Positive tools for thriving families.

Grieving the pregnancy loss of a child is complicated, especially for siblings. A 4-year-old girl is participating in circle time in preschool. As her turn comes to share her weekend news, she innocently says, “We went to visit my dead brother in the graveyard. He died when he was born. I put flowers for him to smell.” There is silence—and then the teacher simply moves on to the next child.

When the girl’s mother comes to pick her up from school, the teacher pulls the mother aside to state, “Annie shared some very disturbing news with us at circle time. Is something happening at home?” As the mother hears the details, she smiles sadly and fills the teacher in on how her first child died very late in pregnancy, and how they have shared this information openly with their children. And yes, they did go to the grave on Sunday, as they usually do on his birthday. The teacher, stunned, failed to respond adequately. The mother continued, “Please, respond to me and to my daughter, as you would to any other person who had lost a child and a sibling. That is all I expect…”

This is a true story and reflects what families may have to struggle with as they make the choice to embrace the baby’s death openly in the family. Social norms may not be very receptive to talking about death and dying, especially with younger children, and even more so about pregnancy loss. Struggles with secrecy, shame, and privacy, and social pressure to keep things within the home or just between adults may prevent honest, clear, developmentally appropriate, and healthy discussions about pregnancy loss with children.

Sharing the death of a child, via an early or late pregnancy loss, via a stillbirth or immediately after birth, can be excruciatingly painful and complicated for parents. The loss, the trauma, the helplessness, and hopelessness are overwhelming as it is. But it can be even more confusing and difficult as parents try to figure out the best way to share the loss with their other children, and many question whether they should share the death at all.

It is important to clarify that there is no perfect, no absolutely ‘right’ or ‘correct’ way to share or not share the death of your child with your other children. Each family needs to navigate and choose a path that works best for you as individuals, as a couple, and as a family based on your religious, spiritual, and cultural beliefs. However, there are developmentally appropriate ways to talk about the death with your child that can be honest, tangible, understandable, and healing for all concerned. It is these developmentally appropriate tools, means, and skills that I hope to share with you to positively facilitate the process in your family.

Since there are so many configurations and possibilities of family constellations, and the timing and nature of the death, I cannot address each unique situation. However, it is possible to make some generalizations.

Parental Bereavement

The first question you want to ask yourself and your partner: “Are we going to tell our child that she had a sibling who died, and are we going to be honest about how and when it happened?” Whether the death occurred before or after the birth or adoption of your other children, you should probably actively question and discuss with your partner where each of you stands in terms of sharing your reproductive story and the details you want to provide. It is crucial for parents to first and foremost explore and understand each other’s position on the issue. Traumatic as the loss may be, choosing different and conflicted pathways to sharing the death with your children can lead to enormous strife, stress, and gaps in the relationship. If there is significant disagreement between the couple regarding this issue, perhaps it is best to seek therapy to help you come to a mutually agreeable life-long path of sharing and support within your family unit.

If you have children who are aware of your pregnancy, the loss, the birth, and perhaps the funeral and the decision to share, may already be made for you. Not including children in the grieving process could be confusing to them, as they may experience it as their sibling suddenly “disappearing,” with little adult explanation and support over time. The lack of explanation or processing can be also be damaging to children as they may blame themselves, blame their parents, and worry that they might “disappear” too. A mystifying loss can also increase anxiety, as children may misunderstand their parents’ grief and depression. Here too, children may blame themselves and become over-protective, clingy, or even angry as they try to make sense of their parents’ despair. It is also not unusual that children may experience some anxiety around separations, transitions, and bedtimes after a family loss, which can become problematic in the long-term if these concerns are not addressed early.

Hence, when children are aware that no new baby is coming to join their family, it is perhaps emotionally apt that the parents work closely with their children, in developmentally appropriate ways, to help them understand, process, and heal from the loss as well. Kids need support, time, and space to grieve, understand, cope, and heal, too, as their limited cognitive and emotional capacity does not allow them to fully grasp the meaning and impact of the death.

Infant Loss

Many parents inquire about the concrete meaning of “developmentally appropriate” ways to inform and discuss the death with children. Based on age, experience, and temperament, children progress through varying developmental stages, which determines their emotional, cognitive, physical, verbal, and social capacities and skills. Each child is unique in his or her individual developmental process, regardless of similarities in age. It is critical to assess and understand where your child is developmentally across different domains, to determine the content and words to use to explain the death. Usually, the younger the child, the simpler and more concrete the information has to be. Young children do not have the ability to grasp abstract information about death and dying. In fact, even older children struggle to grasp the permanence of death.

Many parents may ask, “Well, how do I assess the developmental level of my child?” You don’t have to be an expert. Exploring and reading some basic developmental psychology books, researching child developmental stages, observing your child’s language and play, and being sensitive to their confusion and vulnerability may give you a basic sense. Or, you can consult with a therapist who works with children, and get some guidance on how to process the information.

In general, regardless of the child’s age, perhaps clear, simple, but age-appropriate honesty is the best route to go. You may have to protect your child by not sharing minute details, but for the most part, it is better to stick to the truth. This is because as time passes, your child will be inquisitive and ask for more details. You don’t want to have to change your story, or make up fictional details, which can later be refuted and can lead to mistrust. So saying that, “The baby was sick in my uterus,” or “The baby could not breathe well,” or “The baby did not stay long enough in my body to grow big and strong,” are all simple ways to share the truth.

