Grief Counseling for Children: How to Find the Right Help

While we may think of death as a grown-up topic, the truth is that many children will be touched by grief and loss at an early age. By the time they turn 18, roughly 5.8 million children will experience the death of a parent or sibling. The number of children grieving any kind of loss, including the death of a close friend or extended family member, is much higher: 1 in 3.

Some children benefit from having a person to talk to about their grief who isn’t a family member or friend. Counseling can help children to process their feelings, and make it less likely that they’ll struggle with their emotions later in life. Some forms of therapy are a more natural fit for grief counseling than others, and finding a child therapist who is experienced with grief can make a world of difference.

Do All Grieving Children Need Counseling?

If your child is reluctant to go to therapy, there’s no need to push. While grief therapy can be very helpful, it may not be necessary for every child. Grief is painful and difficult, but it’s also a natural process and the result of the close bond your child formed with their loved one. Research shows that many kids are able to adjust and cope with their loss on their own, with fewer lasting difficulties as they grow. These children might appreciate having a listening ear to talk to, but may not want or need it.

Other children have a harder time dealing with their intense feelings of grief. They may feel “stuck” in their grieving for a long time, or their emotions might be so overwhelming that they interfere with school, family, or friends. A child’s temperament, age, gender, support system, and trauma history can all influence the way they grieve. The way that a loved one died can also have a big impact.

If these more vulnerable kids don’t get help to move through their grief, their unresolved feelings put them at risk for problems later in life. These children may struggle with tantrums, problems with school or peers, and increased anxiety or depression. As adults, they may be more likely to develop mental health problems or unhealthy ways of coping with feelings.

When to Look for Help for Your Child

How can you tell if your child is coping well, or if they will need counseling to get through their grief? Your child’s feelings and behavior, as well as the circumstances surrounding their loved one’s death, can guide your decision-making.

If any of the following are true for your child, they may be more likely to need a grief counselor:

• Your child did not have many opportunities to mourn, such by attending a funeral or memorial service

• Your child struggled with anxiety, depression, or low self-esteem before the death

• Your child has a history of other traumas or losses

Some types of losses also make it harder to grieve, such as:

• The loss of a parent

• A death that was sudden, unexpected, or violent

• A death that happened when your child was very young (under age 8)

Regardless of the circumstances, if your child is showing signs of ongoing anxiety, depression, or anger following the death, they might benefit from therapy. Some of these signs include:

• Feeling guilty or believing they did something to cause their loved one’s death

• Avoiding talking about the death or doing things that could trigger memories of their loved one

• Feelings of hopelessness

• Intense feelings that get in the way of daily life

• A lack of interest in doing things, or big changes in behavior that continue after the initial wave of grief has passed

• Nightmares or trouble sleeping

• Any mention of self-harm or a wish to die: this should always be taken seriously

Sometimes, a child who is seemingly doing just fine will ask to go to therapy. It’s possible for kids to be grieving deeply on the inside but not show it on the outside. If at all possible, find a way to set your child up with a counselor for at least a few sessions to get some support and see if ongoing therapy would be a good fit.

What Types of Therapy Can Help Grieving Kids?

If you’ve decided to pursue counseling for your child, you’re faced with a ton of options. Should you look for individual therapy or a group? Does your child need a therapist, psychologist, or psychiatrist? Let’s take a look at a few options for therapy that are a good fit for grieving kids. We’ll talk about how they work and why they can help with grief. We’ll also discuss what situations these types of therapy tend to work best for.

Play Therapy: Sitting on a couch and talking about feelings works well for older kids and adults, but it’s not always the most natural thing for young children to do. If you’re seeking therapy for a child under the age of 10, I strongly recommend finding a counselor who uses play therapy in their sessions.

Children use play to learn and make sense of the world around them. It’s why we see children repeating the same situations in play over and over until they master that concept and move on. Creative play and make-believe can help children sort through their confusion and strong feelings about death. It gives young children an opportunity to express big emotions and ideas that might be too complex to put into words.

A skilled play therapist can guide this process for children and keep an eye out for signs of trauma, self-blame, or big misunderstandings about death that could be causing additional pain. Look for somebody who describes themselves as a Registered Play Therapist to find someone highly trained in this type of work.

Trauma-Focused Cognitive Behavioral Therapy: Grief is shocking and stressful for everybody, but some children may experience their loss as a traumatic event. This is especially true if a child has lost a parent, or if their loved one’s death was very sudden or due to a violent act. Children who go through these kinds of losses may experience traumatic grief, which includes symptoms of PTSD.

Children suffering from traumatic grief might struggle with frequent nightmares, or deal with unwanted memories or images of their loved one’s death that pop up during the day. Sometimes, it might even feel like they’re living through that moment in time all over again, which is called a flashback. Traumatic grief feelings are so strong that children may avoid doing anything that they associate with their loved one or the death, so they don’t have to think about it.

These children need therapy that helps them deal with both their trauma and their grief, so they can think about their loved one without getting overwhelmed or avoiding things they used to enjoy. Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT, was designed to help children learn the skills they need to manage strong feelings and gradually tell the story of what happened to them. Kids get a lot of support from their therapist and caregivers along the way.

Group Therapy and Support Groups: Many bereaved children feel isolated. Even though grief is a common experience, it’s likely they don’t have any friends who have gone through a similar loss. Peers may not know what to say to a grieving child, or how to help. Young grievers may avoid talking to their friends about what has happened for fear of upsetting them or appearing vulnerable.

It’s also common for grieving children to worry about whether or not their grief is “normal.” Grief can bring up all kinds of feelings and reactions, some of which are confusing or even contradict each other. Reading stories about grief can help children realize that these complicated emotions are normal and okay. Talking to another grieving child, however, can be even more validating.

Being around other kids who “get it” can help grieving children in a way that individual therapy can’t. Instead of learning about grief from an adult, children can hear directly from other peers about how loss has touched their lives. Children can share their stories and struggles in a safe environment where they know everyone else will understand what they are going through.

Therapy groups are led by a licensed mental health professional, while support groups usually are not. Both types can have a lot to offer grieving children. You can find a therapy or support group near you by entering your zip code into this tool from The Dougy Center.

What Do Children Do in Grief Therapy?

If you’re considering grief counseling for your child, you may be curious about what exactly happens in the therapy room. Your child might be curious, too! Every therapist is different, but here are some general ideas of activities your child’s therapist might introduce to help your child learn about and express their grief:

• Read books or play games to learn age-appropriate facts about death and grieving.

• Use art or pretend play to explore feelings of grief without having to talk about them directly.

• Draw pictures, write poetry, or use other forms of art to express feelings and memories.

• Create rituals to honor and remember your loved one’s life.

• Write a letter to your child’s loved one to express things that were left unsaid.

• Learn coping skills to manage the strong feelings of anger, sadness, and other feelings that sometimes come along with grief.

A grief therapist will never push your child to talk about things before they feel ready. While they may make suggestions, your child gets to choose the pace. It’s always okay for your child to say they aren’t ready to share.

Help Your Child While You Look for a Grief Counselor

Once you’ve decided to find a grief counselor, it may take a while before you book your first appointment. Not all children’s therapists specialize in grief, or work with every age range. The demand for children’s therapy is high in many places, which means you might need to time on a waiting list or search longer to find someone who has availability.

While you wait for your first appointment, you can help your child begin to cope with their grief at home. As a parent or caregiver, your support will be one of the most helpful resources a grieving child can have. My book, A Parent’s Guide to Managing Childhood Grief, was created to help parents and other caring adults guide children through the difficult, complex feelings that come with loss.

This book is filled with simple, easy-to-follow activities that tackle big ideas like finding meaning and imagining a hopeful future after loss. You’ll find over 100 ideas for how to use creative play, books, and games to start gentle conversations about death, express difficult emotions, and strengthen family bonds after loss.

While not a substitute for therapy, these activities are inspired by my own work as a child therapist, and borrow ideas from cognitive behavioral therapy and other approaches often used with grieving kids. The book is available for presale on Amazon, as well as other major bookstores near you.

To find a grief counselor near you, check out The Dougy Center or the National Alliance on Children’s Grief. Both have directories to help you find local children’s therapists or support groups. If you live in New York, North Carolina, or Florida and would like to learn more about counseling with me, you can contact me here.

What is Prolonged Grief Disorder, and How Does it Affect Kids?

How long is too long to grieve? We all have our own ways of dealing with loss, and there’s no right or wrong way to respond when a loved one dies. Grief never really ends, but mental health experts recently created a new diagnosis for people who grieve intensely for over a year: Prolonged Grief Disorder. Both kids and adults can receive this diagnosis, and attend therapy designed to help them move through their feelings of grief.

Is it really helpful to put a timeline on someone’s grieving process? How can you tell if you or your child is experiencing prolonged grief? Let’s talk about what Prolonged Grief Disorder is, and how you can help a child who is struggling after a loss.

Prolonged Grief Disorder is a New Diagnosis

Grief is a universal emotion, but until very recently it wasn’t considered a mental health issue. Most of us will experience grief during our lifetime. As painful as it is, grief is a healthy, natural response to losing someone we love. Many mental health problems, like anxiety, involve having a big emotional reaction that is out of proportion to the situation. It’s hard to imagine having a reaction that’s too big to the death of a loved one.

Still, grief can seriously impact a person’s life. Like trauma, it can affect a survivor’s relationships with others, their worldview, and their hopes for the future. For a small number of people, grief has a major and lasting effect on their ability to get through daily life. They may feel numb or have a hard time adjusting to the reality of what has happened. They might feel hopeless about the future, or cope with their feelings in unhealthy ways. Prolonged Grief Disorder was created to give a name to people with these kinds of struggles.

Not Everyone Agrees That Grief is a Mental Health Problem

You can find Prolonged Grief Disorder in the DSM-5, the “therapy bible” that therapists use as a guide to diagnose and treat people with mental health conditions. However, not everyone agrees that it should be there. The idea that grief should be listed alongside mental health problems like depression and OCD has been a little bit controversial.

Some critics think it’s not helpful to decide when grief “should” be over, because everyone’s process is so different. Who is to say that one year is the right or wrong amount of time to grieve? The diagnosis could make grievers feel added pressure to “get over it” or “just move on” with their lives after a death. Some grievers already feel this pressure, as phone calls and support from friends tend to fade away in the weeks or months after a funeral.

There’s also worry that putting a label on grief could make a hard time even more difficult for grievers. There is still stigma around mental illness, and being told you have a “disorder” could make a grieving person feel ashamed or as though their feelings are not valid. Many people already feel self-conscious about how they have responded to their loved one’s death—will getting this label make that feeling worse?

On the other hand, getting a diagnosis makes it much easier to get into therapy. People benefit from therapy after all kinds of life transitions, including deaths, and it doesn’t mean the feelings they’re having are wrong. Hopefully, adding Prolonged Grief Disorder as a diagnosis will help therapists and grievers find new ways to get help and heal after loss.

The Symptoms of Prolonged Grief Disorder

According to the American Psychiatric Association, prolonged grief happens when a person has been intensely mourning a loss for a long time. For adults, this means grieving for over a year. For children and teens, this means grieving for over six months. Prolonged Grief Disorder is more likely to happen after the the death of someone very close, like a parent, child, or spouse. It’s also more likely if the death was sudden or unexpected, like from an accident.

Some symptoms of Prolonged Grief Disorder include:

• Shock and disbelief

• Yearning or longing for the deceased person

• Feeling like a part of your own identity is gone

• Feeling emotionally numb, or feeling extreme emotions like sadness or anger

• Trouble returning to day-to-day activities

• A belief that life is hopeless or meaningless

• Avoiding people, places or things that remind you of the death

These symptoms don’t just happen once in a while: they’re present for most of the day, almost every day. They are so frequent and so severe that they make it hard for the griever to keep moving forward in life.

When Children Experience Prolonged Grief

Children grieve differently than adults, and this is true when it comes to prolonged grief, too. You might have noticed above that kids and teens only need to have prolonged grief symptoms for 6 months—half as long as adults—in order to get a diagnosis. Children, in general, move through grief more quickly than adults do. They also tend to work through grief a little bit at a time rather than all at once, giving them time between spurts of grieving to focus on just being a kid.

Kids who have lost a parent, sibling, or other close relative or friend are at risk of developing prolonged grief, just like adults. In addition to the symptoms listed above, a child’s grief may show up in other ways, such as:

• Difficulty believing their loved one isn’t coming back

• Tantrums and intense emotional outbursts

• Focusing on or reliving the details of the death

• Worries that they somehow caused the death with their thoughts or actions

• Anxiety about bad things happening to other family members

Many grieving kids will have some of these symptoms, but kids with prolonged grief will have them most of the time, on most days of the week. Over time, they can lead to social isolation, or added trouble with depression, anxiety, or other mental health problems.

Grieving Children Are More Emotionally Vulnerable As They Grow

Grief on its own is not a mental health problem, but it is a tremendous stress and sometimes even a traumatic event. Grief is painful no matter your age, but it can be especially tough for young children who lose an important person early in life. Bereavement affects kids both in the short term, causing problems like depression, and in the long term, leading to struggles at school, difficulty in relationships, and substance abuse.

Not all bereaved kids will develop these mental health issues. In fact, most children will find healthy ways to keep living and growing through grief. All kids need lots of help from caring adults to understand death, grief, and loss. This is especially true for kids dealing with prolonged grief.

Help for Grieving Kids and Families

As a parent, caregiver, or someone who loves a grieving child, you are your child’s biggest source of support. Many grieving children do not need to attend therapy. Simply having an adult who listens and cares reduces their chance of developing mental illnesses later in life.

You can help your child understand their feelings and find ways to remember and honor their special person together. If you need help finding ways to do this, A Parent’s Guide to Managing Childhood Grief offers over 100 activities you and your child can complete together. Using simple materials and play-based learning, you and your child can share your feelings, learn age-appropriate information about death, and regain a sense of safety after loss.

If you suspect your child may have Prolonged Grief Disorder, a child counselor can help. Therapy gives children a safe place to work through feelings at their own pace, and learn how to cope with the strong feelings that come with loss. If you’re located in North Carolina, Florida, or New York, I may be able to help with in person or online child counseling. You can also run a search for therapists near you using Psychology Today or a similar directory.

5 Coping Skills for Kids with OCD

If your child is struggling with OCD symptoms, feel at a loss for how to help. Maybe you’ve tried using logic to help your child see how unlikely their worries are. Or, maybe you’ve been working really hard on relaxation and deep breathing techniques, but you aren’t seeing a lot of change. This is totally normal! The usual coping skills that help kids deal with anxiety and stress aren’t as helpful for OCD.

While many children with OCD benefit from counseling, there are still things you can try at home to help your child cope. You can help your child learn to understand what OCD is and how it works, and equip them with tools they can use to “fight back” against recurrent worries and rituals. Children with strong coping skills feel less alone, can manage their symptoms better, and they will likely progress through therapy more quickly, too. Let’s take a look at 5 coping skills you and your child can practice together.

Learn About How OCD Works

Obsessive-compulsive disorder, also known as OCD, is a mental health problem that is similar to anxiety, but with its own unique characteristics. It causes people to have unwanted worries or thoughts over and over again. To deal with these thoughts, people with OCD feel like they have to repeatedly do an action in order to relieve their anxiety or prevent something bad from happening. The repeated thoughts are called obsessions, and the repeated actions are called compulsions.

OCD often begins in childhood, and it can be confusing and frustrating for kids and parents alike. Kids really do not want to be thinking about the terrible things their OCD prompts them to think about. They may feel as though they’re going crazy, or worry that having bad thoughts means they are a bad person. Parents may be shocked by the seemingly out-of-the blue appearance of OCD worries. It can be tough to understand why a child is suddenly so afraid, especially when their worries do not seem logical or realistic.

