In January 2025, a close friend of mine experienced the devastating loss of her 5-year-old son, Harvey, due to complications from a congenital heart defect. Watching her navigate the depth of that grief gave me a new understanding of how isolating and overwhelming child loss can be — and how essential the right kind of support truly is. 

In the aftermath of the recent, tragic Texas floods — where so many families, including young children, lost their lives — this same friend was moved to write a personal list on how others can support grieving parents. She created it from her own lived experience and as a way to offer something concrete and heartfelt to others now facing unimaginable sorrow. 

With her blessing, I’m sharing this list in hopes that it will guide friends, extended family members, and community supporters who want to help, but may not know how. Grief is overwhelming and isolating, but thoughtful support — even in the smallest ways — can be healing. 

Offer Emotional Support 

• Any message of love, encouragement, or remembrance — text or handwritten — can be impactful. 
• Reach out even if you haven’t been in touch recently or don’t feel “close enough.” Grieving families often find comfort in hearing from old friends.
• The message doesn’t need to be perfect — sentiment matters more than wording. 
• Bonus: Share a photo, memory, or specific trait you remember about their child. It offers a small but powerful piece of their memory back to the family.

Support Surviving Siblings 

• If your children are close in age, consider inviting their child over to play or planning a low-pressure outing.
• Grieving parents often feel guilt about not being emotionally or physically available to their surviving children. Helping with sibling play can be a double gift: a break for the parent and joy for the child. 
• If possible, organize a group or rotating schedule to plan recurring playdates, reducing the parent’s mental load. 
• Even for younger kids, entertainment — without the need for deep conversations — can be valuable. 

Give Practical Gifts 

• Food delivery is invaluable. It removes the burden of planning meals during an emotionally and mentally overwhelming time. 
• Coordinate with others to avoid gaps or over-saturation in meal deliveries. 
• Allow monetary donations in meal trains if possible — unexpected expenses related to grief (e.g., funeral expenses, therapy) can be significant. 
• Don’t underestimate the value of supporting healthy coping outlets like therapy, physical movement, and time outside. 

Avoid Common Missteps

• Avoid toxic optimism (e.g., “at least…” phrases like “at least you had five good years”). These phrases can feel dismissive and hurtful. 
• Don’t ask “how are you?” — it's hard to answer honestly. Try “I’ve been thinking of you” or “It’s good to see you” instead. These phrases feel more supportive and less demanding of a painful answer. 
• Don’t avoid using their child’s name. The parent chose that special name just for them; the loss of using it adds to the pain. It may feel tender, but hearing their name affirms their memory and legacy. 
• Refrain from saying, “Let me know how I can help.” Most grieving people won’t reach out, even if they need something. Offer specific help instead: “I can bring dinner Wednesday,” or “Can I take your kids to the park for an hour?” 

In times of collective grief — whether from personal loss or community tragedy — we often search for ways to feel less alone and more connected. At Cook Children’s, we recognize that many families are grieving together right now, and we want you to know that you are not alone. We are here to offer support, guidance, and compassionate care as you navigate the days ahead. Even in the darkest seasons, community and kindness can be a powerful source of light.

Related Stories:

Camp Mystic: Psychiatrist, Mother Shares Advice for Parents (CheckupNewsroom.com)

Central Texas Floods: Cook Children's Provides Mental Health Resources (CheckupNewsroom.com)

Cook Children's: Helping Parents Support Kids Through Tough (CheckupNewsroom.com) 

I’ve been heartbroken this week.

There was a stabbing at a high school track meet not far from here. A place where teens should be running races, cheering for friends, and making memories turned into a crime scene.

At the same time, the Netflix show Adolescence is blowing up, and for good reason. It’s raw and real. It doesn’t shy away from the messiness of being a teen today—loneliness, peer pressure, violence, and the constant pull of social media.

As a pediatrician, I’m seeing more families asking questions about youth violence. It’s easy to feel helpless—but you’re not.

How to stay engaged and help your teen avoid violent behavior:
1. Stay curious. Ask about the show your teen is watching. Watch it with them. Talk about what’s real and what’s not.
2. Stay connected. Eat together when you can. Car rides are golden—no phones, just you and them.
3. Stay safe. Ask how your teen’s school is handling conflict and safety, and advocate if something feels off.
4. Stay consistent. Teens need boundaries just as much as love—even when they act like they don’t.

How to help your child avoid becoming a victim of youth violence:
1. Know their circle. Ask who they hang out with and where they spend time. This isn’t being nosy—it’s being wise.
2. Teach exit strategies. “If things feel off, it’s okay to leave.” Give them permission and a plan.
3. Model confidence. Help them practice setting boundaries and speaking up, even with friends.
4. Watch for red flags. Sudden withdrawal, anxiety about school, or unexplained injuries should always be taken seriously.
5. Don’t ignore gut feelings. If your teen seems off, trust your instinct and start the conversation.

Being a teen is hard. Parenting a teen can feel even harder. But you don’t have to do it alone.

We can’t bubble-wrap the world. But we can equip our kids to walk through it safely.

Resources

Cook Children's Health Care System shares these resources for families.

How to cope with traumatic stress

How to help children and teens manage their stress

How to Help Children Cope With Trauma - Child Mind Institute

Acute Stress Disorder in Children: A Quick Guide

The national suicide/crisis hotline (call, text, or chat options): 988 Lifeline 

The purpose of this series is to provide an understanding of grief in adults and children. Our world is filled with many things that are worthy of our grief. It is helpful to identify grief, experience and process the grief, and then understand the other side of grief which is not the absence of it.

