• Every source, from Indian Health Service Chartbooks to your cousin can tell you that death is more frequent on the reservation. The leading causes of death are heart disease, cancer, accidental injury, diabetes and chronic liver disease.

• Infant mortality rates for Native Americans as a whole are 150% the rate of the total U.S. population. The Aberdeen area of the Indian Health Service (the area in which the Spirit Lake Reservation is located) shows an infant mortality rate of 2% - many times the U.S. rate, many times even the high rate for Native Americans.

==== > DID YOU KNOW>>> That of all of the ethnic groups, tribes, etc. in the United States, the two most at-risk of Sudden Infant Death Syndrome are two groups of Native Americans, i.e, Native Americans residing in Washington State and the Lakota Sioux. {Yes, I do know that Spirit Lake is Dakota, but I still thought it was a disturbing fact.}

• The leading causes of death for Native American men are heart disease, accidents, malignant neoplasms (cancer), chronic liver disease, and suicide, in that order.

• Native Americans are three times as likely to die in accidents, 4 times as likely to die of chronic liver disease and 5 times as likely to die of tuberculosis, compared to the U.S. population as a whole.

What does this all mean? It means that, during early and middle childhood, the average child on the Spirit Lake Reservation is much more likely to experience death up close and personal than are children of the same age who are not tribal members.

I have a personal interest in how death is understood by and impacts children because, as you may know. my husband died when my children were eight, nine and twelve years of age. At the time, I found very little information about parental death (this was before Princess Diana died, which seemed to spark a brief interest in children's death, which then died out, pardon the expression).
 
 

When a parent dies... what I know now that I wish I knew then. The best book I have read on this topic is Children and grief by J. William Worden. I highly recommend it. The most important points from this book, I think were on the mourning process for children and what adults can do to ease the difficulty for children of experiencing parental loss. Although his research has focused most on loss of a parent, he does discuss somewhat other types of losses, such as siblings, and much of what he has to say would be applicable in this context as well.

THE MOURNING PROCESS Worden says that children must accomplish four tasks.  The first is to ACCEPT THE REALITY OF THE LOSS. The child has to learn to accept the finality of the loss. I remember when my sister-in-law's father died. Although my niece had it explained to her that Grandpa had died, was in heaven and so on, still, at three years old, she had difficulty comprehending this, and from time to time, ask her mother "When's Grandpa coming back?" According to Worden, when children have not seen the body, or when the death is sudden and unexpected, it is easier for them to deny the reality of it. In this case, we did NOT follow Worden's advice about giving children a choice of attending the funeral or not. Personally, when my husband died, I was not much prepared to deal with anything during the first few days. The funeral director, who knew my family through church, was gently insistent that it was important for all of my daughters to attend the funeral, even my nine-year-old, who, literally, had to be dragged there kicking and screaming. Now, at the mature age of thirteen, I asked Jennifer if she thought that was wrong of us to make her go, and she said, "It was all right. I didn't want to go to the funeral home more than the funeral." (Trust me, she was shrieking that she wasn't going to go.) In Worden's study, the great majority of children attend the funeral, and most of those who did not were very young. The second is to EXPERIENCE THE PAIN OR EMOTIONAL ASPECTS OF THE LOSS. Worden says that if children see adults who are not dysfunctional with grief, it is easier for them to express their own feelings. He also says that children are better off if adults are not depressed. While that may be true, I am not sure it is a realistic expectation to put on a parent who has just lost a spouse (or a child). I am sure there were days that I was not very functional - some days I just sat in my living room and cried. My husband had died. I still consider that a very normal response. Another normal response is to be angry. I never really experienced that very much, but I know it is a very common response in both children and adults. Jennifer was mad at her father, she was mad at God.        I think, like the third task, this is something that happens over time. I agree with Worden, too, that young children are particularly vulnerable. My youngest, who was eight when her father died, seemed to be doing okay at first, but a year or so later, when we moved back to California, she started to become depressed and withdrawn, a total personality change for her. I think, when she was still in North Dakota, her very close circle of friends and activities helped to keep her busy and protected from having to deal too much with her father's death. As she got older, and the finality of it set in, as she said "that I will never have a dad", she became much sadder than she had been a year before. The third is to ADJUST TO AN ENVIRONMENT IN WHICH THE DECEASED IS MISSING. I think this is very hard, especially at first. We had a lot of invitations to people's homes the first Thanksgiving after Ron died, and at Christmas time. I decided to stay in North Dakota and "get it over with".  Get what over with? Not having him there to carve the turkey, cut down the Christmas tree, help decorate the house, etc.            I was rather surprised by Worden's findings that death of a mother affects the children much more than death of a father, because I was thinking that there is usually a big change in the family income when the father dies, children have to move, and so on. However, as he pointed out, children are often closer emotionally to their mother and she interacts with them more on a daily basis. She is the one who knows what they like for breakfast, where their shoes are likely to be found, what time band practice is, the phone number for another mother who could pick them up from the basketball game, and a million other little details.       I also totally agreed with Worden's finding that adjustment here is a process and not a one-time event. I know that there were times when our youngest daughter, who was quite a good swimmer, would do well in a meet and be thinking "I can't wait to show Dad my ribbons," only to remember that Dad was not going to be there when she got home. The fourth task is to RELOCATE THE DEAD PERSON IN ONE'S LIFE. Worden says (and I agree) that it is NOT best to forget the person and move on. It is important for children to remember the parent, but to go on living. My children each have some momentos of their father, pictures of him, toys he gave them,  a flag the Veterans of Foreign Wars presented to the family, a star quilt. These are things that are very special to them because they symbolize his life, what was important to him, and that people remembered him.