The first step to coping with OCD is understanding what you’re dealing with. Books like Up and Down the Worry Hill and What to Do When Your Brain Gets Stuck teach kids that OCD is caused by a harmless “brain glitch” that keeps the brain from sorting out unhelpful thoughts. Books like these help children feel less alone, and can reduce feelings of shame and guilt that make it hard to get help. They also give kids helpful language to describe their experiences with OCD.

Cope by Focusing on Strengths, Not Worries

When your child comes to you with a problem, you naturally want to talk about it. We all want to be understanding, responsive parents, and heart-to-heart chats with our kids are part of the deal. This is a great approach for lots of childhood worries and struggles, but it doesn’t always work well for OCD.

The repeated worries that come with OCD aren’t logical. Kids with OCD often worry about events that are highly unlikely to happen, like a plane crashing into your home or contracting a rare disease. Sometimes, the worries don’t make much sense, such as being concerned that stepping on a sidewalk crack will cause something bad to happen.

Most kids know their fears aren’t realistic, but they still can’t stop thinking about them. Talking about the worries in detail and reassuring your child that nothing bad will happen is unlikely to make the worries stop. In fact, the more time we spend talking about and paying attention to OCD worries, the more likely they are to happen again.

You can help your child shift their focus away from the worry and towards something more productive: their own ability to cope. We can’t make anxiety go away, but we can help kids deal with their anxious feelings. Instead of asking lots of questions or giving lots of reassurance, praise your child for their effort to do hard things in spite of their worries. Remind them that they’re brave, strong, and capable of facing their fears…and that it will feel so amazing when they do.

Make an OCD “Worry Monster”

Parents may find themselves bending over backwards to try to soothe their child’s worries, or using tough love to try to muscle through activities that cause anxiety to flare. It’s exhausting, and can start to feel like a battle between parent and child. This leaves kids feeling frustrated or ashamed that they can’t just “get over” their symptoms.

Instead of fighting each other, parents and kids need to team up against the real enemy—OCD. We can help kids cope with their symptoms by externalizing OCD, meaning we imagine it as a force that isn’t a part of them and isn’t their fault. This helps to cut down on the shame kids feel, and can increase a child’s motivation to fight back.

A fun way to externalize OCD is by imagining it as an annoying pest, like a bug, creature, or monster. Ask your child to draw a picture that represents how they imagine their OCD. You might even give the creature a funny name. When you talk about your child’s struggles, blame them on this creature instead: “It sounds like Jim Bob is really giving you a hard time today.” It can inject some humor into a tough situation, and remind your child that they can choose whether or not to listen to what OCD is telling them to do.

Spot Unhelpful or Tricky Thoughts

Most of us go through life without questioning our own thoughts too much. We might misinterpret things at times, but it’s usually not a big deal. People with anxiety and OCD are much more prone to having overly negative, unhelpful thoughts. In particular, kids with OCD have a tough time dismissing thoughts that are upsetting or strange. Instead, these thoughts linger, and kids have to deal with the nagging, “what if?” feeling that comes with recurrent worries.

Kids with OCD can learn to notice when their thoughts are playing tricks on them. We call this skill metacognition, which means learning to think about your own thinking. Instead of just taking their thoughts at face value, kids can examine their worries like a detective. Over time, children can start to notice patterns in their own worries, which helps them not take the worries so seriously.

The book Tiger-Tiger, Is It True? is great for teaching this skill to younger children, and we cover it in depth in my online course for kids and tweens.

Practice “Talking Back” to OCD

So maybe your child has gotten very skilled at spotting their own unhelpful thoughts. What’s next? Kids with OCD have a couple options for coping with these unwanted worries: they can talk back to them, or simply ignore what OCD is telling them to do.

”Talking back” to a worry means finding something you can say to yourself instead that is more accurate or helpful. This could mean taking a huge worry and shrinking it down to a more realistic size, or reminding yourself that even when bad things happen, you can figure them out and move on. Talking back can also mean reminding yourself that you’re in charge of your thoughts, and don’t have to listen to the unhelpful ones. Here are a few examples of thoughts kids with OCD can use to “talk back:”

• “I don’t have any proof that this worry will happen.”

• “I’ve gone to school for 6 whole years, and I’ve never thrown up in class.”

• “Even if something bad does happen, I can handle it.”

• “This is just my OCD talking and I don’t have to listen.”

• “I’ve had this worry a million times and it’s never come true.”

Learning and practicing this coping skill empowers children to stop taking their worries and urges so seriously. Eventually, children may feel ready to ignore their OCD by not following through with compulsive behavior when anxiety arises. Facing scary situations and dealing with the anxiety without rituals or compulsions is the core of Exposure and Response Prevention, the most common and effective therapy treatment for OCD.

More Coping Skills for Kids with Anxiety and OCD

If you’re looking for more ways to help a child with anxiety or OCD, consider checking out my online coping skills course, Worry-Free Tweens. In the course, you’ll find child-friendly, in-depth lessons on how anxiety works, how to deal with it, and why anxiety can actually be a superpower.

You and your child will learn how to notice unhelpful thinking patterns and shift into a more realistic mindset when worries occur. Together, you can learn how and when to use coping skills most effectively. You’ll also find advice for parents on how to support and encourage an anxious child while avoiding the traps that can accidentally worsen anxiety over time.

If the course sounds like what you’re looking for, you can access Worry-Free Tweens here.

Counseling for Kids with OCD in Davidson, North Carolina

Coping skills are a great place to start when you suspect OCD. However, many kids will need the support of a mental health professional in order to overcome their symptoms. OCD often impacts the whole family: everyone has to change the way they do things in order to keep a child’s “worry monster” happy. Counseling can help both you and your child learn new ways to deal with repeated worries and urges, so you can get back to having fun together.

I’m licensed to help kids with anxiety and OCD in North Carolina, New York, and Florida. I offer face-to-face therapy in Davidson, NC, just outside of Charlotte. For families who live farther away, we meet for online therapy using a secure platform similar to Zoom. Both kinds of therapy can be effective (and sometimes even fun) for kids and tweens.

If you’re curious about therapy for OCD, check out my post on ERP. You can also check out my FAQ to learn more about what therapy with me is like. To ask other questions or inquire about setting up an appointment, send me an email. I am always happy to help.

5 Coping Strategies for Grieving Children

Grief can touch every aspect of a child’s life, from their relationships with friends to their thoughts about the future. It’s normal for kids of all ages to struggle with strong emotions after a loved one dies, but they may express their feelings differently than grieving adults. Body aches and pains are common in grieving kids, and you may also notice struggles with separation anxiety, difficulty sleeping, and trouble concentrating at school.

We can’t stop a child from feeling grief, but we can help them work through their feelings and learn to live with their loss. These 5 coping strategies can help your child to process their feelings about the death of a loved one in healthy ways.

Coping Skill #1: Reading Books About Grief and Loss

Reading a story together is a great way to gently introduce the subject of grief and loss to your child. Often, kids don’t have a strong understanding of death before it personally affects them. As hard as it is for adults to cope with a loss, it can be even tougher for children who aren’t sure what exactly is happening. Books about grief provide age-appropriate information that isn’t too overwhelming.

Young children may worry about what has happened to their loved one who died: Are they in pain? Are they scared? Older kids may worry about the thoughts and feelings they’re having in response to grief, and whether or not they’re normal. Children of any age may feel intense guilt about how they treated their loved one, and may even wonder if they somehow did something to cause the death.

When children are better informed, they’re less likely to struggle with worries like these. Seeing how characters grieve in stories give children examples of the many ways grief can look and feel. This can reassure children that no matter how they respond to grief, there is no wrong way to feel. Take a look at my recommended grief books for preschoolers as well as books for elementary-aged kids for ideas to get started.

Coping Skill #2: Scheduling Positive Activities

Sometimes, grieving people need to take a break from their grief. While it’s important to work through the feelings and pain of loss, they can become overwhelming at times. This is especially true for kids, who don’t have the capacity that adults do to handle lots of emotional pain all at once.

When a loved one dies, children may feel like nothing is fun or worth doing anymore. It’s common for kids to retreat from hobbies, extracurriculars, or social events they used to enjoy. Over time, this can lead to feelings of depression, which makes it even harder for a child to get out and enjoy life. A vicious cycle can form where the longer a child self-isolates, the worse they feel.

We can support children in taking breaks from their grief by setting aside time each week for activities that are fun, social, or creative. Tasks that give you a sense of accomplishment when you finish them are great, too. Playdates with friends, a family board game or craft night, gardening, or committing to visiting a new place in your town each week are all ways to help your child stay socially connected even when it feels hard to do.

Once you’ve chosen an activity, make sure to put it on your calendar so you can look forward to it and hold yourselves accountable. Sometimes, kids may feel reluctant to participate when the time comes. That’s okay—you can remind your child that it’s hard to get back to doing fun things after loss. Once they’re immersed in the activity, they may find it’s much easier to enjoy it.

Coping Skill #3: Letting Out Anger

There are many good reasons to be angry when a loved one dies. As a kid, it can feel so unfair to see so many other children enjoying time with their grandparents or other family members when your own time was suddenly cut short. Kids may also be angry at parents, doctors, or emergency workers who had to make medical decisions on behalf of their loved one who died.

It can be hard to figure out how to comfort an angry child, but they need support for their feelings, too. We can provide kids with safe ways to vent anger that don’t hurt people or damage belongings. Drawing a picture and ripping it up can help children release emotion. Other children may enjoy stomping on egg cartons, tearing cardboard, popping bubble wrap, or finding other materials that are safe to destroy.

Anger gives kids a lot of energy, so physical activity can be a big help, too. Any activity that increases a child’s heart rate can help them to discharge angry feelings. Jumping rope, riding a bike, or running laps are quick and easy ways to burn off some extra adrenaline.

Coping Skill #4: Examining Worries

A loved one’s death can change the way a child sees the world. This is especially true when a loved one’s death was sudden or traumatic, such as a death from an accident. Suddenly, the world no longer seems as safe as it used to. Something terrible and unexpected has happened, which makes life feel less predictable.

This can lead to a lot of worries for bereaved kids. They may worry about the health and safety of other loved ones, or about their own risk of dying. Some children may even feel less hopeful about the future, or have a sense that things just won’t turn out well for them in life. In big and small ways, their experience with grief can color a child’s thoughts.

We can help a child to pay attention to their thoughts and not take them at face value. Kids can act like detectives, gently questioning their worries to see how accurate or true they really are. Oftentimes, worries are not based on very much good evidence—they’re just guesses about what might happen in the future.

You can help your child by asking questions like “Do you have any proof that is true?” and “Even if this scary thing did happen, would it be as bad as it seems?” Remind your child of their own strengths and ability to problem-solve, as well as the network of supportive people who could help them in a true emergency.

Books like Tiger, Tiger, Is It True? help younger children to grasp the abstract concept of thinking about thoughts. Tweens can learn about how to “talk back” to worries in my coping skills course, Worry-Free Tweens.

Coping Skill # 5: Letter-Writing

There’s often a lot left unsaid when a loved one dies, especially if there wasn’t a good chance to say goodbye. Children may wish they could apologize for a past argument, share an update about their lives, or simply thank their loved one for the lasting impact they’ve left behind.

Writing a letter gives children a chance to voice all these unexpressed thoughts and feelings. Even though they can’t be directly shared with the deceased loved one, a letter can be read aloud to another supportive adult, like a parent or caregiver.

Letter writing benefits young grievers in other ways, too. Bereaved children need opportunities to tell their story to others and be heard. Repeating their story, and putting feelings into words, helps kids to make sense of what happened to them. The more children talk about their grief, the easier it becomes to discuss. We want to help children feel comfortable sharing their grief, rather than pushing it down.

You can help your child get started writing a letter in whatever format feels best to them: email, a word processor, or old-fashioned stationary can all work well. Your child can address their letter directly to their loved one. If they need help getting started, consider having your child complete a sentence such as:

• Something that reminded me of you recently was…

• I wish I could tell you…

• I want to say sorry for…

• My favorite memory of us is…

Once your child has finished the letter, listen attentively as they share it with you. They can then choose a way to “send” their letter to their loved one, such as bringing it to the gravesite or burning the paper and watching the smoke travel upwards toward the sky.

Help Your Child Cope With Grief and Loss

I hope these 5 strategies have given you ideas you can use right away to help your child cope with grief. Working through grief and loss is a long, complicated process. If you and your child could use some more support, here are some more resources for you.

My book, A Parent’s Guide to Managing Childhood Grief, is available for presale now. It includes over 100 activities you can use with your child at home to help them cope with the many feelings and struggles that accompany death and loss. You can find it at any major bookseller, including Amazon and Barnes & Noble.

If your child’s grief is mostly showing up as anxiety, they might benefit from my online coping skills course, Worry-Free Tweens. It offers a more in-depth look at how kids can spot unhelpful thinking patterns, as well as relax the body and mind and gradually face fears. The course includes a section for parents, too, so you can help your child practice new coping skills and empower them to overcome worries.

Finally, if you’re interested in counseling for your child, I may be able to help. As a children’s counselor and play therapist, I can work with families in North Carolina, New York, and Florida, either in person or online. You can reach out to me here.

What Questions Should I Ask My Child's Therapist?

You take a seat in the therapy office—or log on to your video conferencing platform at the appointed time—to meet your child’s new potential therapist. Maybe this isn’t your first rodeo seeking therapy your child, and you’re wondering if this counselor will have the help you need. Or, maybe it is your first visit, and you’re feeling a little overwhelmed about where to start. Either way, finding a counselor for your child is a big step, and you probably have a lot of questions to ask.

It’s really important to find a therapist who is the right fit for your child. All of us—whether we’re 9 or 99—will heal the best when we’re working with a counselor we like and trust. You don’t always have to see eye to eye, but you do need to feel safe talking to them. It also helps to find someone who truly specializes in the problems bringing you to therapy. So, how do you figure out if you’ve found a good fit? Let’s go over X questions you can bring up in your initial visit with a new therapist to learn more about what to expect.

Therapists Want Your Child to Find The Right Fit—Even if It’s With Someone Else

Sometimes, your first talk or visit with a child therapist might feel a little like a job interview. And it kind of is! You’re getting to know the therapist and how they work, and the therapist is getting to know you and your needs. It might feel awkward to ask questions about your therapist’s expertise or approach: what if you decide afterward that you need to see someone else?

Please know that we want to find the right therapist for your child almost as much as you do. We aren’t going to take it personally if you ask a hard question, or decide need to move in a different direction to find your child help. It feels amazing to be able to find someone the exact kind of help they need, even if that means they need to go elsewhere. I think I speak for most therapists when I say that working with a child I’m not equipped to help is a bummer. I don’t want that for me, and I don’t want that for you!

So, go right ahead and ask the questions you need to ask. You can even ask us to recommend other therapists to you. It’s not a weird request, and most therapists will be happy to oblige.

How Do You Interview a Child Psychologist, Counselor, or Therapist?

Reach out to the therapists who interest you, and see what their protocol is. Some may be happy to offer a consultation with you over the phone, while others may invite you into the office for a full intake session. Some therapists may charge for this service, while others don’t. Whether by phone or in person, it’s helpful to have a fairly in-depth conversation with a new therapist before your child’s first session.

While doing your research, you’ll probably find therapists with all sorts of titles beside their names, including psychologists, counselors, and psychiatrists. You might also see people who specialize in particular types of therapy, like play therapists or drama therapists. You can read more about the differences between types of therapists here to see who might be the best fit for your family. You can also check out my blogs on play therapy and drama therapy to learn more about how those approaches help kids.