Grief: The Other Side

Our first family dog died in 2018. It was absolutely soul-crushing for me and our family. For me, he was my sidekick and walking buddy. He had been there for every big milestone and there when I brought each of my babies home from the hospital. He had protected and guarded their doors and been their jungle gym. He was a constant in the midst of chaos. There was a tangible, physical grief that lasted for several days following his death. Then there was an extreme sadness that set in – I missed that I couldn’t give him crumbs or a bit of leftovers. I was destroyed when I wanted to go on a walk and he wasn’t there. While most people end up getting a new dog and that quickly helps you move to the other side, we waited almost three years before getting a new dog. I can confidently say that there was another side of the grief. I will miss him forever, but there was another side where walks were easy again and our children were not sobbing every time they saw another dog. There is a place where the new circumstance begins to feel somewhat normal – this is the other side.

It’s hard to imagine that there could ever be another side to your grief. In the beginning and in the middle, it can feel so life-altering and paralyzing that there seems to be no way that you will ever get your breath back. For our kids, we may believe that their behaviors and challenges are never going away.  They may feel that too, though they are probably not able to verbalize it. Grief can run our lives at such a level that we believe we will ever get out from under its control. While you begin to see glimpses of a new normal, triggers still exist and can take you right back to the middle or even sometimes the beginning of grief. This is why we often say that grief doesn’t leave. It is true that is always there at some level. There is a loss, and loss cannot be replaced. That person, that event, that circumstance exists – it is not changing. However, how we respond and how we carry our grief can and should change over time. Just like we move from the beginning of grief to the middle, we can also move from the middle of grief to the other side. This is a new chapter, a new normal, and a future hope.

When looking at the same grief image that we have been using, this is the acceptance stage.

Getting to this next stage can be difficult, and it’s true that every circumstance and loss has its own timeline. We do not want to rush the process, but we do want to keep moving and help our children to keep moving toward healing and peace. 

The WARM Place says, “Most grievers do experience sadness, shock, anger, and guilt, but the process of grieving is unique to each person. There is neither a road map for grief nor an end that everyone reaches.” 

Grief doesn’t have a true end. Grief changes and this other side is just a changed, emotionally stable grief. There will still be moments on the other side where your or your child’s heart needs all the things it needed at the beginning. That is more than okay. When we experience triggers and return to a previous place of grief, it does not mean we have regressed or will stay there. It means that our heart still acknowledges the loss and needs to be tended.

So, what are some ways that you can experience the other side for yourself or with your children.

1. Tell your story and encourage your kids to also.  Our story of loss is our own and how we tell it allows our hearts, brains and bodies to process it. Encourage your kids to tell their loss and grief stories and don’t shy away from talking about the hard. Sharing in a comfortable, safe space can be very healing. I have found over my lifetime, that my stories of struggle and grief have brought much encouragement to others that have walked a similar road. I have also found that when others share their stories with me, I feel validated and understood. It is important for kids to feel heard when they do choose to share their stories. Often you will see people tell their stories through writing, art, or music. Some people tell their stories through establishing honors or organizations in memory of another person or experience. We see scholarships and awards come out of the hardest stories. This is a beautiful way of telling the story of loss while also honoring and blessing the person and/or loss. I know someone that does an incredible job of telling her story of several losses in her life. She honors those that she has lost on milestone birthdays and takes the opportunity to tell about these special people in her life. She includes her kids in celebrations to share in their favorite food or go to their favorite place. This kind of honor and celebration allows us to continue to process our grief and reframe the loss into the beauty of what we experienced before the loss or grief. It is also important to acknowledge changes in ourselves and our kids because of our grief. By telling my daughter’s story of her brain tumor, I can acknowledge her bravery and resilience. I can also acknowledge the ways our family has grown and changed because of this struggle. With any grief or loss, there is an opportunity to find the beauty and celebrate it.  
2. Be prepared for random things to trigger re-grief and take the time to address them. Triggers are a very real thing. It may be a certain place, smell, movie, food that makes all your memories and thoughts about a struggle come rising to the surface. I cannot eat a canned biscuit without thinking of my grandmother. There is a certain song that takes me right back to the beginning of learning about our daughter’s brain tumor. I also see triggers in my kids. We had to pick them up early from an event when my grandfather died. Now if plans change and someone else picks them up or I pick them up from school when someone else was supposed to, their brains immediately revisit the moment that I told them about their great-grandad dying, and they are convinced that something terrible happened. It is important to pay attention to these triggers. Often, they are met with extreme emotion and can often take you back to the beginning of grief where you physically feel your grief all over again. It is normal to have triggers and for them to be different for everyone. It is important to name the trigger and the feeling that is attached to it so that you can process it without getting stuck back in another stage of grief. Doing this with your kids will help them to recognize when beginning or middle grief is bubbling back up and allow them to process it in a healthy way so that they can continue to move towards healing. Triggers are the very reason that grief never leaves. However, over time triggers can turn to memories that bring joy and peace as opposed to the flood of emotion and grief that accompany them initially. However, there are some triggers that may always lead to sadness and grief. It is important to know what these are and name them.
3. Don’t be afraid to move on. This sounds a little rough, however, we often do not give ourselves or our kids the permission to truly move to the other side. The thought that grief will surprise you and hurt you worse than before can often make us stay in that space longer than needed, and it quickly becomes unhealthy. We don’t want to move on because there is fear that letting go will mean we forget something precious, or we are caught off guard when a new struggle comes. You’ve heard people say that they are just “waiting for the other shoe to drop.” We start to feel that struggle and pain is so inevitable that we don’t want to celebrate or live joyously because there is inevitably another struggle around the corner. While this may be true, living this way becomes very unhealthy very quickly. We live in a constant state of fight or flight in response to something that has yet to happen. We often anticipate the worst-case scenario. This place can make us and our children bitter and fearful. It is okay to move on to the other side. It is okay to live and live fully in the reality of the new normal. It does not mean that you forget or pretend that something didn’t happen. It means that you acknowledge the loss and struggle and embrace your current circumstances too. Our children need to hear us and see us live on the other side as much as they need to. The pandemic comes to mind when I think about this. There has been another side to the pandemic – a better, more stable and healthier side. Yet many of us weren’t sure when to embrace the other side or let our children embrace it. We debated for months about sending our children back to school or choosing to take our masks off. There was so much pain and change that came with the pandemic that it felt that if we moved to the other side of it, it would knock us back down again and we would have to experience it all over again. While pain and suffering are inevitable, there is so much to be gained by living in the current peace and joy. If you find yourself able to feel joy and peace, know that this is okay to embrace that and encourage your children to embrace that same joy and peace. Children often find themselves on the other side more quickly than adults, but our ability to move to the other side or not can greatly affect our children.