Worden says that, "Three things a child needs after the death of a parent are support, nurturance and continuity," but providing these may be difficult for the parent who is dealing with his or her own grief.

Provide or arrange social support for the child. When my daughter did not want to attend the funeral, someone must have mentioned it to the school principal (Sister Dorothy), who promptly called the homes of four of my daughter's friends that she always hung around with in school and asked their parents if they could come to the funeral and sit with Jennifer. They sat in their own pew in front of us and all cried together. In general, when I think of the number of people who helped our family in diverse ways during this period, I feel truly blessed.

BE THERE FOR THE CHILD TO TALK ABOUT THE DECEASED PARENT Some children may not want to talk about their parent right away. Other children may want to talk but, in Worden's study, they often were worried about burdening the surviving parent. Having other adults around who support a child emotionally, who are willing to let him or her talk about their dead parent, and about other concerns they have, are related to better adjustment. It reminds me of a story I heard once about a little girl who went to visit an elderly neighbor who had lost his wife. When her parents asked her what she had to say to someone so much older, she replied, "I didn't say anything. I just sat on his lap and helped him cry." Sometimes having someone to help you cry can be good.

SEND MONEY. MAKE DINNER. I know this sounds callous, and I was quite surprised by how many people in the first few days after my husband's death sent me checks. In retrospect, I realized these were mostly people who had experienced a death themselves. The more stresses a family has, the more problems they tend to develop. The more you can ease the family's stress, in financial terms, in demands on their time, the better off they will be, particularly in the first period of adjustment. Added on top of a death in the family, everything, from making dinner to paying for the funeral bills, can seem overwhelming. All the cards and words of sympathy are nice, but I will never forget the fellow faculty member who sent her husband over to fix a crack in the foundation of our house where water was pouring in. It was the sort of thing my husband would have done, of course, but he wasn't there to do it.

AS A PARENT, MINIMIZE ANY OTHER CHANGES IN THE CHILD'S LIFE.  This is one area where I think my education in psychology truly helped my children. Stress, I know, is not additive. Having three stressful events happen, such as a death, changing schools and moving to a new neighborhood, put children (and adults) at much more than three times the risk of problems such as depression, substance abuse, etc. Even though my first impulse was to sell the house, move back to California, find a new job and put all the children in new schools, I did not do that. I waited a year to sell the house, and then another eight months before we moved. Let me say this again, because it is important...
If you can at all manage it, do NOT move, do NOT change jobs, do NOT put your child in a new school, do NOT get married again. Wait at least a year to do any of these things.Obviously, there are exceptions to this. If the bank is going to foreclose on your house because you can't make the payments, or your child is getting beat up at school every day, then an immediate change may be in order. Overall, however, it is much better to get adjusted to this major change in your life before doing anything else.

Siblings responses to sudden infant death. The author's seventh (of eight) children died of SIDS. The article is more a scholarly type one than a personal story, although it includes some of both. It does give some insight into sibling responses to sudden infant death. Click here to read this article.

The Sudden Infant Death Syndrome (SIDS) web site is absolutely one of the best places on the web. Be sure you read several of their pages. They provide answers to questions a lot of people have, such as "What should I say (and not say)?" "Is it possible to prevent SIDS?" Click here to go to their home page, but do not stop there.

Click here to go to the next assignment.

Click here to go to the last page in this chapter, on children's friendships.