If possible, set up appointments to talk to at least a couple different therapists. It’s okay to shop around a little bit before making a commitment to begin therapy. Even the most amazing therapist isn’t going to be the right fit for every child or family. Interviewing multiple people makes it more likely you’ll click with someone.

5 Questions to Ask Your Child’s Therapist

Okay, so you’ve done your research, found a few contenders, and set up some times to interview possible therapists for your child. What do you ask once you get to the appointment? I’m going to share 5 questions I think are pretty universal and would benefit any family that’s considering starting therapy. If you’ve never been in counseling before, these may not have occurred to you to ask. Hopefully they’ll be helpful to you!

Of course, every child’s situation is different and you may have more specific questions you need to ask in order to find the best fit. These questions should provide a good jumping-off point for more detailed conversations about your child, family, and needs.

Question 1: How Much Experience Do You Have Working with Children Like Mine?

No matter how skilled a therapist is, it’s impossible to be an expert in everything. You are likely to have the best experience working with a therapist who has helped children navigate similar issues. They’ll already know the ropes, and have an idea of what approaches will help.

You might want to know if your therapist has in-depth training or experience working with a specific diagnosis, like ADHD or OCD. Or, it might be helpful to hear if they specialize in helping children through certain issues, like divorce or grief. Sometimes, it can be helpful to find a therapist who shares or is very knowledgeable about your cultural, racial, or religious background.

Working with children is also very different than working with adults. Just because a therapist specializes in helping adults or teens with anxiety, for example, doesn’t mean they’ll automatically know how to adapt skills to work for kids. Ideally, you want to find a therapist who specializes not just in children, but in kids in your child’s specific age group. After all, a preschooler learns, thinks, and communicates really differently than a tween!

Question 2: How Will I Be Involved In My Child’s Therapy?

Depending on the circumstances, you may hear a lot or a little about what goes on in your child’s therapy sessions. Your child’s age, their specific concerns, and your therapist’s style will have a lot to do with what is shared and what isn’t. However, what you’re told about your child’s therapy should probably be more than nothing, and less than everything.

Ask your potential therapist if they plan to meet with your child alone, or if they’d prefer to have everyone meet together. There’s no wrong answer, but it helps to know what to expect. You should also know how you’ll be kept in the loop about how therapy is going. Some therapists may send home weekly reports, while others will schedule periodic parent sessions to talk about progress and goals.

In general, the younger your child is, the more involved you need to be in their therapy in order to see good results. Young children need their parents help to regulate their feelings, so coping skills only work if you’re there to help. On the other hand, all kids need some element of privacy in order to feel comfortable sharing in therapy. The older your child is, the more personal space they are likely to need.

No matter your child’s age, you should expect to have some information about how therapy is going, what your goals are, and what you can be doing to help. Also, you can always expect to be told if your therapist suspects that your child could be in a dangerous situation or is at risk of hurting themselves or others.

Question 3: What Are Your Fees? How Do You Handle Payment and Cancellations?

It stinks to get all the way through an interview with a new therapist, only to discover you can’t make things work financially. Hopefully, you were able to get a sense of your therapist’s fees from their website before meeting. If you aren’t clear or the information wasn’t listed, please ask! Money conversations might feel a little bit awkward, it’s so important to know up-front what you are committing to.

Therapy sessions in private practice work differently than many other medical appointments. Your therapist may or may not take insurance. If they do, your copay might be different than it is for other types of medical care. If they don’t take insurance, you may still be able to get insurance to reimburse you for some of the cost, but it may be your responsibility to contact your insurance provider. It’s likely you’ll need to be prepared to pay the full fee for your session on the day of your visit.

Also, it’s good to know that many therapists have policies about when and how clients can cancel appointments. This is excellent to talk about in advance, so you can plan ahead and not end up with a charge later that you hadn’t expected. It’s common for therapists to request either 24 or 48 hours’ notice when someone needs to cancel a session for a non-urgent reason.

You can break this big question about fees down into some smaller ones to get a detailed idea of the financial investment you’ll be making if you continue therapy:

• How much is your fee per session?

• Do you charge a different amount for intake or initial sessions?

• What insurances do you take, if any?

• What is your cancellation policy?

• How do I pay for sessions: by cash, check, card, or another way?

Question 4: Can You Estimate How Long It Takes Children to Complete Therapy?

Therapy isn’t just a financial commitment, it’s a time commitment, too. It helps if you have a ballpark idea of what to expect before you get started. That “ballpark” might still be a pretty broad estimate—it can be really hard to predict how quickly a child will move through therapy. Many things—your child’s age, the reason they’re coming to therapy, any trauma history they may have—can influence how much time they will need.

Still, your counselor should be able to talk with you about whether the type of therapy they practice is short, medium, or long-term work. There are some forms of therapy that are designed to be extremely brief, so children might complete the whole sequence in 8 to 12 sessions. That still may feel longer than what you might expect from brief therapy! Therapists who do deep trauma work or use a psychodynamic therapy approach may see clients for many months or years. Many therapy styles fall somewhere in between.

Question 5: Is There Anything I Can Do at Home to Support My Child’s Progress?

I love being asked this question, because the answer is almost always yes! You and your child’s therapist will be partners in their care. Your therapist only sees your child an hour a week, while you are with them day in and day out. Your therapist may have a broad knowledge from having worked with many children your child’s age, but nobody has a deeper knowledge of your child as an individual than you. Therapy just works better when parents are following up at home.

Your therapist may have book recommendations for you and your child, or ideas for coping skills the two of you can try together. If you continue working together, they may be able to help you figure out ways to tweak how you’re handling situations at home to help your child better manage their feelings. Asking this question during your first interview helps you get a better idea of the therapist’s style, and the sort of “homework” you may be asked to do down the road.

Begin Child Therapy in New York, North Carolina, or Florida

If you’re looking for a children’s therapist and you’re in one of these three states—New York, North Carolina, or Florida—I may be able to help! I specialize in helping anxious tweens overcome worries and cope with strong feelings using a combination of play therapy and CBT. Children are welcome to visit my Davidson, North Carolina therapy office for in-person counseling, or meet me online for virtual therapy.

I also have some mental health resources that are available to all families, regardless of location. My coping skills course, Worry-Free Tweens, helps kids and parents learn new strategies they can use at home to combat anxiety. It’s a great first step to take while you’re looking for a therapist. My book, A Parent’s Guide to Childhood Grief, helps children and caregivers reconnect and talk about their loss through play-based activities.

Now that you have your first 5 questions prepared, you’re ready to go forth and interview some therapists. I’m wishing you the best of luck on your search!

6 Helpful Books on Grief for Elementary Students

By elementary school, children have developed an awareness of death. They’ve seen characters pass away in TV shows and movies, and noticed that plants and animals die in real life, too. None of this makes it any easier, however, when a loved one dies. Death brings up many difficult questions for elementary-aged kids, and reading books about grief together can set the stage for healthy conversations about loss.

We’ve already covered picture books to help children under 5 cope with a loss. Today we’ll take a look at books geared toward slightly older kids. These 5 books can help early elementary schoolers—roughly ages 5 through 8—learn about grief, death, and serious illness.

How Stories Help 5, 6, 7, and 8-Year-Olds Through Grief

Stories and picture books give 6 through 8-year-old children accurate, age-appropriate information about death, which can help reduce anxiety. Death is a big unknown for all of us, but especially for kids. Children who don’t have enough information about death may make assumptions on their own that lead to even more worry, such as wondering whether or not they did something to cause their loved one to die.

Reading a book also helps children talk and think about death without having to share their own personal experiences. It’s easier to talk about a fictional character and their grief. Stories help elementary-aged children understand grief through another person’s perspective, and hopefully realize that the feelings they’re having are normal and healthy, too.

Time spent with a parent or loving adult is one of the most helpful experiences a grieving child can have. 5,6, 7, and 8-year-olds will still need a lot of support from you to understand their grief. Sitting down to read a book together is a wonderful way to comfort your child and let them know its okay to talk about grief.

Finding Meaning in the Life Cycle: The Fall of Freddie the Leaf, by Leo Buscaglia

Recommended age range: 4-8

At first glance, the title and plot of this book might seem a little corny—at least it did to me! The story follows a leaf through the four seasons of the year, from growth in the spring to falling off the tree and dying in the fall. It’s accompanied by nature photography that shows the beauty of each season.

While the book is recommended for kids ages 4-8, I think the length and wordiness of the story might challenge the attention spans of some younger readers. The story also raises some big philosophical questions that might be better suited to older kids, like “What’s our purpose in life?” Finding meaning in life and death is an important part of grieving, and few children’s books talk about it. If your child is starting to ask deeper questions, this book is a gentle way to think about how life and death are both natural parts of life.

One small word of caution: at the very end of the book, there’s one brief mention of death feeling like falling asleep. Younger children may take this literally and worry about falling asleep at night. I’d recommend changing the words when you get to that page!

Talking About Causes of Death: When Dinosaurs Die, by Laurie Krasny Brown and Marc Brown

Recommended age range: 4-8

Death is never easy to talk about, but it can be even harder to broach the subject when a loved one’s cause of death was difficult or sensitive. This heavily illustrated book is divided into panels, like a comic strip. The pictures are expressive, colorful, and full of small details for children to notice and study. The pictures alone can prompt a lot of discussion, but this child-friendly book also shares some hard truths about death.

When Dinosaurs Die offers brief, age-appropriate explanations of death caused by violence, racial prejudice, suicide, and substance abuse. It also helps children understand that while most people live to a very old age, it is sometimes possible for very young children and even babies to die. These specifics may be too much information for families looking for a more general introduction to the subject of death. If your little one has experienced one of these causes of death, however, reading about them in print can be extremely reassuring.

Flip through this book in advance to ensure that the content is right for your child’s needs. It’s okay to pick and choose sections to share. This is one of the books I find myself turning to again and again in my child therapy practice to help children make sense of more difficult grief experiences.

Saying Goodbye After an Illness: Ida, Always by Caron Lewis

Recommended age range: 4-8

Ida Always doesn’t feel like an educational or therapy book—it’s just a good story. Like many of my favorite books for kids, this one teaches by showing, not by telling. Readers meet Ida and Gus, two polar bears at the Central Park Zoo (who really existed!) who are best friends. One day, Ida becomes very sick and can’t get better. Over the course of the book, Ida and Gus grieve and prepare for Ida’s death together.

This book offers a child-friendly explanation of death, as well as a good example of what to expect when someone has a terminal illness. Ida sleeps more often, has good and bad days, and sometimes need a moment alone while she is sick. Gus goes through some very human feelings, too: disbelief, anger, humor, and acceptance are all a part of the story.

Gus—and readers—learn that you can continue a friendship during and after terminal illness, and that you don’t need to see someone in order to stay connected to them.

A Spiritual Look at Death: The Endless Story, by Melissa Kircher

Recommended age range: 5-10

This lesser-known book explores the entire life cycle, from birth to death as well as what might happen after. It’s great for children who are asking deeper questions about what gives life meaning, or where people go after they die. The Endless Story explores many ideas different people and cultures have about the afterlife. The book uses simple, open-minded language and doesn’t comment on whether anyone is right or wrong, which makes it appropriate for kids of all beliefs and backgrounds.

The Endless Story describes the life cycle as something universal—it happens to all of us. It’s a gentle and even beautiful way of looking at life and death that works for kids of all ages, but really lends itself to elementary-aged kids. The author, a professional artist, has added beautiful illustrations throughout that will encourage children to read this book again and again.

A Recipe for Getting Through Grief: Tear Soup, by Pat Schweibert

Recommended age range: 8+

This quirky, longer picture book uses the metaphor of creating a recipe to describe the many layered “ingredients” that make up the grieving process. Because it’s more abstract, it’s best for older kids who can easily tell the difference between fantasy and reality. Amazon recommends this book for kids 8 and up, but I think it could work for slightly younger children who are avid readers, too. It’s a little on the long side, so you may want to break the story up into a few reading sessions.

In fact, many adults who have reviewed this books say it’s been helpful for them, too. The story’s main character goes through many feelings associated with grief, including a few that are harder to talk about, like jealousy and hopelessness. Children and adults can learn about how grief isn’t a linear process, and it’s okay to focus on your grief for a little while and then take a step back when it becomes too intense. Finally, the book stresses the importance of finding supportive people who understand and can share your grief with you.

Help Your Elementary Schooler Cope with Grief Through Art and Play

These picture books are a great start to helping your young child understand grief, death, and loss. However, grief is a lifelong process: it will take more than one story to help your child work through their feelings. Losing a loved one is a huge, overwhelming experience, and it’s okay to take things one step at a time.

If you need ideas for more small steps you and your child can take to process grief, my book may be right for you. A Parent’s Guide to Managing Childhood Grief takes you step by step through activities you can use at home to help your child safely express big feelings, understand their loss, and begin to adjust to a “new normal” after a loved one has died.

All activities are geared toward children ages 5-11. You can pick and choose the ones that seem right for your child. The book is available on Amazon, Barnes & Noble, or at an independent bookstore near you.

Picture Books About Death, Grief, and Loss: Five Stories for Kids Five and Under

Preschoolers and kindergarteners are just beginning to understand the basics of what it means when a living thing dies. This makes it challenging to talk about grief and loss with little kids: even though it’s important to do, it can be hard to figure out where to begin. Picture books take these big subjects and break them down into smaller, more manageable pieces. That’s why several of the exercises for younger children in my grief activity book begin with reading a story together.

Picture books are an opportunity for you to sit down with your child and provide some much-needed one-on-one support after a loss. Stories help kids to approach grief in a gentle way, and helps kids to express their fears and feelings without having to speak directly about their own grief. Perhaps most importantly, stories reassure children that the feelings of grief are universal. Picture books take all the big, overwhelming feelings that come after loss and make them just a little bit easier to understand.

Let’s take a look at 10 picture books that can help your young child learn about grief, death, and loss. We’ll focus on stories geared toward children from preschool and kindergarten through the early elementary years.

What to Look for in a Picture Book for Kids About Grief

As a children’s therapist, I am always on the lookout for good books for my play therapy office. Something that’s important to me is that books about tough subjects don’t feel too “therapy-ish.” Really good stories for children don’t feel like after school specials or counseling in disguise, even when the topic is heavy.

Good storytelling—likable characters, strong writing, and beautiful illustrations—hold a child’s interest and help them connect emotionally with what they’re learning. I think even little children can sense the difference between a book focused on storytelling and a book that isn’t.

You may also want to pay attention to how stories describe what happens after someone dies. Some books include religious beliefs, while others don’t. None of the books on this list follow any particular belief system, so they should work for most families. Still, it’s worth paging through your picture books in advance to make sure there aren’t any messages that could be confusing to your child. Some books may use phrases like “went away” or “went to sleep” to describe death, and this kind of abstract language can be hard for young children to grasp.

A Grief Book for the Youngest Children: The Goodbye Book, by Todd Parr

Recommended age range: 3 and up

Preschoolers and kindergarteners may already be familiar with Todd Parr’s popular book series. The bright style of his illustrations is easy to recognize. The Goodbye Book is short and sweet, with basic vocabulary and only one sentence per page, making it ideal for very young readers. The language is simple, but the ideas are pretty grown-up.

Each page describes a different feeling or symptom a person may experience after a loved one dies, such as pretending the death never happened or not wanting to do fun things anymore. Young children will get reassurance that all these grief responses are normal and okay, and that they become easier to manage as time passes. The book never specifically mentions death, only goodbyes.

A Simple Story About Death: The Dead Bird, By Margaret Wise Brown

Recommended age range: 4 and up

Many children’s first encounter with death will be the death of an animal. Whether it’s a pet or simply an animal found outdoors, talking about nature and animal deaths can be a good introduction to conversations about grief and loss. The Dead Bird doesn’t go out of its way to teach young readers specifics about grief or death. It’s just a story about preschool children who discover a dead bird while outside, and hold a funeral for it.