It is helpful if you can be concrete in the sharing process, to make it more tangible for your children, by providing pictures and memories. If you have a picture of the baby in utero, or a picture of the baby at birth, a hand or a footprint, or pictures of the grave or urn…. all are important and concrete ways to make the baby and the death very real and understandable for children, and even for yourself. Sharing the pictures and memory book with family members and close friends, and elaborating on how your family incorporates your baby’s death in your everyday life and celebrations further allows acceptance and a healthy inclusion of the baby as your children grow up. Visiting the graveyard and the urn on a consistent basis, putting pictures up in your home, and allowing a safe space for children to ask questions and discuss the death in an ongoing way, can be very healing in the long term.

This last point is crucial. Just because you have shared the death with your partner and your children at a given moment, don’t expect the topic to be permanently closed. It can be a life-long developmental process for each of you as individuals and as a family unit. Your reproductive story is also your children’s family story and something they may need to integrate as part of their identity and life story. More importantly, even though it may be extremely painful for you to go back to the death in various forms and occasions, your children will benefit if they feel your openness and invitations to questions, thoughts, and ideas about the baby and his/her death in an ongoing way.

Don’t be afraid of this process and try not to avoid it and shut it down. It is absolutely okay for your children to see your grief and sadness about the death, and it is necessary for them to see that you can be honest about it, that you can talk about it, that you can feel and share the pain, and that you can cope with and heal from this devastating trauma. That is exactly where your children’s healing and strength will emerge from in life, as they ask you again, and again, and again, “Daddy, Mommy, where did my brother and sister go?”

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  • Exceptional, impressive, thoroughly 'kid friendly' from beginning to end, "Family Changes: Explaining Divorce to Children" should be a part of every community library Parenting Studies collections. For families with young children who are having to deal with divorce, "Family Changes: Explaining Divorce to Children" will prove to be an invaluable and instructive aid.

    Editor in Chief - Midwest Book Review

  • Those of us parenting, working with, or caring for children experiencing divorce will welcome Family Changes as a unique, positive, and creative resource for helping children understand and cope with this complicated transition. The comprehensive note to adults effectively explains how children work through painful questions and feelings. The touching story—with the endearing Zoey and her attempt to understand a very grown up topic—ends with extremely helpful follow up questions that will be highly valued by parents, child advocates, therapists, and others who wish to better serve children during this difficult time. I highly recommend this book to parents and professionals.

    Sacha Coupet, Ph.D., J.D. Clinical Psychologist and Associate Professor of Family Law, Loyola University, Chicago, IL

  • Family Changes: Explaining Divorce to Children is an outstanding book that is gentle, positive, and validating for both children and adults. With an excellent and informative parent guide about the value of talking to children about their feelings, a highly sensitive and engaging story with exquisite illustrations, and an effective list of questions that children typically ask, this book is essential reading for divorcing families, and for therapists and advocates working with children of divorce.

    Sandra A. Graham-Bermann, Ph.D., Professor of Psychology and Psychiatry, University of Michigan

  • Family Changes is an inspiring and exceptional book on divorce. It explains divorce in a developmentally appropriate and comforting language that validates children's complex feelings about divorce. Dr. Maker's expertise and years of experience working with children who are coping with the grief and confusion that often accompany divorce shine through in every page. I highly recommend this book to divorcing parents, schools, libraries, and professionals working with children of divorce.

    Martha Crowe, M.A. Child Development, Institute for Public Health, San Diego State University, CA

  • Dr. Maker has brought us this excellent child-centric educational book about how to navigate the changes of a family undergoing divorce. Dr. Maker takes us through this experience from the child's point of view and shares the gift of positive transformation that can occur during this life-changing time. The illustrations are sublime and the topic is handled so gently and ingeniously. Of course, it is written by a child psychologist with the gift of creativity. It's a book that every child therapist, library, school, and families going through a divorce should have on their shelves.

    Krista Royabal, M.D., Psychiatrist, Executive Medical Director, True Life Center for Wellbeing, CA

  • Based on the typical emotional turbulence a child feels from separation or divorce, Family Changes receives high recommendation as the first title that adults should turn to in the effort to explain, explore, and support a child's feelings in the matter, concluding with a list of 'process questions' which adults can use to further enhance the story line's overall approach.

    CA Bookwatch/Donovan’s Literary Services/Recommended Reading

  • The story touches on several key issues that children worry about - will their parents still love them, will they have two homes now, did they somehow cause the divorce, etc. The book also opens with a straightforward Note to Adults and ends with a list of questions that adults can discuss with children. Often books that do a good job of explaining divorce and separation are so focused on the child's point-of-view, that they don't offer any advice for the parents, caregivers, and teachers that are trying to help the child makes sense of it all. Family Changes avoids that problem and gives good guidelines for adults. I would recommend this book to parents and other family members, educators, and counselors.

    NetGalley Reviews/The Fairview Review - Librarian

  • This story is filled with little moments that reflect the nature of children perfectly. If you need to explain what it means to be divorced or separated to your child then this is one of the best ways to do that. The book is filled with relatable emotions and questions that a lot of children will have if their family is going through a separation. Dr. Maker’s years of experience are evident in the story as she masterfully addresses many common concerns for children experiencing a divorce in their family.

    The Littlest Bookshelf