Moving to the other side is like taking a deep breath – 10 deep breaths. There is a knowledge that everything is okay in the present and that there is a future waiting to be lived. It is hard to be human knowing that another struggle or loss is inevitable, but as humans, we also have the gift of feeling joy, peace, and hope. Embracing these feelings and living on the other side will ultimately be the best place to bring honor and celebration to your loss or pain. Your grief and pain don’t magically disappear, but I hope that you find yourself on the other side able to take a deep breath and embrace future hope.

The purpose of this series is to provide understanding of grief in adults and children. Our world is filled with many things that are worthy of our grief. It is helpful to identify grief, experience and process the grief, and then understand the other side of grief which is not the absence of it.

Grief: The Middle

Grief is not hard to come by. So much of life includes losses – big and little. In 2017, our family experienced some big losses. My parents moved overseas for my dad’s job. While this was a great move for them, it was a loss for my little family as the distance was hard on my girls and our support system changed. Not even a couple of months later, a close friend of mine died suddenly at a young age. He was not only our close friend, but the dad to our daughters’ close friend. It was a shaking time. Not even 6 months after that, we moved and remodeled a home and our dog of 10 years died. In a short amount of time, we experienced deep sadness and sorrow. Not only did it affect us individually, but it also affected our family unit and our close family and friends.  Once we were able to begin to process this time of grief, we realized so many of our losses were colliding with one another. It took time and support to separate our emotions about each experience and begin to work on healing.

Experiencing loss is universal. Therefore, it’s easy to say that grief is also universal – everyone has grieved at least one thing in their lives and often many events overlap.  Once we have moved past the physical, initial lament of grief, we can start to move towards grieving and healing. In this middle time, though, healing and grieving are happening simultaneously.  We must work through the grief to begin to heal.

This time in grief is when memories can still be painful and sometimes breathtaking. Tears can often flow at strange times and anxiety shows up and throws you back to the beginning physical grief. This middle time truly feels unsteady. Your body is not paralyzed every day from the shock, but moments of deep grief hit you like a wave, and you feel like you are drowning all over again.

This process is okay. Don’t run from the wave, learn how to breathe underwater.

I’ve spoken about many moments from my daughter’s diagnosis with a brain tumor. The initial few days at work, all I could do was name it. People would ask me how I was doing, and I would bluntly and matter-of-factly reply, “My daughter has a brain tumor.” It was a strange feeling, but every time I named it, I was able to catch my breath a little more. Over time, I learned how to breathe in the face of our reality. I remember the first time a doctor called me to help support a family walking through a very similar experience. He immediately said, “Oh I can call someone else if that’s better.” I quickly told him no and that I would be there soon. Standing with that mom, I could feel her initial shock and despair deeply, but it did not overtake me. Oftentimes, we can learn to do something better by helping someone else do it or by being present with them.

Children experience the middle time of grief also. Often, children’s behavior is the evidence of their grief. As my daughter has walked through her brain tumor diagnosis and brain surgery, we have seen grief present itself. Her process of grief did not begin until well after her surgery. Most recently, it has looked like absolute rebellion to pack for our trips to follow-up appointments. She has verbalized that there is fear every time she has an MRI, and she doesn’t want to do it again. So, she chooses not to pack at all. She knows that refusing to pack will not stop us from going to her appointment, but it is part of her grief process and the expression of her anger with a little bit of denial. While there will probably always be some level of anxiety for her around scans, currently each scan provides an opportunity to process and grieve the first scan that revealed her brain tumor and the scan after surgery showing that there was some residue tumor. She has verbalized often, “I don’t want to have to go to follow-up appointments. I wish I never had a brain tumor.” Her behaviors are expressing her stages of grief. 

This middle time of grief has no timeline. It is very fluid and very looping through the stages. In reviewing the graphic of stages, it is important to be mindful of how long you or your child is staying in one stage. While anger is an appropriate emotion, staying in anger or returning to anger over and over (or any stage) could be the beginning of complicated grief. It is normal to loop back to a stage – even denial. It is normal to not want something to be real long after you’ve embraced the reality. We see this happen every time we want to pick up the phone to call someone that has been gone for years. Our bodies and our deep love for them remember their presence and return to those moments. So, it is normal and expected to return to these stages. It is just important that we work to move through them while also recognizing that they may come back up again. 

So, what are some ways that we can continue to move through and help our kids move through grief knowing that it will take time and revisiting stages before we begin to see the other side?

