"If ever there is tomorrow when we're not together... there is something you must always remember. You are braver than you believe, stronger than you seem, and smarter than you think. But the most important thing is, even if we're apart... I'll always be with you."
— A.A. Milne, author of "Winnie the Pooh."
There is nothing that can ever truly prepare someone for the loss of a loved one. And grief, at any age, can be hard — especially during the holidays.
For children, who are still learning how to express their feelings over such a loss, grieving brings with it many confusing emotions throughout the journey.
Three local experts shared advice on how to deliver the news, how to let children express their grief and how to teach them it's OK to move on.
Delivering the news
The hardest part for any parent or guardian is having to tell children about the death of their loved one.
"I think it's always best to be honest," said Gaye Shelley, an outpatient therapist at Brook Lane.
She cautions, however, to gear the conversation to the particular age level of the child.
For instance, a teen might be able to handle the news in more technical terms or a more straightforward conversation. However, when talking to a younger child, he or she might not have a concept of what death is.
Shelley said a talk about a grandparent's death could be: "Nana or Pop-Pop has gone to live with God. They've gone to heaven. We aren't going to see them here anymore."
She said the conversation can be whatever that fits into a family's cultural background. Don't make up stories such as "they moved away," she said, which gives a child hope they can just go see them.
"Honesty and sensitivity are key," she said.
And being able to help the child know that it's OK to feel sad are key, she said.
Lou A. Lichti, a psychologist with City Park Psychological Services in Frederick, Md., said this is the time when a family's faith and spiritual belief becomes important.
"Depending on what your belief system is, I think that part of what you want to do — especially in light of what happened recently — is that you want them to feel safe, that they feel loved, that they think their loved one who has passed is also safe and loved and in a good place," she said.
Grief comes in all forms
Robin Morris, a bereavement specialist at Hospice of Washington County in Hagerstown, knows the pain of losing someone at the holidays.
Although she was grown when her sister, Candi Quarles, passed away on Dec. 26, 2009, Morris said that first Christmas following her sister's death was hard.
But Morris said "sharing the grief" and learning to celebrate happier moments with family during the following Christmas made the grief more manageable.
To help children and teens, Morris holds six-week programs throughout Washington County schools that help children deal with grief during the holidays. She also hosts Healing Hearts groups at Brook Lane, specifically geared toward adolescents.
Grief, Morris said, takes time. On average, it can take 18 to 24 months to grieve, she said, but usually in a matter of days a child returns to school or an adult to work
"But then we are all still numb," she said.
Grief can take on different forms, especially with children.
"It depends on the age and the emotional maturity level," Shelley said.
She said small children, especially, often cannot verbalize their feelings.
"And all kids are prone to acting out as opposed to expressing and verbalizing because most of us, even adults, will regress emotionally under duress," Shelley said.
She said it's not unusual for a child of 17 or 18 to act like a 3- or 4-year-old for a time.
Shelley said the Kubler-Ross model that uses five stages of grief don't always apply.
Expressing their grief could come in any type of form — not eating, being depressed, being angry, feeling anxious or not being able to understand why.
Morris said in elementary school-aged children there might be clinginess with a child and an adult, or the child will exhibit anxiety, fear or worry.
Children in middle school, which she said is "a really, really tough time for youngsters anyway," might become more defiant or withdrawn because they think they believe they should be able to handle the grief.
For a teenager, grief can by shown through exhibiting anger, she said, because the loss is a "lack of control over the emotions that are way too 'not cool' to be having in the first place."
One sign of grief, especially in teenagers, could be that their personal hygiene doesn't matter anymore, Morris said.
Morris said a lot of middle-schoolers and teens might engage in risky behavior such as sexual promiscuity or substance abuse, which, she said, are ways to self-medicate.
"It's like, 'Nothing can hurt me,'" she said. "And the reason nothing can hurt me is because I'm already hurting."
It's because of that, Shelley said it is hard to say what's going to happen during a child's grieving process.
"Gear yourself to be ready for anything out of the ordinary," Shelley said. "The best thing is to validate the feeling and normalize it for them — of course we don't accept inappropriate behaviors — but they really need lots of validation."
She said it's OK to indulge a teen's temporary regressive behavior such as thumb sucking or extra cuddle time.
"If it continues to go on, you may have to look into getting additional assistance," she said.
Remember, Shelley said, "Grief takes as long as it takes."
Managing the grief
There is no deadline to grief. And it's not best, Shelley said, to think that a person should be over the loss at a certain time.
"The best thing is to get them to express (the grief)," Shelley said, "whether it's through verbal expression or through drawing or painting or projects or games. But to continue to express it. Let them cry. Let them feel the feelings so they can move through it as opposed to getting stuck in it."
Sometimes, however, it can move from grief to depression. Shelley said parents or guardians should be aware of major changes in sleep and appetite for more than two weeks.
She said other signs of grief could be if a child has had significant weight loss or gain; if he or she is acting out, or extremely moody.
"That's when you should consider getting professional help," she said.
Getting a child to express his or her feelings about the loss can be trying. Teenagers are often known for not talking to adults over everyday issues, let alone the death of a loved one. But helping them find the words is important.
"A very dear friend of mine who raised two teenage boys told me 'The books all say teenagers grunt. Well, I never let that be acceptable in my house,'" Shelley said.
