

Q: How do I choose a therapist?
A: Make your choice of therapy and therapist carefully. Ask for recommendations from your doctor or through friends, and check the credentials of the therapist you choose.

Ask what training the therapist has undertaken. Some professional titles are not regulated, meaning they can be used with little or no training, so do check the qualifications of the therapist you choose. Check that the therapist is licensed to practice. Like anyone working with children, your therapist should have an up-to-date criminal records check. Therapists should also be registered with the professional body responsible for their work. Ask for details of the approach they will use, how effective it is, and how long therapy is expected to take. Discuss the limits of confidentiality. Therapists will not share the content of your child’s therapy with you but you should expect them to tell you if your child is at risk of harming herself or others.

Whatever therapy your child receives, your support at home will be vital to its success. Read up on the difficulty your child is experiencing so you are aware of what she’s going through and anything that might help or hinder her recovery. Obtain specific advice from her therapist as to how you can support her. This may involve changes in how you relate to each other or specific homework with your child to back up what she’s doing in therapy. Ask how much she wishes siblings or relatives to know about the difficulty and respect as far as possible her right to keep things confidential. Avoid grilling her about her therapy sessions. Pressure to tell you about them can give her a feeling that they’re not private, and she may disclose less to her therapist as a result.

Q: My child keeps asking me if I’m going to die. Might it be because her aunt passed away?
A: Loss of a loved one can raise anxieties for your child about your mortality. Do bring up this topic yourself if you think your child is too anxious to ask. Avoid denying the problem: Her fears about your mortality are first and foremost about her own well-being. Much as we want to reassure our kids (and ourselves) that we’ll be around for a very long time, no one has a crystal ball. Thus, the first best answer to your daughter’s fears is, “Sweetie, we will make sure that you are always well taken care of, no matter what.” If she persists asking about your mortality, best to get at the feeling that she’s expressing (“You sound pretty scared that I won’t be there for you”) before tackling the harsh realities of death. When your child is involved in ceremonies like funerals and memorials, they take part in the grieving process and can show their feelings just as you do. A small number of children do not resolve their grief without help. If initial distress is maintained, or a child has emotional difficulties that interfere with her life, therapy, usually involving the family, is recommended.
Q: I think my child is having night terrors. What are the signs?
A: During a night terror your child may thrash around and call out for help in his sleep. They tend to occur around the same time every night, usually before midnight if your child goes to bed around 7:00 pm. This is more frightening for you than for your child, who will often have no memory of the event. It will not help to wake him, and he will usually settle down within 10 minutes. Because sleepwalking can occur, its important to take precautions to avoid your child falling or leaving the house. A gate at the stairs or a deadbolt on the front door may be sufficient. Night terrors are not a sign of psychological distress or upsetting life events. They are a physical fear reaction caused by arousal of the central nervous system. Most children grow out of them by adolescence, but you can step in to reduce them if they are frequent and disruptive.

The solution to this problem begins with finding out exactly when the terror happens each night. Stay awake to observe, and make a note of the exact time he starts to have the night terror each night for a week so that you can see the pattern clearly. The next step is to wake your child about 15 minutes before his night terror would usually start, and keep him awake for 15 minutes. This may not be easy when your child is in a deep sleep, but it is necessary in order to break the pattern. If this is not effective within a week, seek help from your pediatrician.

Death of a pet Talking about big issues

When our beloved cat, Bubbles, died recently I wasn’t prepared for how hard my little girl Chloe would take it. She was distraught. The only way to take the edge off her feelings was to treat Bubbles to a proper burial. We wrapped her up carefully in a towel and found a box for her, buried her in the yard, and I helped Chloe plant a little bush over the top to mark the spot. We talked about where the animal’s spirit has gone and the joy she brought into our lives. Even though it was sad, it got us talking about some big issues, such as the cycle of life and death, which I wouldn’t otherwise have thought to bring up.

Dealing with death

When there is a death in, or close to, your family, you may be coping with your own grief as well as trying to help your child with hers. Finding comfort for yourself and being able to attend to your child is paramount. Your child will need to have some explanation when a person dies. She’ll understand that death is final and that she will never see the person again. Her thinking is quite concrete at this age, and she’ll probably want to see the coffin or urn and the cemetery.

Straightforward and honest communication is welcomed. Say, for example, “Grandpa is dead” rather than “We’ve lost Grandpa” or “Grandpa is at rest.” If you use euphemisms for death, such as, “He went to sleep,” your child may be reluctant to go to sleep herself in case she dies, too. Include your child in mourning the loss. Trying to protect her by not telling her about the death or keeping her away from the funeral can make dying very mysterious and frightening.

Your child may ask over and over again about death and dying as she tries to make sense of her feelings and fears. This can be distressing for you as you deal with your own pain. Share the load with your partner or other relatives who can help by going over the subject with her. This may be a time to talk through your spiritual beliefs—for example, it can be reassuring for her to think about people’s spirits going to a place such as heaven after death. She may let her feelings out through drawings of the person who has died and pictures of heaven or similar places. This is not morbid, but a way for her to express her loss.

When do mood swings require therapy?

Just under one in 10 children will experience a psychological problem in their early years. The most common difficulties are behavior problems, fear and anxiety issues, and repetitive habits. The trigger for a psychological problem is often a combination of vulnerability in your child and a stressful event in her life. Perhaps she has a sensitive or shy personality or there is a family history of difficulties that make her more at risk of developing problems herself. She may be suffering from bullying or be reacting to the death of a loved one. None of these experiences mean she will automatically have a psychological difficulty but, for some children, they can be a trigger.

Strong emotions

Your young child will experience a wide range of moods and behaviors that are an entirely normal reaction to everyday life. Events such as falling out with friends, achieving a personal goal, or moving to a new house will trigger strong emotions such as sadness, elation, or frustration. However, keep a watchful eye on your child if you notice she has become sad, appears worried, has difficulty sleeping, or has habits that get in the way of relationships and everyday life. If these persist over a period of a few weeks, find a quiet time to let her know you are concerned, ask for her perspective, and seek advice from your doctor.

Where to get help

Your pediatrician is the first route into help for your child. Both you and she should go to see the doctor together if possible. Be ready to describe how long the problem has been going on, how it affects family life, and any triggers you’re aware of. If your doctor thinks your child has mild difficulties, he may recommend a period of two to four weeks of “watchful waiting.” Most childhood distress improves without any therapy, but it can recur; this period allows you to monitor your child to see if the problem persists. If her difficulty continues, your doctor will usually refer you to specialist services for some talk therapy. Medication is helpful in only a few situations.

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