If you’ve ever been in a similar situation with your preschooler, you might have been surprised by the seemingly morbid curiosity little kids can display when they find a dead animal. It may seem weird to adults, but it’s totally natural for children to wonder about what physically happens when a living thing dies. Similarly, this story has some descriptions of death that might seem jarring at first: it describes how the bird’s body starts off as warm, and then becomes cool and stiff. Learning this kind of information can help children begin to differentiate between living and dead, and understand that death is permanent.

This is a classic, older book that’s been updated with new illustrations showing a diverse group of kids. It’s a good option for a first conversation about death, or to help children better understand funerals and mourning.

A Children’s Book About the Death of a Grandparent: Nana Upstairs & Nana Downstairs, by Tomie dePaola

Recommended age range: 3 and up

The death of a grandparent or great-grandparent is another common way children are introduced to grief and loss. This story for young children touches on themes of aging, dementia, and the special relationship that little children and their older relatives can share. Like The Dead Bird, this book focuses more on telling a story than teaching specific concepts about death or grief. It’s an entertaining story for children in its own right that could also lead to some helpful discussions about what happens as grandparents and other loved ones grow old.

This true story, based on author Tomie dePaola’s childhood, explores the relationship between a little boy, his grandmother, and his great-grandmother, who live together in a nearby house. It gently refers to death as a part of life, and something that happens to everyone. While dementia or Alzheimer’s aren’t specifically mentioned, talking about great-grandmother’s behavior in the story might be a helpful jumping-off point for conversations about these illnesses in real life.

An Informational Book for Preschoolers and Kindergarteners: I Miss You, by Pat Thomas

Recommended age range: 4 and up

If someone in your family or circle of friends has recently died, you may need to speak a little more directly about death with your young child. The death of a loved one can bring up a lot of questions and curiosity for preschoolers and kindergarteners. Children may wonder what happens to the body when someone dies, why people die, or what happens at a funeral. It’s also common for young children to worry that they might have done something to cause their loved one’s death, or to believe that death is a punishment for being bad.

I Miss You: A First Look at Death answers these questions in a way that’s detailed but easy to understand. It’s aimed at a similar age group as The Goodbye Book, listed above, but it’s a longer and more complex read. In addition to answering common questions and dispelling misconceptions a child might have about death, it normalizes many of the complicated feelings a grieving child might have, such as guilt, regret, and anger. It also reviews a few simple beliefs different cultures have about what happens after death. There is a lot here for kids to think about and revisit over time.

Staying Connected Through Love: The Invisible String, by Patrice Karst

Recommended age range: 4 and up

Of all the books in this list, this is the one that feels the most “therapy-ish” to me. It’s a very simple, straightforward book without a lot of story to it. However, the idea of the invisible string is easy for children to understand: it’s a metaphor for the love that connects family, friends, and other special people. This image can be a big comfort when a loved one dies, leaves, or moves far away.

The book briefly mentions death and heaven, but isn’t solely focused on grief. Instead, it talks about how the bond between two people remains no matter where they are, how they’re feeling, or what they’re doing. The book points out that love doesn’t go away even when a person is angry, which can be a really important message for grieving children to hear.

Children (and adults) have to find ways to continue to love and remember the person who has died as part of the grieving process. This book can be a great opener to having conversations with very young kids about how they can continue to maintain a connection to their loved one.

A Book for Caregivers: A Parent’s Guide to Managing Childhood Grief

Caregivers need support navigating the grieving process, too. If you’re the parent of a young child who is grieving a loss, My new book, A Parent’s Guide to Managing Childhood Grief, can help you move on to deeper conversations after reading picture books like these.

The book combines guidance and grief education with hands-on activities you and your child can work on together. You’ll find ways to learn about grief and loss, express feelings, and strengthen your parent-child bond.

It’s available for on Amazon, at Barnes & Noble, and at your local independent bookstore.

Should Children Attend Funerals?

What’s the right age for a child to go to a funeral? Will an elementary-aged child get anything out of the experience, or will it just be scary? Will your tween regret not attending as they grow up? What if your child is really little—2, 3, or 4 years old. Is a funeral too much for them to tolerate?

If you’re a parent who has recently lost a loved one, you may be grappling with tough questions like these. In the midst of planning for a funeral, you’re also having to consider the wellbeing of your child. You want to help your child say a healthy goodbye, but funerals can be a lot to handle, even for adults.

Let’s take a look at the benefits and drawbacks of having your child go to their loved one’s funeral. We’ll talk about why the ritual of a funeral service can be helpful for many kids. You’ll also learn how you can set your child up to have a meaningful funeral experience if they choose to attend.

What Age is Appropriate for a Child to Attend a Funeral?

There is no right or wrong age to attend a funeral. Think about how your child handles other family or group events, like church or holiday dinners. Is your child able to sit for a period of time without melting down? Can they follow social cues like taking turns or being quiet when others are speaking? If so, they should be capable of handling the funeral—provided they want to attend.

Your child’s own wishes are your most helpful guideline when making your decision. In general, if a child is old enough to express a desire to attend, they will likely benefit from having the experience. Even really young kids can benefit from being involved in an important family ritual and getting a chance to say goodbye.

It is true that children of different ages have different needs when attending a funeral. If your child is very young, you may want to think about what a reasonable amount of time would be for your child to participate.

Many Children Benefit From Attending Funerals or Memorial Services

Children grieve differently than adults, but they still need opportunities to express their feelings, talk about their loved one, and say goodbye. Rituals help us all to move through important moments in life, and connect us to something that feels bigger than ourselves. The funeral is the biggest—and sometimes the only—ritual that happens when someone dies.

Grief experts tend to agree that funerals and memorial services are beneficial for many children. They can help bereaved children move forward in their grief process and begin to heal. When asked, adults who lost loved ones as children and weren’t allowed to attend the funeral usually say they regret not being there. As sad and difficult as funerals are, they’re an important part of mourning, and we only get one chance to attend.

Some of the benefits of attending funerals for children include:

• Coming to terms with the fact that a loved one has really died

• Seeing a loved one for the last time

• Getting a chance to say goodbye

• Receiving support from other grievers

• Observing how others grieve, which can reassure a child that their feelings are normal

• Feeling as though they’ve done something important to honor their loved one

There Can Be Drawbacks to Attending if a Child Isn’t Ready

There are a few instances when it’s not the right choice for a child to attend a funeral. If a child is not well prepared, they may leave the funeral feeling worse, instead of better. Children are more likely to have a bad experience if they’re forced to attend the funeral, pushed to do something they don’t want to do, or if they encounter something they weren’t expected to see.

Children should be allowed to take the lead in when and how they participate. If your child doesn’t want to touch their loved one’s body, for example, there’s no need to press the issue. Children who aren’t ready to attend the funeral may experience some drawbacks from attending, such as:

• Increased anxiety or fearfulness

• Distress about confusing things they saw or experienced

• Troubling memories, especially if they were pushed to do things that didn’t feel comfortable

• Feeling a lack of control, if forced to attend

Let Your Child Make an Informed Decision About What Feels Right

At the end of the day, the most important thing is not whether or not your child attends the funeral. What matters most is that your child was given a choice. So much about death is out of our control, especially for kids, who have very little say in what happens. When possible, it makes sense to give some control back to kids and allow them to make decisions for themselves.

Help your child make an informed decision by letting them know exactly what they can expect to happen at the funeral. You can talk about where the funeral will be, who will be there, and what everyone will do to commemorate your loved one. It’s also important to give your child a heads-up about how people might behave, so they’re prepared to see a wide range of emotions from attendees. Finally, talk with your child about how their loved one’s body will appear, and whether or not there will be an open casket.

If your child decides to attend, figure out a way for them to participate that honors their age and maturity level—more on that in the next section of this post. If your child opts out of attending, offer a “Plan B” that is familiar, comforting, and low-key. The plan should include staying with a person your child knows and trusts, in a place that feels safe. New experiences can be stressful for a grieving child, and big outings like special time with friends might lead a child to decline attending a funeral when they’d otherwise choose to go.

Find Age-Appropriate Ways For Your Child to Participate in the Funeral

Kids love having a job to do and feeling included in grown-up activities. This is true for funerals, too. If your child was very close to the loved one who died, finding a way for your child to participate in the funeral or memorial service can mean a lot.

Think about ways that your child might be comfortable contributing in some way to the service. Older, more extroverted children might appreciate being asked to read something aloud. Others might prefer to choose a song or poem for someone else to share. Even something as simple as picking out a bouquet of flowers or choosing a special candle to light can help younger children feel that their voices and feelings matter.

Depending on your child’s age, you may want to consider how long, and to what extent, your child participates in the funeral. Younger children may not be capable of sitting still through an entire service. Coming up with a plan in advance will make it easier for you to follow your child’s lead on the day of the funeral. It helps to select a friend or family member to be your child’s support person. This person can quietly usher your child out of the service if it becomes too much for them to handle.

It’s also worth considering if attending a virtual funeral service makes sense for your child. If your loved one’s funeral is being live streamed, this option can offer some flexibility, especially for younger kids. Your child can watch from the comfort of home and step away as needed if their attention wanes.

Questions to Ask When Deciding Whether A Child Should Attend a Funeral

If you’re on the fence about what’s the best decision for your child, here are a few points to consider. You know your child best, and can probably make good educated guesses about what your child will need in order to process their feelings about a funeral. If you’re trying to decide how to involve your child, ask yourself the following:

• Is my child able to sit still and focus during group gatherings?

• Is my child highly sensitive or prone to anxiety?

• How well does my child currently understand death?

• What was my child’s relationship to the person who died?

• How does my child feel about attending?

If your child is highly sensitive, or doesn’t currently have a strong understanding of what death means, you may need to spend some extra time preparing your child before making a decision.

If Your Child Does Not Attend, Find Another Way to Honor Your Loved One

It’s okay if your child chooses not to attend the funeral or memorial service. As long as they have been given the information they need to make a thoughtful decision, whatever choice they make is just fine. You can help your child experience some of the benefits of a funeral by creating your own rituals at home.

Help your child memorialize their loved one by setting aside time to do something together that feels special. You can think about what your child might enjoy, or consider finding something that was meaningful to your loved one. Reading a book or poem together, planting a memorial tree, cooking a loved one’s favorite meal, or visiting somewhere significant to your loved one are all ways to help your child grieve. Whatever activity you choose, be sure to offer ample opportunities to share feelings and to say goodbye to your child’s loved one.

Help Your Child Navigate Funerals, Grief, and Loss

If your child has recently lost a loved one, the funeral is just the beginning of a long process of mourning and healing. Children need ongoing support from someone they love and trust in order to recover from grief. You can help your child sort through their complicated feelings over time through repeated opportunities to remember and share memories of their loved one.

My book, A Parent’s Guide to Managing Childhood Grief, offers simple ways to support children before, during, and after a funeral. In it, you’ll find activities designed to help kids explore and learn about many facets of grief that can be tricky to talk about. From learning about death and dying to finding meaning and reflecting on growth, the activities can help your family process grief in the days immediately following a death as well as in the months or years to come.

A Parent’s Guide to Managing Childhood Grief is available on Amazon, Barnes & Noble, or through your local independent bookstore.

Talking to Kids About Death: Finding the Right Words in Difficult Conversations

You’ve probably imagined many difficult conversations you’ll need to have with your kids in the years to come: talks about bullying, puberty, and real-life issues like racism and violence. For some reason, talking to kids about death wasn’t at the top of my mind. Maybe that’s because we aren’t very comfortable talking about mortality as adults either.

Even though the subject of death may not get as much attention, it’s important to think about. Losses, both big and small, are a natural part of childhood. Many children encounter death for the first time through the loss of an animal, such as their classroom goldfish or the family dog. Kids who are fortunate enough to have close relationships with grandparents and extended family may also learn about grief as their loved ones age.

Whether you’re anticipating a loss in your child’s future, or just want to introduce the concept of death in a healthy way, it can be hard to find the right words. So, let’s talk about how we talk about death. We’ll go over how to tailor information to your child’s age, words to use (and words to avoid), and how you can make conversations about death a part of your day-to-day life.

At What Age Should You Tell a Child About Death?

Death is a huge concept, and it takes a long time for children to really understand what it means. However, even the youngest children feel grief when a loved one dies, even if they don’t grasp exactly what has happened. If you’ve recently lost a loved one, any child who is old enough to express their feelings through talking and playing is ready for a very simple explanation of death.

Usually, children begin to understand that plants, pets, and sometimes even people die by around age 4 or 5. However, it will be a long time before your child is fully aware that death is permanent and happens to every living thing. If you’re not mourning a loss and just want to broach the subject of mortality with your child, you can let their own curiosity about life and death guide your conversations.

Young children are famous for asking lots of questions—remember the “why” phase? You don’t need to volunteer lots of information about death and dying, but if your child asks you a question, it’s okay to give a short, honest answer. In general, if your child is old enough to ask, they’re developmentally ready to hear your response.

Tailor Your Talk to Your Child’s Age and Maturity Level

Talks with kids about death are not one size fits all. The information your child needs will depend on their age, where they are in their development, and your child’s individual personality. Your child is unique, so use your best judgment and your knowledge of your child when considering what to share. Let’s take a look about how kids tend to think about death, according to their age.

Preschoolers are just starting to develop a concept of death: before this age, the word doesn’t really hold any meaning at all. Little children may worry that death can be a punishment for bad behavior, or that the things they think and do might cause someone else to die. Keep your explanation of death very simple and concrete, and help your preschooler to understand that the things they do can’t make others get sick or hurt. Be prepared to answer lots of repeated questions, and to remind your child that death is permanent.

Elementary school-aged kids have a better understanding of death as a permanent event. As they realize that death happens to all living things, they may start to think about their own mortality. This can lead to worries about their own health and safety, or the safety of loved ones. It can help to remind your child that most people live to a very old age, and discuss who would take care of your child in the event of an emergency. School-aged kids are ready for a more detailed explanation of death and any religious beliefs your family holds. You can let their questions guide how deep your conversation goes.

Tweens and teens are more capable of the abstract thinking, which allows them to appreciate spirituality and the permanence of death in a deeper way. Kids this age are figuring out who they are and what they believe about life. They may enjoy reflecting on their own spirituality and what they think about religion. Teens may be ready for harder conversations about death, and may ask uncomfortable questions without simple answers. Honesty is the best policy, especially with this age group, even if the answer you have is “I don’t know.”

Simple Language Is Best for Kids

At this point, it’s common advice to use straightforward words when talking to kids about death. Euphemisms that sound comforting to us can be confusing for kids, because they’re abstract. Children may fill in the gaps in their understanding with their own assumptions, which are often scarier than the truth.

We understand what it means when someone “passes away,” but a young child doesn’t. Where did they pass to?, a child might wonder. Is it like passing out? If a family pet has been put to sleep, a child might fear going to bed at night, in case something bad happens to them, too. Even phrases like “she’s gone to a better place” can cause children to wonder if a loved one chose to leave them to go somewhere else.

Using basic language cuts down on confusion and reduces the chances that a child will experience unnecessary worries. The words “dead” and ‘died” might sound harsh to adult ears, but they’re often easier for children to hear. If your child is too young to fully understand what “dead” means, you can give simple examples of what’s physically different after someone dies. For example, the heart stops beating, the lungs stop breathing, the body stops moving, and a dead person no longer feels hunger, pain, or fear.

Build Conversations About Death Into Everyday Life

It can be intimidating to talk about death with children. It’s a sad, hard, uncomfortable thing to think about. It’s even more daunting if we envision having a serious, sit-down talk where we lay out everything our child needs to know about death and dying. Conversations about death don’t always have to be a big deal. Small events in your day-to-day life can be great learning opportunities for kids.