1.  Know who your safe people are and who your kids’ safe people are. I like to call these people your wave riders. They are willing to ride the waves of grief that inevitably come. Grief done alone can become very complicated. It is important to have people that you can honestly share the process with. When the wave begins to come or you find yourself underwater, it is important to have a safe person or persons that you can trust to be in that moment with you. These are the people who you can meet, call or text, and they will meet you in that space, empathize with you and encourage you. They are people who have understood the grief you’ve felt and known from the beginning. For our kids, we want to be their safe person as much as we are emotionally able to be. It’s important as parents and caregivers to see a behavior and recognize if it is part of their grief process and be willing to process it with them. It is important to note, though, that when the whole family is grieving, it is okay for your children to have others that they feel safe sharing with also. It can be very helpful for their process to have others that will acknowledge their grief too. However, when a whole family is grieving, it is equally as important that the family is open and communicative about their grief and their struggles. When everyone grieves alone without any communication, it creates a very complicated grief process where people are more likely to get stuck in a stage. Safe people – your wave riders – will help you move through this middle grief.
2. Be willing to do the hard work. Grief is not easy – it is hard work, and to move through it takes intentionality. When you’ve moved past the beginning paralysis of grief, this middle time is an opportunity to begin moving towards the other side. This may look like needing to utilize professional counseling outside of your wave riders. Counseling can help you start to process the looping thoughts and the triggers that take you back to a stage over and over again. It is important to recognize when this could also be helpful for your child. Play therapy, art therapy and music therapy are all good options for professional guidance to help our kids process grief. It is also important to notify school counselors, youth pastors and other adults that can be available to your child as they walk through this time. 
3. Honor the grief. This is a great time to establish tradition or memorialize the event or person.  By honoring this grief in some way, you are naming it but also looking through a positive lens and helping your body and emotions move towards the other side. For the death of a person, this often begins at the funeral or memorial service. This can take on many forms, though. During the peak of the pandemic, my girls and I put together a COVID time capsule. It was an opportunity to process the horror of the time, while also taking the time to find the positives and creating a memorial that we could revisit in moments that we are remembering that season. This can also look like establishing other kinds of legacy. Years ago, one of my co-workers began a tradition of a group of us adopting a family every Christmas to honor a co-worker that died and left a legacy of love and hospitality. Every year that we do this, we remember him fondly and honor the best parts of him. Often people will establish financial memorials and foundations to honor someone’s life and legacy.  Simple traditions can be established like eating someone’s favorite food in honor of their birthday or anniversary of their death. Story-telling is also a simple way of honoring our grief. As we tell stories of our grief, we begin to see the purpose of an event or a person’s life. The words begin to give purpose to the pain and struggle. There are so many ways that you can honor grief, but any honor or memorial that is given to the pain or struggle creates a path towards the other side of the deep grief. It gives our heart an opportunity to celebrate the event or person.

There is so much that could be said about the nitty gritty middle time of grief. This is the trench in the grief process. It is messy and beautiful at the same time. By allowing others to ride the waves with you and your kids, tapping into resources and honoring your grief, your family will be grieving in a healthy and life-giving way.

Tears welled in his eyes as his sweet, pre-teen voice cracked, “Mamaw M died and then my friend died and now my other friend died! Plus, middle school is a lot different than elementary school! This year has just been hard and sad. I thought being a kid was supposed to be fun. This is the worst year ever, Mom!”

Sadness. Grief. Uncertainty.

Death is hard. Change is hard. The two often go hand-in-hand, especially during the holiday season, when kids are practically indoctrinated that winter holidays should be the highlight of their year, filled with brand new gifts, unlimited candy, and family traditions that make the eyes roll while their hearts burst with joy.

Just like being a kid is supposed to be fun, holidays are supposed to be fun. Holidays after the death of a loved one, however, are reminders that life is different now. Holidays highlight who is missing.

When someone is missing, sadness, grief, and uncertainty reappear year after year. It can be exhausting, especially if you are also grieving. You may grieve differently than the tween working to make meaning of multiples deaths and the new stress of middle school, and that’s OK. Everyone grieves differently and copes in their own way. 

Speaking to your children

Younger children often don’t have the verbal skills to express their grief and feelings. Instead, you might see their grief shown through an increased want for physical touch and reassurance, tantrums, regression, and the overall need to move their little bodies a lot! Caregivers can support young children by:

• Keeping the child’s routine as normal as holiday observations allow,
• Prioritizing one-on-one time with the child.
• Providing activities that promote physical movement. Keeping naptime in place and setting aside 20 minutes to play at the park are great ways to support a young, grieving child.

Older children who are grieving may approach holiday gatherings with a quiet, reflective spirit or they may share their feelings with any and every person they encounter, asking questions about death and dying, and talking very directly about the death. 

Caregivers can support older children by simply being present and allowing them to talk it out or sit with them in the silence. This crafty age group often find meaning in creating an art project or participating in rituals that honor the memory of their loved one. Drawing a picture, leaving an empty seat at the table, making a favorite recipe, or asking people to share their favorite memory are great ways for older children to process their grief throughout the holiday season.

The only thing more unpredictable than a teenager is a grieving teenager during the holidays. 

Teens are still learning how to cope with life in general, coping with grief is next level, especially when they are expected to show up, celebrate, and smile for the pictures. Caregivers can support grieving teens by acknowledging that it may be difficult to be around family and fostering their emerging sense of independence by working together to create expectations around holiday observations. 

Allowing teens to weigh in on when and how long they must be present, allowing them the freedom to leave and go to a friend's house when they need a break reinforces healthy coping skills as teens process their grief during this busy season.

An ongoing conversation

The holiday season may start the conversation about the grief in a child's life, but, in reality, it's an ongoing conversation. As children grow and develop physically and mentally, their conversations, understandings, and experiences of grief grow and develop too. Grief has no timeline, so if you, as a grown-up reading this, find tears welling up in your eyes and your voice cracking as you declare this is the worst time of year, know you are not broken or alone in your grief. Be gentle with yourself as you approach this holiday season. 

