Case Study: 4 year old boy

We were referred a young 4yr old boy in September 2020 following the sudden death of his father, who had suddenly collapsed outside his bedroom door one night - this was the last time that he saw his Dad. The father was taken to Critical Care where he died unexpectedly 24 hours later. As this was at the start of the pandemic, family were not allowed in to visit or to be present to say their goodbyes.

We first met this little boy less than a week after the death, he had been told that his Dad's death had occurred but he had not been informed of the details - Grandparents were also divided at this point over whether he should be told however Mum was in full support of us exploring this with her son. Each session lasted an hour and we saw him on a weekly basis for the first 3 months followed by twice monthly for the next 3 months.

When we first met him he spoke in baby 'gurgles', was not sleeping and behaviourally had regressed. Mum was really struggling with how to deal with this alongside suddenly being a single parent.

At this point we felt our priorities for this boy and his Mum were:

1. Understanding what death was, including its permanency

We spent time chatting to him about how death was different to sleeping, what happens when someone dies and the consistent message throughout was that he would never see his Dad again. This may sound blunt however at his young age this matched his level of understanding and was very well received.

2. Understanding what had caused his Dad's death

He said he thought that Dad had been killed by someone as this is what he had seen on a video game and thought you could only die by being shot. We explained about the organs in the body and that something had gone wrong with one of his Dad's organs and this meant that he could not get better and that he died. We kept things very basic but again this helped him to make sense of what had happened and that his Dad had died this way.

3. Exploring fears about night-time/sleep specifically being scared to sleep in case Mum also died

If he woke in the night he couldn't get back to sleep independently and went into Mum's bed which meant she was also disturbed. Mum was not coping well with little sleep and was frustrated with the situation. We spoke to the little one about this and  finally unpicked  that he was scared about being asleep as his Dad had become poorly overnight. He was scared that this would happen to Mum also. On one occasion we facilitated a session from his bedroom, with Mum's consent, playing and talking about night-time, how sleep was important and that mum would be safe if he slept. We used his cuddly toys to encourage thinking about his bedroom as a safe place.

4. Supporting Mum to gain confidence to talk openly and honestly about his Dad to enable her to build a skill set to use for the remainder of their lives 

Alongside memory making this was probably the biggest piece of work that we did with the family. As previously mentioned Grandparents were divided about the information that he received, in particular they didn't want him to be told that Dad had died and how this had happened as they perceived this to be too upsetting. Mum was being pulled in all directions, constantly juggling her own grief alongside trying to do the best by their son. It was evident that the little boy was already filling the gaps about what had happened with 'magical thinking' (i.e thinking that someone had killed Dad) and Mum was hesitant about the value of speaking about Dad in front of the little boy. We gave Mum some examples from lived experience. One of the practitioners at Windmills had experienced  the death of their father also at the age of four. In the practitioner's case the deceased was not talked about frequently which resulted in the practitioner having no memory of their father or feeling comfortable to talk openly with the family. This example was a real turning point for Mum who could see how including the boy's Dad in daily conversations, whilst difficult at first, would become much easier and have a positive effect on their overall grieving process, as they would both experience many milestones throughout their life without Dad being present.

5. Making memories

We included a craft project in each session.  This gave us a non-threatening environment with no expectations from the child. We often find that whilst they are doing the craft work they drop their guard and can talk openly and honestly with no direct pressure of a 'question and answer' session which can be difficult. We used craft items to make a photograph mobile, we made a huge snowman at Christmas that he took to 'Daddy's Garden' and we also made anxiety relieving projects to aid focusing of thoughts and relaxation to aid sleep. Some of these items were kept safe in his memory box which took pride of place in his bedroom.

We also used bereavement books with him and Mum as a reinforcement tool of what we had worked on during the sessions. They were also useful as an aide memoire for the future. Mum used these books also to evidence best practice to the Grandparents. This resulted in them all agreeing to be fully inclusive for the little boy.

By the time we reached our final session this little boy was talking appropriately for age, proud to speak about Dad, which had become a 'normal' part of life between him and Mum - he also took us to visit 'Daddy's Garden' to show us all the things we had made together that were displayed there.

Mum had completely transformed also, she was standing taller, much more confident in herself and talking excitedly about what the future would look like for them both. Some time following this boy being discharged from Windmills, we received a lovely message from Mum with a picture showing a craft project which they had completed together for Dad's birthday. Her son was proudly showing a decorated plant pot which he had potted in memory of his Daddy.

This case study shows how family groups become united in their individual grieving journeys with all members learning valuable tools for living beyond grief. Children and young people have become included within the dying phase and post death phase of a loved one. This gives them the life experience of death and dealing with emotions in a positive and proactive way. Experience of death is a certainty in anyone's lifetime however as a society we have moved further away from being open and honest around this area of life. Death doesn't need to be a traumatic experience which can affect a person's whole lifetime. By promoting inclusion and memory making, our children and young people experience bereavement holistically which promotes a positive outlook, the necessary tools to cope with emotions and the ability to lead a fulfilling life.