The natural world offers lots of chances to talk about life, aging, illness, and death. Whether you’re going on a nature walk or tending to a garden, examples of the life cycle are all around you. Talk with your kids about what you see when you’re outside. Can they notice how plants are changing when fall turns to winter? Can they spot any dead worms on the sidewalk after it rains?

Many kids are naturally curious about dead things, which can be awkward for adults. When possible, let your child express their curiosity and ask questions. If you drive by roadkill or spot a bird that has flown into a window, it’s an opportunity for you to show your child that it’s okay to talk about—and have feelings about—death.

Books can be a great starting point for conversations about death, too. The Dead Bird is a short and simple picture book for preschoolers that tells the story of a group of children who discover a dead bird outside. It’s a great way to help very young children think about death and nature. Elementary-aged kids may enjoy Lifetimes, a beautifully-illustrated book that describes the life cycles of different animals.

Leave Space for Questions and Feelings

One of the most helpful messages you can give your child is that any feelings they have about grief and loss are okay. If your child expresses sadness or worry about death, you might feel an urge to help the feel better right away. It’s tempting to rush in and fix things, but sometimes putting a name to your child’s feelings is the most helpful thing you can do. This lets your child know that it’s okay to have negative feelings, too.

It will take children a long time to work through their thoughts and feelings about death. Kids learn through repetition, and you may notice your child asking similar questions about death and dying over and over again. Sometimes, the questions might even seem a little odd! It might feel strange to wonder with your child about where dead pets go to the bathroom, or to answer the same question multiple times in a day. However, by answering honestly and consistently, you’re helping your child make sense of a big, scary topic. You’re helping your child feel more secure, and teaching them that it’s okay to ask you more questions in the future.

If your child stumps you with a question, it’s perfectly fine to say “I don’t know.” Sometimes that’s the most honest answer we can give. If you’re not sure how to respond in a child-friendly way, it’s also okay to tell your child you need to think about their question, and you’ll get back to them later with an answer.

Incorporating Religion Into Talks About Death

So far, we’ve covered the concept of death in a very practical, body-focused way. We haven’t talked about more spiritual aspects of death, like what happens to a person’s soul. If your family is religious, you may be wondering how to incorporate your beliefs into conversations with kids about death.

First, some good news: research shows that learning facts about death doesn’t get in the way of a child’s religious development. Especially as kids grow older, they can hold both the scientific and spiritual aspects of death in mind at the same time. What’s more, a basic understanding of what physically happens when somebody dies can make abstract concepts like the afterlife a little less confusing.

Find ways to tie together what happens when a person dies to your family’s beliefs about what comes after death. For younger children, its best to keep this conversation very simple. For example, “When a person dies, their body stops working and doesn’t start working again. Their body doesn’t eat, feel, think, or move. A person’s soul, which we can’t see, goes to Heaven when they die.” Because young kids are concrete thinkers, you may need to clarify that Heaven is not a place that we can visit, and that loved ones can return from in their physical form.

Older children may be ready for more in-depth conversations about your family’s belief system about death and the afterlife. It’s helpful for older kids to know that not everyone they meet will share the same ideas about what happens after we die. You can also explain to your older child that some aspects of death and what comes after are a mystery to all of us, regardless of our religion.

As always, leave space in your talks about death and religion for questions from your child. "I’m not sure,” “I don’t know,” and “Let me think about that and get back to you” are perfectly okay responses when there isn’t an easy answer.

More Ways to Help Children Understand Death and Loss

Helping a child understand death is an ongoing process. There’s no need to find the perfect words or to have one perfect conversation: you’ll have many opportunities to talk about death, grief, and loss as your child grows. Your child probably won’t remember the exact phrases you used, anyway. What they will remember is that you showed up for them, you were honest, and you cared enough to talk about difficult things.

If you’re anticipating a loss or someone you love has recently died, you may be wondering how to support your child in the weeks and months to come. How can you keep healthy conversations about death and grief flowing? How do you create a safe space for them to let out their feelings without pushing too hard?

If you’d like more step-by-step guidance, A Parents’ Guide to Managing Childhood Grief may be helpful to you. I wrote this activity book especially for parents and caregivers of school-aged kids who are going through grief. Inside, you’ll find deeper advice on how children grieve differently than adults, what to say (and avoid saying) to a bereaved child, and 10 chapters of play-based activities you and your child can try at home to explore many aspects of grief and loss.

You can order the book now on Amazon, at Barnes & Noble, or find a local Indie bookstore to support through IndieBound.

What to Say to a Grieving Child: 5 Messages Kids Need to Hear

Wondering what you should say to a child who is grieving? Your actions and words can both speak volumes.

My Child Just Lost a Loved One. What Do I Say?

It’s so hard to know what to say to someone who has just experienced a loss. Even when we’re talking to other adults, death can feel so overwhelming and huge. How do you figure out what a child needs to hear at a time like this? Go-to phrases like “I’m so sorry this happened” and “I’m here to help” fall a little flat when we are trying to support young people.

Whether you’re a parent, a caregiver, or another important adult in a grieving child’s life, this post is for you. Children understand and process death differently than adults, so the words they need to hear from people around them are a little different, too. We’ll talk about 5 messages that children need to hear from the adults in their lives as they begin to process a loss. Whether you say these phrases out loud, put them into your own words, or show them through your actions, they will help your child feel safe, loved, and understood.

First Things First: Talk Honestly About Death

Before you talk about anything else, it’s important to have an open conversation with your child about death. Younger kids need help to understand the concept of death as something that is permanent and irreversible. Kids of all ages need at least some information about what caused their loved one to die.

We’ll go into detail about how to tell a child a loved one has died in another post, but honesty is the best policy when it comes to talks about death and dying. That means avoiding euphemisms like “passed away,” and describing death as something that makes the body and brain permanently stop working. In general, if your child is old enough to ask a question, they’re old enough to hear an age-appropriate answer. It’s always okay if that answer is “I don’t know.”

Grief Message 1: “It’s Not Your Fault.”

Have you ever noticed that kids tend to believe the world revolves around them? It can be a little exasperating at times, but it’s totally normal and healthy for young children to have this mindset. Kids are the main characters in their life stories, and they’re still figuring out the impact they have on the world around them.

Up until about age 7, kids are still learning that their internal thoughts and feelings don’t affect the outside world. For example, thinking a mean thought about a sibling can’t cause them to actually get hurt in real life. Wishing a person would just go away doesn’t mean they will disappear.

When somebody dies, it’s very common for children to blame themselves. They might over-estimate the power they had to change a situation. They may also worry that their thoughts somehow caused their loved one’s death. This kind of guilt can happen even in situations where the death was nobody’s fault, such as a death from cancer or old age. As you can probably imagine, it’s a terrible feeling, and a tough one for many kids to talk about.

Make it clear to your child that nothing they said, did, thought, or felt caused their loved one to die. You can let them know that many people—adults and kids—feel guilty when someone dies. It’s a normal feeling, but it doesn’t mean the death was your fault. We can’t control another person’s life, health, or decisions, and we usually can’t prevent accidents from happening, either.

Grief Message 2: “All Your Feelings Are Okay.”

Talking about feelings can help children after someone has died. Photo via Pexels by Ketut Subuyanto.

When we think about a grieving person, we probably imagine someone who is very sad or crying. In fact, this is usually how grief is portrayed in the media, too. While it’s true that sadness is a big part of grief, there’s a whole range of other emotions involved, too.

Adults may be aware that grief is complicated, but kids usually aren’t. Most kids don’t have very much personal experience with grieving. They look to books, TV, and movies to figure out how they’re supposed to feel.

Actually, there’s one other place kids are looking to figure out how to feel: you.

Children turn to parents and caregivers to see how they are responding to grief, and to decide whether their own feelings seem “normal” or okay. You can be a role model for your child, and help them to accept and cope with the many confusing, conflicting feelings they might experience.

You can help your child understand that there’s no right or wrong way to grieve. Any feelings they have are okay. Whether those feelings are big or small, scary or sad, angry or happy, it’s all normal. It’s even alright if they aren’t feeling much of anything at all, especially right after the death when many people are still in shock.

You can affirm your child’s feelings in two ways: by talking about them directly, and by showing your own emotions in front of your child. It’s okay to share when you’re feeling sad or frustrated or worried. When your child sees you dealing with your own grief, they learn that feelings aren’t something they need to hide.

Grief Message 3: “There Will Always Be Someone to Take Care of You.”

Human brains are hardwired for survival. We’re good at looking for signs of danger—in fact, sometimes we’re a little too good at it, and we end up with anxiety. Kids understand that, in order to survive, they need to stay close to grownups who can take care of them.

The death of a loved one is a scary reminder to kids that bad things can happen to the grownups in their lives. It can leave children feeling vulnerable and unsafe. What’s more, the things that kids usually turn to for safety—routine, predictability, and time with caregivers—may all be disrupted for a while as the family deals with their loss.

Remember earlier when we talked about how kids are the main characters of their own life stories? That comes into play here, too. When children hear about a loved one’s death, they often wonder “What does this mean for me? Who will be there to take care of me?”

You can help your child feel safe by reminding them that, no matter what, there will always be someone looking out for them. Even if something unexpected happened, you have plans for who would step in to help. You can name the many adults in your child’s life who provide for them, either physically or emotionally. Keep your child in the loop about who will be taking them to school or tucking them into bed at night, so they know what to expect.

Grief Message 4: "We Can Talk About Anything, Even the Hard Stuff.”

Parents and caregivers sometimes worry that bringing up a deceased loved one in conversation could upset their child. It can be painful to bring up old memories, and the child has already suffered so much pain. If a child isn’t talking about the death, should adults around them bring it up?

We never want to force children to talk when they aren’t feeling up to it. On the other hand, if adults never talk about their grief, it can give children the mistaken idea that it’s not okay for them to talk about it, either. Kids often worry about their caregivers a lot following a death, and pay close attention to their responses to grief. They may interpret silence as a sign that you aren’t ready to talk, or that hearing about your child’s grief would be too much for you to bear.

It’s okay to take the lead on conversations about grief. It’s not too forward to ask your child how they have been feeling. If they say they’ve been fine or haven’t been thinking about their loved one lately, that’s just fine—there’s no need to push. You can always try again another time.

Sharing your own thoughts and feelings about grief can be really helpful, too. It can help make painful emotions feel less taboo to talk about. By bringing up your own positive and negative emotions, you’re letting your child know that you can handle hearing about theirs.

Grief Message 5: “I Remember Your Loved One, Too.”

Remembering a loved one is another way you can talk about grief with kids.

It’s normal for grieving people of any age to think about their loved ones more on special days. Anniversaries, milestones, and holidays can bring up difficult feelings at times of the year when we’re “supposed” to be happy. The mixed feelings can be a lot for a young person to handle.

Grieving kids have another layer of complexity to deal with, too: the older they get, the more they understand their loss. With each passing month or year, a grieving child becomes older and wiser. The realization that death is permanent really starts to sink in. Celebrations and anniversaries are a reminder of everything a child has lost: not just their loved one, but all the memories they could have made together in the future.

With your words or with your actions, you can let your child know they’re not alone in thinking about their loved one. Share a funny story about them, light a candle, or just let your child know they’ve been on your mind. There isn’t a timeline on grief, and sharing your own thoughts takes pressure off your child to just get over it and move on.

No Matter What You Say, Keep the Conversation Going

The stakes can feel really high when we’re talking to kids about grief. This sensitive, vulnerable little person is depending on us to help them figure out a life-altering event. There’s a lot of pressure to not mess up. What if you say something wrong, and end up doing more harm than good?

We’ve probably all heard the Maya Angelou quote about how people will forget what we say and do, but they’ll always remember how we made them feel. It’s a little cliché, but in this case it’s true. Children may not hang on to your every word for the rest of their lives, but they’ll remember the ways that you helped them to feel safe and supported.

It’s okay if your response to your child is honest, but awkwardly worded. It’s okay if a conversation falls a little flat. It’s even okay if you misspeak, and need to come back later and make things right. What’s most important is that you’re keeping lines of communication open with your child. If you miss an opportunity, don’t worry—you’ll get another one. You are letting your child know that you care, and that you’ll be there for them when they’re ready.

Need More Ways to Talk About Grief With Your Child?

Talking about grief with kids is an ongoing process. Children will need repeated opportunities to work through their feelings about a loved one’s death. That repetition is part of what helps children to learn and make sense of information. These conversations don’t all have to be heart-to-heart chats, although those are wonderful: playing, making art, and spending time together can all help your child grieve.

A Parent’s Guide to Managing Childhood Grief is an activity book for parents, caregivers, and any adult who wants to support a bereaved child. I wrote it with children ages 5-11 in mind. It includes 100 activities that you and your child can do together to talk about death and dying, cope with hard feelings, and honor the memory of your loved one. If you’d like more ideas and advice for helping grieving children, it’s available on Amazon, at Barnes and Noble, and in local bookstores.

Thank you for supporting your child! As always, if you have any questions or would like to learn more about children’s counseling, you’re welcome to send me a message.

What Are the 4 Types of OCD?

Pop culture is getting better about representing people with mental health conditions on TV, in movies, and in books. It’s allowed many people to get familiar with mental health conditions that aren’t always talked about, but affect millions of people. At this point, you’ve probably encountered a character that has OCD. In all likelihood, this character was super clean, hyper-organized, and maybe a little nitpicky or eccentric.

Although more representation for mental health issues is a good thing, for OCD it’s come with a small downside. Most portrayals of OCD only focus on one or two types of the disorder. As a result, most of us have an overly narrow idea of what OCD looks like. While it’s true that some people with OCD are very neat and tidy, many aren’t.

If you are wondering whether your child may have OCD, it helps to learn about all 4 types. This way, you’ll be prepared to spot all of the signs and symptoms of OCD, not just the ones we see on TV. Let’s take a closer look at each of the 4 main types and how it commonly manifests in kids.

OCD Type #1: Contamination and Cleaning

Many people associate OCD with germs and germaphobia. But this type of OCD is more than just practicing good hygiene or keeping a spotless home. People with contamination OCD worry about coming into contact with things that could get them dirty, sick, or even just feeling unclean. They may worry about their belongings becoming contaminated as well, or that they might spread their contamination to other people.

Sometimes, people with contamination OCD are concerned with germs or dirt. However, lots of other things can trigger it, too. Some kids with contamination OCD might be triggered by bodily fluids, certain strong smells, or even just by people or things that feel wrong to them.

Feeling contaminated causes anxiety to spike, so kids with this OCD type will do whatever they can to avoid the feeling or make it go away. This often means compulsively cleaning, avoiding “dirty” places and things, having difficulty sharing belongings, or completing rituals that help make something feel clean again.

What Contamination OCD Looks Like in Kids

I’ve met more children with contamination OCD in the wake of the Covid-19 pandemic. This makes sense: we’ve spent over a year talking about washing and avoiding germs, which I imagine makes it an easy subject for OCD to grab on to. Here are a few common ways contamination OCD may show up for kids:

• Repeatedly washing hands or taking multiple showers a day

• Not wanting to touch or use objects that have come in contact with something “dirty”

• Difficulty sharing toys or allowing others to use their things

• Overwhelming worries about getting sick or making others sick

• Cleaning belongings (like toys or school supplies) more often or thoroughly than is normal

• Bathroom difficulties due to worries about urine or feces contaminating clothing

OCD Type #2: Checking and Rechecking

Ever walked out of the house, only to stop and wonder if you locked the door on your way out? We all get that nagging “did I forget” feeling occasionally, but for people with this type of OCD it’s a daily occurrence. It’s harder for them to brush these thoughts aside, because they happen so frequently and feel so intense. To calm the feeling, they check or re-do things over and over, even if they know they just did them moments ago. Unfortunately, the “did I forget” feeling doesn’t stay away for long, which leads to a need to check again. As you can imagine, this can be really aggravating and take up a lot of time.