No matter if you are living with grief yourself, if this is your first year supporting a grieving child, or if grief has greeted every holiday in your recent memory, it's OK to miss the one who is still missing from your holidays because, no matter how many years have passed, death and change are still hard.

The purpose of this series is to provide an understanding of grief in adults and children. Our world is filled with many things that are worthy of our grief. It is helpful to identify grief, experience and process the grief, and then understand the other side of grief, which is not the absence of it.

Grief: The Beginning

In grad school, I took a memorable class from an incredible professor on grief. One of the assignments was to create a timeline of loss from childhood to present day. That assignment was over 15 years ago, and since that time, I’ve been married and had three children. My timeline is inevitably filled with more losses than I would have imagined. Throughout my timeline were the deaths of grandparents and great-grandparents, moving across the ocean and then across the country, losing friendships, inevitable goodbyes, relationships and breakups, and the death of pets. Since then, I’ve added more deaths of family members, deaths of co-workers and friends, loss of jobs, moves of family and friends, my children’s grief and loss, a global pandemic, and new cancer diagnoses for my children and friends. There is no way to fully describe the grief that surrounds each of these experiences. They are each their own story, and my grief may be different than the grief of the other people these events impacted.

The Center for Loss and Life Transition talks about grief being a counterpart to love.

“It is the normal and necessary journey we embark on after something we have valued no longer exists.

• If someone we love dies, we grieve.
• If a beloved pet dies, we grieve.
• If someone we love leaves us, we grieve.
• If something we value is taken away from us, we grieve.
• If circumstances we were comfortable with or attached to change, we grieve.
• In general, the stronger our attachment to the person or the thing, the stronger our grief will be.”  

I think it is important to remember that grief is not limited to death. While it is instinctive for us to grieve a death, our bodies also grieve other losses. I wrote an article in 2020: Everybody is Grieving Something. This was at the beginning of the pandemic, and my own children were deeply grieving many aspects of their lives: their schedules and routines, their friends, their normal.  Even in the last three years, there has been more and more added to their grief, and I have seen their grief bubble back up as they remember that time.

While grief is inevitable and necessary in every way, it is not easy – it is work.  The beginning of grief can be the most difficult for many people. Many have probably heard of the five stages of grief by Kubler-Ross: denial, anger, bargaining, depression, and acceptance. Often denial, anger and bargaining can all fall at the beginning of grief. In this series, we are talking about grief in terms of the beginning, the middle, and the other side. However, it is important to understand that the grief process is not linear. There is movement back and forth between the different stages and feelings. In my opinion, this graphic represents the process most accurately:

The loops in this graphic represent the reality of returning to different stages in the grief process repeatedly. Returning to shock and denial may seem impossible after accepting that a loss is real, but the response to experiencing many feelings at the same time can take you back to a certain stage even after someone has seemingly moved through it.

I find the beginning of grief to be the most difficult often because it is the most physical time of grief. Grief is not limited to crying. Your body can respond in ways that you never expected, and I have seen initial grief manifest in the most surprising and difficult ways.

My grandfather died just days before my daughter was diagnosed with a brain tumor. Initially I was so angry that he died, and I was shocked by my own anger. I had seen him only two weeks prior, and I had plans to spend some more time with him. I felt robbed, and I was livid. On the way home from his funeral, I knew I was finally going to share my daughter’s diagnosis with my parents. I had been waiting for them to get through the funeral. The two-hour ride home from the funeral was physically debilitating. I had the emptiest feeling in the pit of my stomach, yet my heart was about to beat out of my chest. I was in the middle of a panic attack and felt like I had no control over my body. It was the most physical manifestation of grief that I’ve ever felt. Many will not be able to sleep or eat. Others are nauseous or cannot keep food down. Many people cannot stand or sit; they must curl up and be on the ground.

For children, their grief may look very different in the beginning. Often people are amazed when a child learns of a death or a loss, and they go on playing or coloring and seem otherwise unbothered. However, it is important to pay attention to them during this time. Their play and their art will most likely indicate how they are feeling. You may see a drawing of a family, but they leave a certain family member out or put them in the sky for the drawing. You may notice that other small things upset them more quickly and intensely than normal. They will find a way to release their emotions. It is important to remember that play is a means of communication for children. Kids may also withdraw. This is not a problem as they don’t always have the words to communicate what they are feeling. However, it is important to meet them in their withdrawal and help them begin to process their grief. 

We know that there is no way around grief. In choosing to ignore grief, we complicate things further down the line. When ungrieved losses start to pile up, it can take a great deal of time to sort through each feeling and loss and effectively grieve each one of them. So what can we do in the beginning of grief?

1. Name the loss. My grandfather died. My daughter has a brain tumor. Our dog died. My friend has aggressive breast cancer. Naming the loss allows it to become real and the power of denial to become less of an issue. Help your kids learn to name their loss.  Ask questions that will help them name their loss. Use language that children can understand. Words like “passed” or “went to sleep” are not concrete enough for children and do not clearly explain the permanency of the loss. We encourage you to use the words “died” and “dead” and never lie about any part of a loss.
2. Allow for safe space to grieve. This can be a physical space or an emotional space. A mom may need to be on the floor as she grieves, so I often place a blanket on the floor. A person may need to walk outside or pace. Allow space for these initial physical moments of grief.  Do what you need to do so that feelings can be felt. For a child, this may mean providing them with a safe sleeping space that is closer to you or providing them a physical outlet like running or going on a bike ride. While children may not physically react, their bodies are still having a similar physical response, and they may need an outlet to release the tension and stress.
3. Meet basic needs. Meal trains were invented for the beginning of grief. When adults can’t find their footing to make dinner or even heat up food for themselves or others, making sure that people have food and meals readily available is essential. If you are grieving, find something that you can eat and drink and accept the meals. Show up to help with daily tasks and chores and allow people to help you get things done if you are the one grieving. These things inevitably allow for the space needed to move through the beginning of grief. Children need the same things. Make sure they have their basic needs met. Safety is a basic need for children. It may look like longer tuck-ins or eating the same comfort food over and over.