Shelley said sometimes it might be best to sit the child down and say, "You may be feeling a little wonky, like one minute you're happy, the next minute you're sad and you don't know why. And it's not unusual to have a lot of very strange or difficult and very changeable feelings in the face in a significant event. And that's normal. But the sad news is that normal stinks sometimes. But this is normal for this situation. If you need to scream, if you need to cry, there are some ways to get this extra intensity out."
She said she often likes to use ritual, such as burying an object, as an activity that allows the child to work through a process of grief.
"Kids like activity. Usually any type of activity around (grieving) can be very helpful," she said.
Talking about the death is key.
"The idea is for parents and caregivers not to treat the death or the loss like it's the elephant in the room," Morris said. "You have to be able to open up and say, 'Hey, it's really sad that Uncle Joe or Mom or whomever isn't here this year. How are you feeling about this?'"
Morris suggests when talking to children, take on a "strength perspective." For instance, say "I can only imagine how difficult it must be for you at this time of year when everything you see on television on magazines is about family and you're missing your — fill in the blank. How do you do it? You are remarkable. If it were me, I probably wouldn't be able to get out of bed in the morning."
By starting such a dialogue, it lets them make every honest attempt to cope, Morris said. It helps the child is starting to talk about how he or she is grieving.
Saying things such as "Have you been thinking about your mom lately?" is intrusive, Morris said.
But asking it differently "allows them to speak to their strengths and gives them more of an edge to talk about things that bother them."
Holidays and traditions
Life does go on, and continuing holiday traditions can be a healthy way to help a child heal during the holidays, the experts said. Most importantly, don't think that because the loved one has died means that the traditions must stop.
"The thing is, in our culture, life goes on even in the midst of intense feelings," Shelley said
She said to express to the child that it's OK if you're opening presents on Christmas Day and you suddenly burst into tears. Or that it's OK during the Christmas pageant if you wet your pants and you're 5 years old and you haven't done that since you were 2.
"We acknowledge the grief while we're in the process of living," she said. "Because the last thing you want is to shut everything down and get stuck in the grief."
Lichti said it's OK to ask the kids how they want to celebrate the holidays.
Because the holidays can be overwhelming in general without the addition of loss, Lichti said the first reaction might be to not celebrate. But, she cautions, that "you have to do something" to celebrate.
It's OK if it's not at the same scale as it was the year before, but maybe celebrated in a different way. Lichti suggests honoring or paying tribute to a loved one.
Maybe it's a Christmas tree ornament, or something next to a menorah or placing a wreath at the grave, Lichti said, any way to validate the feelings.
Or, Lichti said, it's OK to find new activities. "Maybe you all go to 'The Nutcracker,' and do something different."
Morris said it's fine to have the children talk about their loved one. "Ask them, 'Are you going to honor your mom this Christmas?' Have you thought about including her this Christmas?'"
The sadness, she said, turns into "pure inquisitiveness" on how they can honor the loved one — purchasing a gift or making a gift.
"By doing things in honor of a loved one, it takes the pain away," Morris said.
She said one of the major parts of grief is getting to the point where a child can continue the relationship with a deceased a loved one in a different way.
The first Christmas after her sister died, Morris said they found ways to honor her. After the tears fell, she said, they shared funny stories about her.
"You have to encourage children to do this," she said. "Write about how they used to belch or used to snore. Write down something funny on a piece of paper and put it on a hook and hang it on the tree. I couldn't give my sister a hug for Christmas but talking about her brought her right into the room."
Taking care of you
Parents or guardians will be working through their own grief while helping the children with theirs.
That's why, Lichti said, it's really important to be in touch with your own grief because if children see you are consumed by your own grief "it feels like they've lost two parents instead of one."
"We don't do grief well our culture," Shelley said. "The interesting thing about kids is they are such sponges. You can't hide your feelings from them. You might be hiding them from yourself, but the kids are going to pick up on it."
Shelley said it's also important that the child doesn't start caring for the adult in a role reversal.
"The adults still have to be the adults, particularly with little children," she said. "Adults have to remember to seek comfort from appropriate sources such as peers or spouses or other adult family members, not children. Kids will want to do that because it makes them feel important, but it also can create confusion."
"There are no guidelines. There aren't really any rules for grieving," Shelley said. "It takes as long as it takes."
Lichti said to be sure to surround yourself with support. Find support in friends, family and the community, all the experts said.
For instance, Lichti said, when it gets hard be sure to have someone who can step in to offer some support such as an aunt or uncle, or grandparents.
For families who are in the grieving process now, the experts said it will get better.
"Hang in there. Grief, like everything else, is a process. You have to move through it," Shelley said. "There's no shortcutting it. There's no putting it aside and not having it come back."
"It does get better," Lichti said. "It takes time. Just make sure to take care of yourself. There's support out there ... Talk to others so you don't feel alone.
"You have to be brokenhearted, but isolating and being alone doesn't help to heal that broken heart," she said. "Talking to people and surrounding yourself with people — you don't have to talk, just have someone sit with you — I think it probably is one of the more healing things you can do. People want to help. So let them."
The loss of that person will never truly ever goes away, Morris said.
"When you lose someone dear to you, you will grieve that person's life for the rest of your life," she said. "You might go through a period of four years and you are riding down the road. That's usually when they think there's something wrong with them. Grief doesn't come in stages. That's grief — it's a process. You grow into your grief, you become more and more comfortable with your grief."