Compulsive checking activities may be physical actions, like flipping a light switch or turning a knob on the oven. They can also be mental actions, like double-checking that the fire alarm still has batteries or that a door is closed. Sometimes, repeated worries prompt kids to repeatedly ask parents for reassurance. This is another kind of checking that might be easy for parents to miss.

What Checking OCD Looks Like in Kids

Symptoms of compulsive checking range from super subtle to very overt. How easy they are to spot depends on what your child feels compelled to check. Here are a few examples of compulsive checking that you might notice in a child with this form of OCD:

• Repeatedly doing things like locking and unlocking doors, flipping light switches, or turning faucets on and off

• Asking the same question over and over, without a decrease in anxiety—for example, repeatedly asking a parent if they are sick

• Going back to check on things more often than seems normal

• Repeatedly asking parents for reassurance that something bad is not going to happen

• Asking parents if the child has forgotten something or if their memory is accurate

OCD Type 3: Perfection and Order

This is the type many people likely imagine when they think of OCD. Along with germaphobia, this is the other common OCD form that gets a lot of representation in pop culture. People with this OCD type may worry about symmetry, organization, or doing things just right. In fact, this type is also sometimes called “just right OCD.”

While this may sound like the hyper-organized, neat freak stereotype we often associate with OCD, the reality is it’s much more complex. Some people with this OCD type may be neat and tidy, or be concerned with appearances. However, this type also includes compulsive behavior like tapping things an even number of times, arranging items to appear symmetrical, or fixing and re-fixing something that nobody else would notice was “wrong.”

This OCD type also includes people who feel compelled to do things perfectly. This might lead to a lot of anxiety when working on school assignments or participating in sports or other activities. Some people with this type might fixate on a facial feature or part of their body and worry that it is not good enough.

What Perfectionistic OCD Looks Like in Kids

Although this type is more understood, it’s helpful for parents to remember that “perfection” and “order” doesn’t necessarily mean color-coded school binders and a clutter-free bedroom. A child’s focus can be on a very specific area that we don’t usually think about as something that needs to be organized or even, which can make these signs of OCD slightly tricky to spot. Here are some ways perfectionism and “just right” OCD might show up in children:

• Extreme difficulty completing homework assignments, especially open-ended ones, due to a fear of not being able to do them well enough

• Needing to feel that things are “even” on both sides of the body

• Doing things a set number of times, for example, saying the same thing three times in a row or stepping on the “right” number of leaves outside

• Fixating on a small detail related to clothes, hair, or makeup

• Having trouble texting friends due to fear about not saying the right thing

OCD Type 4: Mental Rituals & “Bad” Thoughts

This type of OCD is a little different than the others. Most forms of OCD involve acting out some kind of repeated or ritualized behavior. The behavior may be subtle, but it’s noticeable if you know what you’re looking for. Mental ritual OCD is sneakier. Rather than doing something repeatedly, people with this type of OCD think something repeatedly. This can make it much more difficult for parents to identify. In fact, until fairly recently, mental health professionals had a hart time identifying it too!

Mental ritual OCD is relatively new. You may also hear it described as “Pure O” OCD, which is short for “purely obsessional.” It’s called this because there aren’t any compulsions for those of us on the outside to see. However, that doesn’t mean they aren’t there.

People with “Pure O” or mental rituals are often bothered by thoughts that feel inappropriate: for example, thoughts about violence or sexual behavior. Some people may also be preoccupied with thoughts about religion or worries that they’ve done something wrong. They may worry that having these bad, taboo thoughts means that they are bad people.

To counteract the “bad” thought, a person may try to replace it with a “good” one or perform some mental action to make it better. This could include thinking a special thought, saying a number or word inside their head, praying, or reassuring themselves that they are okay.

What Mental Ritual OCD Looks Like in Kids

Mental rituals are extremely difficult to spot unless the person experiencing them says something about them. Some children with this form of OCD may also repeatedly ask for reassurance as a way to cope with upsetting thoughts or mental images. That can sometimes be a tipoff that other mental rituals could be happening, too. Here are some ways mental rituals might show up for “Pure O” kids:

• Compulsively saying prayers or confessing to things inside their head

• Repeatedly going over memories to see if they really happened

• Saying special words, numbers, or thinking of a special picture to make a bad thought go away

• Checking to see if a bad thought is still there

• Repeatedly reassuring oneself that something didn’t really happen, or that they would never do that thing in real life

Are There Any Other Types of OCD?

Yes and no! The 4 types of OCD I’ve outlined here are used by both therapists and people with OCD to describe different ways that OCD can look and feel. However, you won’t find them in the DSM-5, the big book of mental health problems that therapists use to help diagnose people. So even though they are common and helpful, they aren’t super duper official.

While many people divide OCD into 4 broad categories, others may identify as many as 6, 7, or 8 different types. It all depend on how specific you want to get with your labels. Here are some other OCD types you may hear others mention:

• Hoarding

• Ruminating

• Intrusive Thoughts

• Mental Contamination

• Moral OCD

• Doubt or Incompleteness

• Thoughts of harm or self-harm

I Think My Child Has OCD…What’s Next?

If you read through these 4 types of OCD and recognized your child in one (or more) of them, you may be wondering where to go from here. I’ve written a fair amount about OCD in children and OCD treatment on this blog if you’d like to learn more.

Learning anxiety coping skills is a good first step to help your child at home. There are several educational and self-help books for kids about OCD, too. What to Do When Your Brain Gets Stuck is my favorite.

Although books and coping skills can help, many children with OCD will need more support to overcome their symptoms. Research suggests OCD is not likely to go away on its own without professional help. Fortunately, children with OCD have options when it comes to therapy. Cognitive behavioral therapy can be really helpful, and there’s even a version of it designed especially for kids with OCD called Exposure and Response Prevention.

If you’re looking for a child therapist in North Carolina, New York, or Florida, I may be able to help. I meet with kids in person (in Davidson, NC) and online (everywhere else) to work through anxiety, stress, and trauma. You can email me here to ask question or set up an appointment.

My Child is Afraid of Halloween! What Do I Do?

Maybe it’s just me, but I love a good baby Halloween costume. I started researching them long before I became a parent, and I’m excited to have at least a year or two of freedom to dress my baby up without objections from him about my style decisions. Eventually, though, all good things must come to an end.

As children grow up and begin to develop their own (strong) opinions about things, including Halloween. What if your child’s views are not so enthusiastic? What if they are downright scared of Halloween? You may be wondering if it’s okay to push them to face their fears so they don’t miss out on any fun—or keep their siblings from having a good time. On the other hand, you don’t want to overwhelm your poor kiddo by subjecting them to an evening of skeletons and eyeballs.

What’s a parent to do? Let’s take a look at a few strategies to help children who are afraid of Halloween feel secure enough to (gently) try out some spooky fun.

Is it Normal for Kids to Be Afraid of Halloween?

If everyone else’s children are eagerly jumping into their Pennywise costumes or laughing with glee at the scary chainsaw man on the haunted hayride, you may wonder if it’s normal for your child to feel so scared.

When you stop to think about it, many Halloween traditions are very weird and unlike our normal day-to-day life. It’s a day deliberately intended to scare people. On Halloween, kids get to do a lot of things they aren’t allowed to do any other night of the year, like walk around the neighborhood in the dark and take candy from strangers. No wonder some kids have a hard time adapting.

I wonder if the abundance of scary games, movies, and other content geared towards children has led to more kids fearing Halloween. I can’t tell you how many kids have come into my therapy office deathly afraid of characters like Pennywise, Annabelle, or the cast of Five Nights at Freddy’s. Even creepy memes can have a lasting effect on kids. Remember Momo? She was a major subject in my office for about 6 months in 2019.

I do think it’s worth mentioning that while mild anxiety is totally normal and understandable, extreme anxiety may be a different story. A child who is creeped out by Halloween decorations or who is hesitant to go trick or treating is experiencing pretty typical fears. On the other hand, if your child is so paralyzed by fear that they have nightmares the entire month of October, or refuse to go to public places because they might have decorations up, she may be dealing with a more severe phobia that could use some outside help.

How to Help a Child Who is Scared of Halloween

We all want to protect our children from harm and help them avoid upsetting experiences when we can. That said, please don’t wrap your child in psychological bubble wrap and avoid all things Halloween-themed. While this might help your child (and you) feel less anxious in the short term, it is likely to make your child’s fears stronger and more persistent over the long term.

Anxiety makes us want to avoid the things that scare us. We get the sense that something terrible will happen if we don’t. The problem is that every time we avoid something scary, we reinforce the idea that it is worth being afraid of. The longer a child avoids a scary situation, the harder it will be to return to it when the time comes. This is why it can be so hard to go back to school after summer vacation, and why so many kids developed separation anxiety after months of togetherness during quarantine.

To help an anxious child, we want to:

• Let them know their feelings are normal and okay

• Talk, read, and play about feelings and scary things

• Clear up any misunderstandings that might make anxiety worse

• Support them in gently and gradually facing their fears

Let’s see how we can apply those ideas to help a child who is afraid of Halloween.

Practice in Advance of the Big Day

The best time to start addressing Halloween anxiety is not October 30th. I say this knowing full well that this blog post will go up on October 30th, the night before Halloween. But, I am assuming that you are likely reading this blog post at some future time. Hopefully, Future You has decided to Google this issue in September or early October, which gives you plenty of time to prepare.

Kids learn and make sense of things around them through repetition and play. Ever seen your child act out the same game over and over for a week and then move on to something else? They’re learning! Children also thrive on routine, which helps the world feel more predictable and safe. Repeated conversations about Halloween traditions helps children learn what to expect, and takes away the element of surprise that can be so frightening.

Reading books about Halloween together is a great way to facilitate conversation. As an added bonus, books are a gentle form of exposure for anxiety. You are gently showing your child that he can handle talking and thinking about scary subjects, and you’ll be right there to support him.

Talk About the Difference Between Real and Pretend

Little kids have a hard time distinguishing between fantasy and reality. Their imaginations and ability to “make believe” can add a lot of magic to childhood. On the flip side, it can also add a lot of fear!

Older kids and adults can delight in scary movies because they know that there’s no chance of Godzilla lurking around the corner when they leave the theater. Pretend scary stories let us experience the adrenaline rush of a good scare at a time when we know that nothing bad can actually happen. Imagine how it must feel if you aren’t so sure the Godzilla won’t be there!

You can use TV shows and movies as an opportunity to show your child that the stories are pretend, and the actors are playing make-believe. Mister Rogers once invited the actress who played the Wicked Witch of the West onto his show to teach this exact concept. Onscreen, the actress showed how she put on her costume and makeup, and used a pretend scary voice to play the part. In reality, she was a really nice lady! You can talk with your child about how actors use makeup and costumes to look scary, when really they are normal people—there’s plenty of videos of actors in and out of costume to back up your point.

Use Exposure to Make Scary Items Feel Familiar

Exposure is a big part of the kind of therapy I practice for kids with anxiety, called Cognitive Behavioral Therapy. In exposure, we help a child face unhelpful fears, but we do it in a gradual way. This helps kids build up their confidence, and learn to tolerate anxious feelings without becoming totally overwhelmed.

You can practice exposure at home by giving kids a chance to look at and handle scary Halloween props in small doses. This could mean taking the scary mask from a sibling’s costume out for your younger child to handle and play with. It could also mean walking on the opposite side of the street from a Halloween display to view it from a safe distance before getting closer. It often helps to make these exposure situations funny: try talking with your child in a goofy witch voice, or encourage them to make fun of a monster that frightens them. It’s hard for things to be both funny and scary at the same time.

Involve Your Child in Halloween Prep

Helping your child participate in Halloween traditions in an age-appropriate way gives them another opportunity for exposure. It’s also another chance to highlight the difference between real and pretend by showing kids how things are made. A glowing jack-o-lantern seems a lot less intimidating when you saw the pumpkin that was scooped and carved to make it.

Giving your child a role in the Halloween festivities allows them to feel a sense of control over the situation. You can let your child pick out your decorations, play their choice of music, and decide what snacks to enjoy or what candy to give out to trick-or-treaters. Feeling in control can ease anxiety, and getting to pick out all the details might give children an added motivation to participate.

Fun is Most Important!

Okay, so I’ve gone on and on in this post about the importance of exposure and facing your fears. All of that is true! But also…Halloween is a holiday, and it’s one day a year. While I encourage you to gently help your child overcome Halloween anxieties, there’s no need to push them so far out of their comfort zone that the holiday stops being fun.

We’re looking for progress, not perfection. Maybe this isn’t the year that you go trick-or-treating in the neighborhood that goes all out for Halloween with super gory decorations. Maybe your young child would be more into a casual daytime party with friends rather than a nighttime trek with the big kids. Some aspects of Halloween may just be too intense for young or sensitive kids to handle, and that’s perfectly okay.

What’s most important is communicating to your child that having anxiety is okay, and that we don’t always have to do what it tells us to do. By staying calm and finding small opportunities for exposure, you are showing your child that you can handle their big feelings. They may be terrified of the ghost hanging on the neighbor’s house, but you aren’t!

Help for Anxious Kids in Davidson, NC

Do your child’s anxieties extend past Halloween? If you’ve got a sensitive kid who is prone to big feelings, it might feel like there’s a minefield of situations you have to tread carefully around to avoid triggering a meltdown. If anxiety is getting in the way of your child living their best life, counseling can help make things more manageable.

I am a former-anxious-kid-turned-therapist who loves working with children and tweens. I see kids in person for CBT and play therapy at my office in Davidson, North Carolina, just outside of Charlotte. If you aren’t close by, we may still be able to work together! I see kids throughout North Carolina, New York, and Florida for online therapy. If you’re not sure you’re ready to start therapy, or need some basic help right away, check out my coping skills course for anxious kids and tweens.

If you’re ready to start child anxiety therapy, drop me a line. I’m always happy to hear from you.

How to Help a Child with Intrusive Thoughts

Dark, bad, scary, negative, weird…whatever words you or your child use to describe intrusive thoughts, the effects are the same. Intrusive thoughts are like unwanted guests in our minds, barging in without being invited to spoil the party. While any child can have intrusive thoughts, they’re more common in children with anxiety, OCD, or a history of trauma. Keep reading to learn what you can do at home to help your child with the normal, common, but still very stressful phenomenon of intrusive thoughts.

Why Does My Child Have These Negative Thoughts?

If you’re curious to learn more about intrusive thought and why they happen, check out last month’s blog post. I break down what intrusive thoughts are in detail, with real-life examples. I also talk about what mental health problems might make kids more prone to experiencing them.

If you don’t have time to read the whole post, the gist is that intrusive thoughts are normal, and not always a problem. Many people—if not most people—will have intrusive thoughts at some point in their lives. They’re just one of the many weird things our brains and bodies do in an effort to keep us safe. When most of us have these seemingly random thoughts, we can shrug them off and quickly forget about them.

However, some kids are not so lucky. It can be harder for kids to distinguish between a useful thought and a useless one. This makes it more difficult to brush the thoughts aside. Instead, children may end up focusing on the thought and worrying about it. This leads to more anxiety, which increases the likelihood that these bothersome thoughts will pop up again.

An occasional intrusive thought is no problem, but kids with anxiety or OCD may get them so often that it feels debilitating. Children also sometimes experience these thoughts after a trauma as a part of PTSD.

How Can I Help My Child With Intrusive Thoughts?

There’s a lot you can do as a parent to support a child struggling with intrusive thoughts. You hold a powerful role in your child’s life. Your child looks to you as a guide to decide how she should think and feel about things, so your responses carry a lot of weight. By responding calmly and compassionately, you can help your child self-soothe and take the power away from overly dark or negative thoughts.