The beginning of grief can be exhausting for everyone involved, but it is also the most crucial time. The beginning of grief is the acceptance of entering into the work of grief. The work of grief doesn’t have a timeframe, but the beginning allows for the grief work to start and is an invitation for the body and heart to begin healing. We want to be people who enter into grief and help our children learn how to grieve effectively. And while the beginning of grief is challenging, it is also the beginning of healing.

This pediatrician has watched your mental battles from the sidelines this year, Mama.

2020 was not an easy year to be a mom.

Personally, I can tell you it kind of sucked, right? Just a little. The pandemic brought about so many hard choices that NO mother should ever have to make. My brain’s stream-of-consciousness ran a little something like this:

“Should I let my kids play with other kids? Will they get sick if they do? Will not interacting with others harm them more than catching COVID will? Should we start in-person school? Will masking all day be hard for them? Is virtual school a better option for us? Will looking at a screen all day hurt my kid’s eyes? Will lack of interaction with peers lead to social regressions? Are my kids eating and snacking too much? Do I need to choose between my kids seeing their friends, and my kids seeing their grandparents? Is my child in his room too much? Is he exercising enough? Is he sad too often? Is social media going to influence his behavior? Is it normal for sleep to be this much of a struggle – for both me and my kid? Am I telling my kids to wash their hands too much? Will this give them a germ complex? What do I tell my kids when they see those protests on the street? What do I tell them when they see the news on TV? What do I say when they hear people angry and shouting at each other?”…and so on and so forth…over and over…and for me, usually happening at 3 a.m.

So now that you know that I worried about a lot of the same things you did, let’s talk.

This Mother’s Day I’d like to tell you about what I’ve seen and heard in the privacy of my exam rooms.

More anxiety than I’ve ever seen in my career. In both parents and kids.

More depression in children and teens.

More mental crises.

More weight gain.

More screen addiction.

More sleep problems.

More suicidal thoughts.

Momming has never been more difficult. Not only have we been burdened by our own mental struggles, but we’re trying to cope with our kids’ mental strain now more than ever.

Some advice:

1. “Put on your own oxygen mask first – and then help your children with theirs”. Take care of yourself so that you can then throw that energy into your child and his/her struggles.
2. Look for help – Cook Children’s pediatricians, psychologists, and psychiatrists and hospital staff are here for you. We know kids - especially the mental health of kids. Check out the new Cook Children’s JOY Campaign for TONS of resources.
3. Please, ask questions. If your kid is struggling, ask your pediatrician – will some socializing be okay? Should my kiddo return to school/ go to camp? Is it safe? What are the pros/cons? What is the risk by doing this activity or that one? How much screentime is healthy for my kid? Is this behavior normal, or is my teenager showing signs of a problem? What are some resources so I can learn more?
4. Look into counseling. At my office EVERY DAY I tell parents: every single human on the planet goes through a time in their life where they’d benefit from therapy. Do it. Don’t feel weird about it. Just go talk to someone – and take your kid to talk to someone. Psychologists are trained to help you through this.

From one mom to another: we are not meant, as humans, to deal with as much stress as we have in the past year and come out unscathed.

There’s a reason you keep hearing the word “unprecedented” when it comes to 2020 and 2021. The pandemic, the politics, the civil unrest - this was a year that no one anticipated, and no one was prepared for. Know that you’re not alone in what you or your child may be dealing with.

So put down your armor, you warriors. And reach out your arms and accept some help! And give yourself a little grace.

This year was a scary and painful mess. And this Mother’s Day, no matter how much you yelled at your kids, no matter how much you felt you didn’t have the answers, and no matter how much you questioned your decisions, I want you to pat yourselves on the back. Because just surviving has been the victory here. And you’re doing the best you can.

Our family moved through the week with my best friend, her firefighter husband, and their three kids the best we could. Three out of four of us are frontline workers, but we had yet to grasp all that was going to change. We headed home on Sunday night. As we drove, spring break had been extended by two weeks, our child care had been canceled, President Trump had said 10 or less people in one place, and grief began.

Dr. Alan Wolfeldt says, “In other words, grief is the instinctive human response to loss…It is the normal and necessary journey we embark on when something we have valued no longer exists.”

My two oldest girls attend public school – one is a first grader and the other a third grader. My youngest attends a preschool two days a week and has gone there for three years. My girls LOVE school. I realize this is not everyone’s story; but my girls love school, the people, the teachers, the events, all of it! (Please don’t hear that they have never pitched a fit in the early morning hours about going to school – but overall, they are big fans.)

We have close friends that attend a private school where they homeschool three days a week and attend school the other two. We have many other close friends that home school primarily. I also have friends that have their first baby or only babies at home. My parents are retired, empty-nesters. We have single friends and married-without-children friends. What I can tell you is this: everyone is grieving something.

You would think in my line of work that I would be prepared for the grief that my kids have experienced. We are often preparing patients and families for the losses associated with their diagnosis. For the Type 1 diabetic patient, they grieve that meal time and snack time will NEVER be the same. We prepare kids every day that break their arm or leg for the loss of a sports season that they were looking forward to, or the patient that needs an appendectomy and will miss a big trip due to surgery. Grief and grieving are wrapped up in most of what I do on a daily basis.

But nothing prepared me for the grief I would see from my children or FEEL on behalf of mine and others’ children.

I have now cried on the sidelines of every Zoom meeting my kids have had. I have wept for the seniors – all the losses that are once in a lifetime experiences. I have cried for and with my girls as they realized that there was most likely no church camp this summer or as they beg to play with the neighbors.

We have gone from grieving the big things like playing with friends, going back to school, and missing church to grieving the little things. My girls sat around at lunch the other day and said they missed the cafeteria! You know what…So do I!

I miss taking my girls their lunch and meeting and seeing their friends and teachers. They miss sharing their lunch with their friends. My oldest brought out her collection of bingo prizes from her teacher’s prize bucket and showed each one to us. She reflected, “I miss the prize bucket… Mrs. {Teacher} was the best…”

The “was” caught me off guard. We have yet to discuss that they are almost positively not going back to school this year, but my oldest is processing it. She is working on grieving the future. She has mentioned her locker filled with her things, and if she could have a class reunion when this is over. And she is not the only one…

Maybe you or your kids aren’t grieving like this. But here are the people I’m thinking about:

• The kiddo that looks forward to that one teacher or person that smiles at him every day and sure hopes that person is there next year.
• That kiddo that knew where his meal was coming from every day, but now is hungry and wondering.
• That new mama that wishes all her friends could come over and snuggle her baby while she took a nap.
• The teacher who woke up every morning knowing that what she/he did was a calling and wonders if their kids are getting hugs and encouragement at all during the day.
• The grandparent that desperately wants to see their grandkids and help their own kids.
• The parents who need a minute but there are no minutes or moments because they are working from home and homeschooling.
• The kids missing their lasts or celebrations from seniors in high school to seniors in college.
• The college kids that were just getting their groove and they are back home losing the independence they were gaining.
• The moms or dads who work on the frontlines and being home with their kiddos all day isn’t even an option.
• And so many, many more scenarios.

So how can you help your kids during this time? You are most likely are grieving too. And while positivity, hope, and gratitude are great things to remember and practice, most people in the middle of grief need to know that grieving is OK.

1. Grieve with your kids. Ask them what is hard about this time, who they can’t wait to see, what their favorite part of the school day was. Don’t attempt to constantly distract them from the grief. Let them tell you what is hard, what they hate, and then admit your own grief. Let them know that you miss your friends, you are looking forward to going to dinner at a restaurant again, and that you are sad about the losses too.
2. Offer space not solutions. Provide opportunity for your kids to share what is difficult without telling them how they should feel or what to do to fix it. Space means a platform to process. This could be a Facetime call with a friend, journaling each day about their feelings, or taking a drive by the places they miss. Space just means that you don’t attempt to replace their feelings with a solution – you give respect to what they are experiencing.
3. Trust the process of grief. Allowing the process of grief to occur is what brings about healing. You may assume that your children are not grieving because they have not verbalized their grief. However, you will often see unresolved grief show up as difficult behaviors. While working through grief may be difficult and overwhelming at times, it is important to allow grief to occur so that healing can follow. Taking the time to listen, be there, and validate their emotions will be worth the time and energy it takes.
4. Lastly, speak truth where you are able. My kids favorite grieving statement right now is “I will never see my friends again.” This is not true. I will often reply with, “I know it feels like you will never see them again, but there will be an end to this difficult time and you will get to see them.” The other thing I’ve heard in this grief is, “I love Mrs. {Teacher}, and she will never be my teacher again.” This is most likely true. Don’t sidestep this. “Yes, Mrs. {Teacher} will not be your teacher next year most likely, but she is your teacher for this year, and she has been such a special teacher.”

I know that this time is super difficult for many of us. You are not alone if your children are struggling. If your children haven’t verbalized their grief, check on them and make sure they have the invitation to grieve if needed. There has been so much lost in this time, and while it is not forever, we want these kids (and ourselves) to come out on the other side healthy and able to move into the next season with confidence.

“The pain passes, but the beauty remains.” Auguste Renoir

But recently, a mom wrote in for help, looking for advice to help her with a heartbreaking problem. Her husband is dying and she wanted to know how to talk to her young children about what her family would be going through in the very near future. For the answers, we went to our experts.

“It’s important to explain to children that a parent is sick, and it’s a type of sickness in which he or she will get sicker, not better,” Joy Crabtree, Psy.D., a licensed psychologist at Cook Children’s Urgent Care and Specialties in Southlake, Texas. “The dying parent should be involved as much as that person is able in terms of planning and engaging in special activities with the kids (together and separately) during periods that he or she is well enough to do so.”

Crabtree suggests lots of pictures be taken and the parent write special letters to each child to be opened later at specific ages or milestones. In the future, after the parent passes, there will be periods of grief that pop up and perhaps a sense of sadness or a feeling from the kids that they were robbed the opportunity to share proud moments or special occasions with both mom and dad.

“If that comes up, the kids can be encouraged to write those thoughts down, either randomly or in letter format,” Crabtree said. “They can simply keep an ongoing journal of what they wish they could tell the parent who died or even write it on a note and tie it to a balloon and set it free. They might keep a box of drawings or notes that they make for mom or dad.”

Crabtree suggest the children go into therapy and the dying parent join as well if possible to address and get support/guidance for questions/behaviors that are coming up for the kids. “There is certainly no guidebook or specific right or wrong way to handle the process,” Crabtree said. “It will be tough no matter what, but with open communication, sharing memories, and the understanding that all questions and thoughts are welcome, they can work through it together.”

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said she has seen a family go through this first-hand. She said the young father did an “incredible job of leaving a legacy” for his 2 year old by writing a book for her and lots of letters for her at critical points in her life, such as starting kindergarten, middle school, high school, graduation, turning 13 and 16, getting married and becoming a mom. The parents also bought charms for their daughter to be given to her on those critical dates.