We’ll go over each of these in more depth in a minute, but here are 3 ways you can help:

• Normalize intrusive thoughts for your child

• Teach the difference between thinking and doing

• Help your child name and accept intrusive thoughts

These steps can go a long way toward helping kids handle disturbing thoughts with less worry and stress. Next, let’s break down each one to see why it helps and how you can practice it at home.

Let Your Child Know Her “Bad Thoughts” Are Normal (and Not So Bad)

Intrusive thoughts can be disturbing, but they’re also really, really common. So common, in fact, that one study found that 94% of people experience them. They’re just a part of being human! As common as they are, we don’t tend to bring up intrusive thoughts during polite conversation. Because nobody ever talks about them, a child may assume she’s the only one who gets intrusive thoughts. The thoughts can become a big source of shame, especially because they might be about taboo subjects.

Things always feel scarier when we don’t understand them. Teaching children about intrusive thoughts takes away some of their power. When you tell children that many people have these bad thoughts and they aren’t alone, you alleviate their shame. Reducing fear and shame not only helps your child feel better; it can also reduce her intrusive thoughts over time.

Try explaining this to your child: “Our brains are always thinking, and always looking for ways to keep us safe.” Giving us these “bad thoughts” is sort of like the brain showing us a flashing danger sign. The only problem is, the brain isn’t always right! Sometimes, the more we try to ignore these bad thoughts, the more our brain pushes the thoughts back. These thoughts can be really weird, or scary, or even be about things we’d never want to do in real life. As weird as they seem, most people have them sometimes and they are totally normal.

Explain That Thinking Isn’t The Same as Doing

Have you ever knocked on wood to keep something bad from happening? Or worn your “lucky shirt” on game day to help your team win? If so, you’ve experienced magical thinking. Magical thinking is the belief that our private thoughts and behaviors influence what happens in the outside world.

Magical thinking is really common in children, especially younger kids. It’s usually most noticeable from the toddler years through about age 7. If you think back to your own childhood, you’ll probably discover magical thinking everywhere: cootie shots, lucky charms, and “step on a crack, break your mama’s back” are all examples of magical thinking that are fun for kids.

However, there can be a dark side to magical thinking, too. Children often believe that their thoughts can cause things to happen in the world around them. If a child worries their thoughts are responsible for something bad happening, this can cause terrible fear and guilt. It’s easy to imagine how a child who gets intrusive thoughts about violence or crime could begin to worry about accidentally hurting others.

Help your child understand that having bad thoughts does not make you a bad person. It’s our actions and choices—not our thoughts and feelings—that hep us to be “good people.” Next, reassure your child that thinking angry or scary thoughts about a person can’t hurt them or cause something bad to happen. Even if they feel bad to us, thoughts are not that powerful.

Shine Some Light on Dark Thoughts By Naming and Accepting Them

When I think about kids struggling with dark intrusive thoughts, a quote from famous psychiatrist Dan Siegel comes to mind: “Name it to tame it.” Dr. Siegel came up with this phrase, and it’s since been adopted by many therapists to describe a simple process that makes strong feelings more bearable.

“Name it to tame it” is exactly what it sounds like. Often, the simple act of labeling our thoughts and feelings as we have them can make them feel better. This is because naming something requires us to take a step back and go into observing mode, rather than being totally absorbed and overwhelmed by our feelings.

Naming intrusive thoughts as they happen can be a helpful reminder that we are not our thoughts. Thoughts come and go, but it’s up to us to decide how much attention they deserve. Calling out intrusive thoughts for what they are is also a helpful reminder that they are common and harmless: after all, they’ve happened to enough people that we’ve given them a name!

You can help your child practice saying one of these phrases (or something similar) the next time an intrusive thought strikes:

• “My brain is giving me one of those garbage thoughts again.”

• “I’m having an intrusive thought right now.”

• “This seems like one of those thoughts I don’t need to listen to.”

Once the thought has been named, don’t dwell! We can just let the thought pass by. The more a child resists having intrusive thoughts, the more likely they are to pop up again. It may sound counterintuitive, but accepting intrusive thoughts can actually reduce how often they happen. By naming the dark thought and moving on, your child is teaching herself that they’re nothing to be afraid of.

Need More Help? Begin Child Therapy for Intrusive Thoughts in North Carolina

Sometimes, a child’s intrusive thoughts grow to be so big and overwhelming that at-home strategies aren’t enough to tame them. Maybe your child’s thoughts are part of a larger problem with anxiety or OCD. Sometimes, intrusive thoughts show up after a child experiences something traumatic or highly stressful. If your child’s intrusive thoughts are very frequent or very overwhelming, therapy can help sort things out.

Cognitive-behavioral therapy teaches children that they have more power than they might think over their thoughts and actions. They can learn to spot intrusive thoughts when they happen, and dismiss them rather than worrying about what they mean. Play therapy can also help younger kids work through anxiety and other feelings that are sometimes difficult to put into words. If your child survived a trauma, TF-CBT is a special, kid-friendly form of therapy designed to help children work through their symptoms in a safe way.

I’m a play and CBT therapist who specializes in helping kids with anxiety and trauma. I can work with families in three states: North Carolina, New York, and Florida. Children who live near my Davidson, NC child therapy office are welcome to stop by in person. If that’s not possible, no worries! I really enjoy online therapy and have found it to be just as helpful for many kids.

Ready to learn more? Drop me a line here. I’m always happy to hear from you.

Intrusive Thoughts in Children, Explained

Every kid worries from time to time. It’s normal (and even healthy!) to wonder about fitting in before the first day of school, or to imagine the worst-case scenario before taking a big test. Usually, these worries are easy for kids to talk about, because they know other kids have felt the same way. They also tend to be time-limited: once the test or first day of school is over, the worries are over, too.

For some kids, worries aren’t so easy to talk about. A troubling thought or mental image might pop up out of nowhere, when a child isn’t expecting it. Their worries may be repetitive and feel very difficult to control. Often, these thoughts are really scary and upsetting. They can be dark, violent, or about a taboo subject. These kinds of worries are called intrusive thoughts.

Kids don’t want to be thinking these things, and know they would never act on the thoughts they’re having. So why do they keep happening? In this post, we’ll be talking about what exactly intrusive thoughts are, why they happen, and when to seek help.

What Are Intrusive Thoughts?

Take a second and imagine an intruder. What do you think of? Someone who busts down the door, unannounced, without being invited. What a scary scenario! It’s safe to assume that most of us would be pretty freaked out to discover an intruder in our home. We’d probably dread having it happen again, and try everything we could to make sure our house was secure in the future.

Intrusive thoughts are the brain equivalent of an unwanted guest. They show up to ruin the party. Intrusive thoughts tend to:

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

Intrusive thoughts are ego dystonic. This is therapy jargon that means a person doesn’t agree with the thoughts, and it may not even feel like the thoughts really belong to them. Intrusive thoughts include imagery that is violent, sexual, or feels “wrong” to a child. Other times, worries about worst-case scenarios might come up again and again. They aren’t things that kids would choose to think about, and they’re often the opposite of what a child would do or hope for.

Kids with intrusive thoughts may feel distressed, anxious, or ashamed. They may not understand why the thoughts are happening, but can guess that not everyone is bothered by their thinking in this way. Because the thoughts feel out of control, children may dread having more and try to avoid them.

At What Age Do Kids Get Intrusive Thoughts?

There is no set age at which intrusive thoughts start. However, they may be more common or noticeable in tweens and teens. Intrusive thoughts are sometimes a symptom of OCD, which can show up as early as age 7 or 8 and as late as the teens or early twenties.

In my child therapy office, it’s usually middle or high school kids who are able to put the weird experience of having unwanted thoughts into words. They are old enough to think about their own thinking and notice their thoughts as they pass by, so they know that something doesn’t feel right.

Although they may not talk about it as much, younger kids can be bothered by these thoughts, too. Because they don’t have the vocabulary to talk about what’s going on, you might see changes in their actions, instead. For example, they may ask for reassurance about the same subject again and again.

Why Do Children Have Intrusive Thoughts?

Now that we have spent the past several paragraphs talking about how difficult and upsetting intrusive thoughts can be, you’re probably wondering why kids get them in the first place. The answer may surprise you! Many people experience intrusive thoughts, and it doesn’t necessarily mean something is wrong. They may happen when a person is going through a lot of stress, or they may just happen randomly.

Having an intrusive thought every once in a while isn’t a sign of mental illness. They can be totally normal, like the brain version of a hiccup. A child with occasional intrusive thoughts can usually brush them off without taking them too seriously.

What Mental Health Problems Cause Intrusive Thoughts?

Children who are struggling with repeated, ongoing intrusive thoughts can’t brush them off so easily. In these cases, a child may be dealing with a mental health problem that needs attention. OCD and PTSD are two common mental health conditions that can cause children to have intrusive thoughts.

Kids with OCD deal with repeated thoughts, worries, or mental pictures that upset or scare them. Kids are bothered by these worries, and feel pushed to do something to make the worry go away or prevent something bad from happening. This creates a cycle of repeated worries and repeated behaviors, called obsessions and compulsions, that take up a lot of time and add even more stress.

Children who have survived extremely frightening or dangerous events may have lingering problems after the fact. While some kids will bounce back, others may be diagnosed with PTSD. Kids with PTSD will re-experience parts of their trauma in some way, often through intrusive thoughts or flashbacks. Flashbacks are vivid memories that pop up suddenly and intensely, almost as if a child is living through the event again.

What Are Some Examples of Intrusive Thoughts in Children?

Most of the intrusive thoughts children have fall into one of three broad categories: worries, flashbacks, and “inappropriate” thoughts. If you think your child may be having intrusive thoughts, keep reading to take a closer look at each category. I’ll share some examples of each intrusive thought type. It can be helpful for both kids and parents to discover that they’re not alone, and many kids (and adults) deal with these kinds of thoughts.

Worries: Children with anxiety or OCD may have repeated, unwanted worries that they cant seem to shake. These are often “what if” worries that focus on something bad that could happen in the future. Other times, these “what if” thoughts could be about something naughty a child worries they could have done. Some children with OCD may also get a nagging sense that if they don’t do something exactly right, they could cause something bad to happen. These thoughts may not always be logical, which can make them even more confusing and bothersome for kids. Here are some examples:

• “What if I throw up in public?”

• “What if I accidentally lied to the teacher?”

• “I have to step on all the sidewalk cracks or I won’t be safe.”

Flashbacks: These are most common in kids with PTSD. Flashbacks may feel like they come out of nowhere, or they can be triggered by something that reminds a child of their trauma in some way. They can include any of the 5 senses, and often activate a child’s fight-or-flight system as if the dangerous event was happening again. Examples of flashbacks include:

• Feeling as though you’re back in the place where a trauma happened

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

“Inappropriate” Thoughts: I put inappropriate thoughts in quotes here because there’s a big difference between thinking something and acting on it. We all have weird thoughts from time to time about things we probably wouldn’t be proud to share. Sometimes, intrusive thoughts are about the exact subjects we try to push away or not think about in our day-to-day lives: things like sex, violence, and criminal behavior. These kinds of thoughts can cause a lot of shame, guilt, and distress for children, who worry these thoughts mean they are bad or naughty. They may have thoughts like:

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

The short answer: yes. Intrusive thoughts can be weird, annoying, or disturbing, but they are totally normal. In fact, most of us will probably have intrusive thoughts at some point in our lives. One recent study found that 94% of people have them, which is a surprisingly huge number.

That number is particularly surprising when you consider that most kids with intrusive thoughts feel like the odd one out. They may worry they’re the only ones who have ever had thoughts like this, and that it means they’re bad or weird. Most adults with intrusive thoughts don’t talk about them with other people, either because they quickly disregard them or because it would feel odd to mention in casual conversation. No wonder kids feel so alone.

So, intrusive thoughts are normal—but we know that they can still cause problems for kids. Those issues aren’t caused by the thoughts themselves. Problems arise when the thoughts are very frequent or intense, or when kids have a hard time dismissing them.

Children with OCD have a tougher time disregarding stray thoughts that the rest of us would shrug off. They may take these thoughts more seriously or begin to fixate on them, which causes the thought to pop up more often. Trauma-related thoughts and flashbacks may be so upsetting that they quickly overwhelm a child.

Help for Kids with Intrusive Thoughts in Charlotte, NC

If your child is complaining of an occasional intrusive thought, a little reassurance and education may be all she needs to feel better. It’s helpful for kids to hear that their thoughts are normal, and can’t hurt them or others. Armed with that knowledge, it may be easier for kids to let intrusive thoughts pass by without taking them too seriously. This reduces anxiety which, over time, can also reduce how often the thoughts happen.

On the other hand, you may be on this page because your child’s thoughts are causing larger problems. Maybe you recognized your child in the descriptions of OCD or trauma. If these thoughts have been happening for a long time, are disrupting your daily life, or are combined with other symptoms, therapy can help.

Cognitive behavioral therapy helps anxious kids learn how to catch themselves when their thoughts aren’t doing them any favors. Being able to put a name to your worries helps you to gently shift your mindset. In CBT kids learn that they have control over their thinking, and what thoughts they choose to listen to. A specialized form of CBT called Exposure and Response Prevention helps kids with OCD break the cycle of obsessive thinking and repetitive behavior.

Play therapy helps younger children work through their complicated feelings after trauma. Kids naturally make sense of the world around them through play, and this gentle, child-led approach lets kids handle scary topics in the way that feels safest to them. For kids who are ready to tell their story more directly, TF-CBT gives children a step-by-step path toward managing strong feelings, talking about their experiences, and coping with reminders of trauma.

If you are looking for therapy in North Carolina, New York, or Florida, I’d love to help. We can meet online or in-person in my counseling and play therapy offices just North of Charlotte, North Carolina. If you’ve got questions or would like to schedule an appointment, contact me here.

Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Signs of Depression in Children and Teens: Know When to Get Help

The pandemic hasn’t been easy for any of us, but teenagers have been hit particularly hard. From the loss of highly anticipated milestones like prom and homecoming to the social isolation of ongoing lockdowns, it’s been a straight-up bummer of a year. Middle and high school aren’t usually a walk in the park under normal circumstances, so it’s understandable that many tweens and teens have felt more down than usual under these exceptional circumstances.

It’s normal (and natural and human) for any of us to feel a little down this year—kids included. But if you are like many of the parents I know, you may be trying to figure out where the line is between normal sadness and clinical depression when it comes to your child. How can you recognize when a typical reaction to a stressful situation is becoming something more?

Any childhood mental health struggle is cause for concern, but depression can feel extra scary due to the highly publicized rise in suicide rates over the last decade for young people ages 10-24. Most children and teens with depression won’t experience the serious suicidal thoughts that put them at risk. However, it’s helpful to be familiar with the signs and symptoms of depression and take them seriously when they arise. Let’s take a look at some common signs of depression in kids and teens, so you’ll know when to get help if your child is ever in need.

What Causes Depression in Children and Teenagers?

You may have heard that a chemical imbalance is to blame for depression. Many of us have heard of serotonin, and how a lack of it might lead people of all ages to feel depressed. While serotonin and other chemicals in the brain are a part of the puzzle, the causes of depression are much more complicated. Many parts of the brain are involved in depression. In fact, researchers are still trying to figure out exactly what happens in our brains and nervous systems that makes some of us more vulnerable to feeling depressed.