Lena Zettler, MA, LPA, director of Psychology at Cook Children’s, said finding the right words to describe what’s happening will be crucial to helping the child through such a difficult time and the way the message is delivered will depend on the age of the child.

• Very young children will not understand the abstract concept of death, and saying that “daddy is passing on” may be more confusing.

• Children should know that their parent will not be asleep, and some concrete things like “death happens when our heart stops beating."

• Kids will usually ask questions that they are ready to hear the answers to, so listen to what they are actually asking about and answer that. Most times they need more concrete answers than we expect.

• When answering, give kids some time to process … say a few sentences, and then wait until the child is ready to hear more.

“We often use a lot of words and kids under 10 may not be able to process more than a few sentences at a time,” Zettler said. “Make sure all the kids get the same info, but it may mean talking separately to the children if their age ranges are broad (example, a 3 year old and a 10 year old). Include both parents in the conversations if both parents able physically.”

Zettler says if you don’t know the answer to a question, it’s OK to say you don’t know (for instance, “How long can daddy play ball with me?”). Also, kids of all ages need the same information over and over again, so be prepared to have many conversations. They may ask you a serious question and after a brief, but accurate answer from the parent, they may go right back to playing and acting normally. That is OK … they are taking in the amount of information they can process at that time.

“Celebrate mom or dad’s life NOW while that person is still here; talk about what is happening,” Zettler said. “Don’t forget that kids need to play. That doesn’t change when something like this happens. In fact, playing is the best way that kids have to learn new coping skills.”

Remember to provide support for the children and notify caring adults at the children’s schools. There may be additional support that teachers, nurses and counselors can provide.

Read age appropriate books on grief/terminal illness together (parent and child, or as a family). Books on death may not seem relevant while the parent is “just sick,” but books on death/loss may be more helpful after the death. Zettler says examples of books on terminal illness and coping with that for kids are: “Beyond the Rainbow” and “Help me Say Goodbye.”

Zettler says some children may struggle academically early on. Some kids, however, may seem less disrupted and more able to keep up their school work. That doesn’t mean they aren’t grieving, or that their academics may not suffer later. If they are getting behind academically, and they have not had school problems, before, don’t panic. They will catch up. If they have had problems before in school, definitely reach out to school personnel and consider getting the help of a psychologist or therapist.

“Kids will be afraid, unhappy and may act out more than usual,” Zettler said. “Don’t see this as abnormal or behavior ‘problems.’ You can still enforce rules especially if kids get aggressive but be patient with each other. Try to help them find words to express their feelings. Tell them that it is OK to have feelings. Reassure kids with words, with your presence, and with other comforting things like maybe a stuffed animal. It is OK if they “regress” during this time and do things they stopped doing when they were younger. If they really struggle with this or with difficult behavior, see a psychologist or therapist who has experience with pediatric grief or loss.”

Resources

“Preparing Your Children For Goodbye: A Guidebook for Dying Parents” by Lori Hedderman.

http://www.centerforloss.com/wp-content/uploads/2014/10/A-Childs-Grief.pdf

http://www.cancer.org/treatment/childrenandcancer/helpingchildrenwhenafamilymemberhascancer/dealingwithaparentsterminalillness/dealing-with-a-parents-terminal-illiness-toc

About our sources

Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages three years through 17, and their families. We also have some limited services available for children age 2. 

As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas.

To access any of our services, please contact our Intake Department. To expedite your call, please have your child’s date of birth and insurance information ready.

A young person with a history of depression is obviously at a greater risk of suicide. Parents want to be alert for any changes in their adolescent’s typical behavior. They may have been very active in sports in the past, or band, theater, or cheerleading, and now are less interested or involved. They may be isolating themselves, not only from family, but also from friends. Motivation may be dropping, along with grades. You may see sleep patterns change and the teenager may be sleeping for extended periods of time and be difficult to wake in the morning. One may also notice their need for sleep is decreased or they are having difficulty falling asleep. Appetite may change as well and they may eat a lot more or a lot less, and actually be losing weight.

If a young person is talking more about death, dying, and have a sense of hopelessness, that is a big concern. Drug use and other impulsive or risky behavior can place them at a greater risk of suicide as well.

When there is a suicide in a community, parents should discuss it with their kids, particularly since they have likely already heard about it at school or from friends. Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them. Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.

Even if a young person does not have a desire to harm themselves, their feelings of grief and sadness about a peer’s suicide can be significant, regardless if they were a close friend or just an acquaintance. Again, be a support for them and encourage them to discuss, and work through their feelings. Answer any questions they may have and explain, if appropriate, any similar feelings the parents may have as well. This may also be an opportunity for the adolescent to make a positive out of a negative experience. They may consider starting a grief support group, work on a memorial for the person who has passed away, or engage in volunteer activities. Sometimes putting feelings of sadness into positive activities can be helpful in the grieving process.

Above all, parents should be “tuned in” to their children. When unusual behavior changes are occurring, ask about them. Additionally, reassure your children you are always there for them, no matter what issue they are facing.

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Additional resources:

• Cook Children's Psychiatry and Psychology department
• Dealing with depression
• Resources & education
• 5 ways to fight depression
• When depression is severe

About the author

Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s, sees patients at Cook Children’s Urgent Care and Pediatric Specialties in Southlake, the first such pediatric facility in town. Previously, she worked seven years in Denton at Cook Children’s Psychology. She moved to Southlake to be closer to home. She sees patients Monday through Thursday, and on Friday she evaluates patients for conditions such as ADHD or autism Joy is married to Tim Crabtree and they have three children. If you feel your child needs to speak to a psychologist or psychiatrist, talk to your pediatrician or call 682-885-3917.