Outside factors like stress and trauma play a major part in depression, too. Any of the following can contribute to a child or teen’s depression:

• Genetics: having a close relative with depression puts a child at increased risk

• Trauma or ongoing stress, especially if the trauma happened early in a child’s life

• Major life changes, like an unwanted move, a breakup, or a divorce or death in the family

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

There isn’t usually a “smoking gun” that we can point to as a cause of a child’s depression. It’s more common that several factors have built on each other over the course of months or years and eventually led to a depressed mood. This is even true for kids during the pandemic: as stressful as it has been, the pandemic itself isn’t usually enough to trigger a major depressive episode. However, if your child was already vulnerable due to genetics, stress, or other life changes, they may be having a harder time with depressive symptoms now.

How is Depression Diagnosed in Kids and Teens?

A pediatrician can be a good first stop if you’re concerned about depression symptoms in your child or teen. However, they’ll probably point you in the direction of a mental health professional to make a definitive diagnosis. Pretty much any mental health worker—a counselor, social worker, psychologist, or psychiatrist—is capable of diagnosing common issues like depression.

Therapists use a manual called the DSM-5 to help them when determining whether a child (or adult) is suffering from depression. The DSM-5 gives specific guidelines about the type and number of symptoms a person needs to have in order to qualify as having depression. This gives therapists something concrete they can turn to, rather than just using their intuition or guessing.

According to the DSM, kids and teens need to have at least 5 of these 8 symptoms in order to be diagnosed with Major Depressive Disorder:

• Depressed or irritable mood most days (this one is mandatory!)

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

• Repeated thoughts about death or suicide, or making a suicide attempt

In addition to having 5 of these, a child’s symptoms have to get in the way of daily life and cause emotional distress to qualify as Major Depressive Disorder. They also can’t be due to another cause, like drug use or a medical condition.

Just because a child doesn’t fully meet criteria for MDD doesn’t mean they aren’t depressed! There are several other forms of depression that may not be as severe or dramatic as MDD, but can still really get in the way of enjoying life.

Signs of Depression in Children

It can be hard to imagine a very young child being depressed: isn’t early childhood supposed to be the most carefree time of our lives? While not as common as anxiety, about 3.2% of U.S. kids ages 3-17 have been diagnosed with depression. Interestingly, young boys (10 and under) seem to be more at risk of depression than young girls.

Little kids may show symptoms of depression differently than older children. It can be harder for them to put their feelings into words, so you may notice that young children’s signs of depression show up more in their behavior. In addition to the symptoms above, here are some signs of depression more specific to younger children to look out for:

• Trouble concentrating at school

• Frequent physical symptoms, like headaches and stomach problems, that don’t respond to treatment

• Sleep problems: either having a hard time sleeping, or sleeping way too much

• Seeming “cranky”, overly sensitive, or quick to cry

• Difficulty handling rejection or criticism

• Low self-esteem

If you’ve noticed multiple signs of depression in your child that have persisted for more than a few weeks, it’s a good idea to have a conversation with your pediatrician or a mental health professional.

Symptoms of Depression in Teenagers

It’s common for depression to begin in the teen years. Teens have to grapple with body image, sexual identity, and social issues that are different from what any other age group experiences. What’s more, teens are navigating all these challenges in a rapidly changing body, while simultaneously trying to manage intense academic pressure on the way to college or a career. It’s no wonder so many teens feel isolated, misunderstood, or suffer from low self-esteem that may pave the way for depression.

Interestingly, while depression is more common in boys in the early years, the opposite is true among teens. By adolescence, girls are significantly more likely than boys to experience depression. Regardless of gender, depressed teens may not fit our stereotypical image of a withdrawn, quiet, sad-seeming person.

Teens experience their emotions intensely, and their depression can often look like outbursts of anger rather than outbursts of tears. They are also more likely than younger children to express their feelings in impulsive and potentially harmful ways, like substance use or self-harm.

Depression symptoms specific to teenagers include:

• Dropping grades at school, especially if the drop is fairly sudden and unusual for the teen

• Feeling hopeless or disinterested about the future due to a belief that things will never get better

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

• Abusing drugs or alcohol as a way to cope with feelings

• Cutting or other forms of self-harm

Speaking to your child’s school counselor or doctor can help you make a plan for your teenager if you notice any of the symptoms above. Any child who talks about suicide or self-harm should be taken seriously. If you worry your teen is at risk of making a suicide attempt, call 911 or your local crisis hotline for help right away.

Counseling for Teens and Tweens with Depression in Davidson, NC

Therapy can make a big difference in a child’s life. The teen years are tough for pretty much everyone, but learning coping skills at an early age can make them a little easier to get through. One of the reasons I love working with tweens and teens is that they’re old enough to learn many of the same skills adults learn in therapy, which means they have a leg up on their current challenges as well as the ones they’ll face in their twenties and beyond.

I use the roleplaying game Dungeons and Dragons as a form of group therapy for tweens with depression. I also provide more traditional talk therapy both in-person and online for tweens and teens. Group therapy can provide kids with the social support from their peers that is so critical to good self-esteem. Individual counseling allows us to take a closer look at the thought patterns that fuel a teen’s depression, and practice coping skills to manage negative thinking.

If your child’s sadness is caused by a recent loss, you can play a big part in giving your child the coping skills to manage grief in a healthy way. My activity book for caregivers and kids is designed to help children ages 5-11 get support and process feelings of grief through simple, play-based activities you can try at home.

If you’re looking for help in the Charlotte area, you’re welcome to request a session at my Davidson, NC teen therapy office. Not local to Charlotte? I also see kids for online therapy throughout North Carolina, Florida, and New York. For more information, contact me here.

Is My Child Having a Panic Attack or an Anxiety Attack?

Your child’s mind is racing. Her stomach is flip-flopping. She’s having a hard time falling asleep at night, and an even harder time getting up for school in the morning. You know something is going on, but you’re not sure what to call it when you describe it to people. Is your child having a panic attack or an anxiety attack? What’s the difference? Today I’m going to break down the difference between panic and anxiety, so you know the next steps to take to help your kiddo.

Panic Attacks and Anxiety Attacks Are Basically The Same Thing

I guess I’m giving away the big reveal in this blog post right up top, huh? Kids and parents often ask me if the symptoms they’re describing sound more like an anxiety attack or a panic attack. The truth is, most people use both terms to describe the same thing, so you can pretty much use them interchangeably. Mentioning either term to a therapist will give them a good idea of what you’re going through.

“Panic attack” is the official name for a sudden bout of intense fear, bodily reactions, and a feeling of impending doom. This is the term used by the DSM-5, the phone book-sized manual therapists use to diagnose mental health problems. The phrase “anxiety attack” isn’t usually used by therapists because it doesn’t appear in the book and isn’t “official.”

Parents might use the phrase “anxiety attack” to describe another intense emotional experience, like a tantrum or extreme worrying, but that’s rarely the case. It makes sense to describe panic as an attack of anxiety, and pretty much everyone will understand what you mean if you do.

What Does Anxiety Look Like in a Child?

The big difference between anxiety and panic is that anxiety is more general and long-lasting, while panic is specific and sudden. Anxiety can be mild or severe, and it can ebb and flow over time. Some kids may only feel nervous in specific situations, such as meeting new people or sleeping in bed alone, while others may have more generalized anxiety that happens most days.

If your child has anxiety, you might see signs like:

• Frequent worries that seem like more than a phase

• Avoiding specific people, places, or things to keep from feeling afraid

• Difficulty falling asleep, or trouble sleeping alone

• Muscle tension, headaches, and stomach aches that don’t have a clear medical cause

• Clinginess and difficulty tolerating being alone

• Repeatedly asking for reassurance

• Irritability or seeming on edge

• Being easily startled by loud sounds or surprises

• Focusing on things that went wrong in the past or that might go wrong in the future

Every child is different, but these are some of the most common signs I hear about from families in therapy.

Signs Your Child Is Having Panic

Panic comes on suddenly, and it can be debilitating. It’s possible for a child to go about her day with anxiety, but a panic attack will stop her in her tracks. While anxiety gradually waxes and wanes, panic is like a light switch flipping on and off. The good news is that although panic attacks are intense, they don’t usually last very long. If your child has a panic attack, it will most likely be over in 15 minutes.

If your child is having a panic attack, you may notice things like:

• Shaking hands or full-body shivering

• Increased sweating

• Hot flashes or chills

• A racing, pounding heartbeat

• Hyperventilating, or feeling like it is hard to breathe

• Dizziness or weakness

• Tingling feelings in the fingers or hands

• A sense of losing control

• Intense terror, as if something bad is about to happen

Your child may or may not be worried about something in particular when a panic attack occurs. Sometimes, panic attacks seem to appear out of the blue, when a child isn’t thinking about anything in particular. Over time, though, your child may start feeling worried about the panic attacks themselves. If she’s already had a few, she may dread the possibility of having another one.

Can a Child Have Both Anxiety and Panic?

Yep! A child can have both anxiety and panic attacks. In fact, it’s pretty common. Being anxiety-prone or sensitive to stress may put a child at risk for experiencing panic attacks. Sometimes, panic attacks happen on their own, and this is called Panic Disorder. It’s also very common for panic attacks to go hand-in-hand with other forms of anxiety, like Social Anxiety, Generalized Anxiety, and Agoraphobia.

If a child is struggling with both anxiety and panic attacks, she probably has lower-level anxiety on an ongoing basis that gets punctuated by brief moments of intense fear. For example, a child may struggle with perfectionism and worries about not doing a good enough job on school assignments. This could lead to problems like avoiding turning in homework, stomach aches on school days, and fitful sleep. Before a test, however, this child might experience a full-blown panic attack with rapid breathing and dizziness.

Anxiety and panic are both tough. Dealing with them both is even harder. The good news is, there are great therapy options to help kids with anxiety, panic, or a mix of both. It’s possible to get worries under control and learn to soothe panic responses in the body, so your child can get back to enjoying life.

Help For Kids With Anxiety and Panic Attacks in Davidson, NC

Anxiety doesn’t have to run your child’s life and call the shots in your house. If you feel like you’re bending over backwards to avoid things that set off your child’s worries, therapy can help. Kids can learn coping skills to feel more in control of anxiety and panic, like the ones I teach in Worry-Free Tweens, my online class for kids.

Child-friendly styles of therapy like Play Therapy and Cognitive Behavioral Therapy have been proven to help anxious kids feel better in a relatively short period of time. With a little practice, your child won’t have to dread their next panic attack, because she’ll know exactly what to do if she feels one coming on.

I love helping anxious kids and tweens in my Davidson, NC child therapy office. I also provide play therapy and CBT online to kids throughout North Carolina, New York, and Florida. I use these approaches because I’ve seen them work, and I know they’re effective. Whether you work with me or another counselor, I hope your family finds therapy helpful, too.

Questions? Ready to schedule an appointment? Reach out to me here.

Signs of Social Anxiety Disorder in Children

How can you tell whether your child is just shy, or if there’s something more going on? If you’ve noticed your child lingering on the edges of the playground or appearing uncomfortable during playdates, you might wonder if social anxiety is to blame. Social anxiety affects about 7% of Americans, and it often starts during late childhood or the teen years.

This post will cover the common symptoms of social anxiety and how they show up in younger kids. You’ll learn what to keep an eye out for, and how to spot the difference between true social anxiety and run-of-the-mill shyness.

How to Tell If Your Child Is Shy…

Kids who are shy have trouble meeting new people. While their shyness may pop up with close friends and family, it’s usually the most noticeable when talking to an unfamiliar person. Shy kids may have a hard time initiating conversations, or responding when an adult says hello. However, after spending some time with a new person, many shy kids are able to warm up and interact more comfortably.

Kids who are shy may appear soft-spoken or socially awkward at times, but their troubles are usually mild or fleeting. Shyness doesn’t usually cause major problems in a child’s life, or keep them from making at least a few good friends. Over time, many children may outgrow their shyness altogether.

…And How to Tell If Your Child Has Social Anxiety

On the flip side, kids who have social anxiety fear judgment from others. They worry about embarrassing themselves or making a mistake in front of friends, teachers, and even strangers. You may hear a socially anxious child worrying aloud about doing something wrong. This fear can be paralyzing, and it doesn’t usually get better on its own.

Because socially anxious kids fear judgment, they can definitely have a hard time talking to friends or meeting new people. However, they can have a hard time with other public activities, too. The “social” in social anxiety refers not just to friendships, but any activities that involve being observed by others. This can include things like reading out loud in class, participating in gym class, or even eating in restaurants or using public restrooms.

Signs and Symptoms of Social Anxiety Disorder

Therapists use a manual called the DSM-5 to diagnose children with Social Anxiety Disorder and other mental health problems. It tells us how many symptoms a child needs to have, and gives us a handy bullet point list of what exactly those symptoms are. It also tells us how long those symptoms need to last in order to be considered social anxiety.

Here are the “official” symptoms of Social Anxiety Disorder, according to the manual:

• Intense and ongoing anxiety about social situations due to a fear of being judged or humiliated

• Avoiding situations that trigger this anxiety, or tolerating them with distress

• The fear is exaggerated or out of proportion to the actual situation

• The anxiety gets in the way of completing day-to-day activities

In order to qualify as social anxiety, the symptoms need last for at least 6 months. There also can’t be a better reason for the anxiety, such as a physical problem or the side effect of a medication.

What Social Anxiety Looks Like in Kids

Okay, now that we know the “official” symptoms of social anxiety, let’s talk about how they actually show up in children. Some kids with social anxiety might be very vocal about their worries, which makes it easier to figure out what’s going on. Others might have a harder time putting feelings into words—or they may feel too embarrassed to talk about it.

Here are a few common scenarios that illustrate what Social Anxiety Disorder may look like in children:

• Your child loves school and learning, but absolutely dreads class presentations. He gets flushed and visibly anxious when he has to read aloud, and stumbles over his words. You have noticed he avoids these projects at all costs, even in classes where he excels. In fact, he always seems to get sick on presentation days.

• You’ve noticed your child is extremely worried about what others may think of her. She feels like all eyes are on her, even in situations where most of her peers probably have other things on their minds. Her thoughts tend to jump to the worst-case scenario, and assume other people are critical of how she dresses, what she says, or how she acts.

• Your child avoids trying out for sports or the school play, even though you have a feeling he’d love to join. Being “in the spotlight” is just too overwhelming for him, and he’d rather be able to participate without anybody looking at him. You’re worried he might be missing out on a lot of fun.

• It’s hard for your kid to order food at a restaurant or answer the phone. You’ve offered a lot of encouragement, but it’s still seems like it’s way harder for her than it should be. You’ve noticed other kids the same age don’t have the same struggle.

• Your younger child throws tantrums when it’s time to go to a birthday party or other social event. It’s hard for him to articulate why, but he dreads going. He complains of headaches and stomach aches, and starts feeling on edge the night before it’s time to go.

Do any of these sound like your child? If so, chatting with a children’s therapist can help you confirm whether or not your child is dealing with Social Anxiety Disorder.

Counseling for Kids with Social Anxiety

Counseling can help your child to overcome her worries, so she can participate more fully in life without a fear of being judged. Therapy approaches like cognitive behavioral therapy can help kids learn how social anxiety affects their thoughts. It can be a big relief for socially anxious kids to realize that, most of the time, other people are focused on their own lives and not thinking negatively about us at all!

Younger children with social anxiety can benefit from play therapy, too. Even if it’s too hard (or embarrassing) to talk about worries out loud, children naturally express their anxieties through their play. A play therapist can help kids work through these feelings in a non-threatening way, and even use play and storytelling to help kids learn coping skills to manage their worries.

If coping skills sound like the way to go for your child, you can also check out my online coping skills courses. My anxiety skills course, Worry-Free Kids, is a good fit for older kids with social anxiety.

I’m a CBT and play therapist in Davidson, North Carolina. I love helping kids with anxiety to learn that they don’t always have to listen to the worries that anxiety gives them. I get to see kids build their self-confidence and face their fears every day in my office, which is part of why I love my job. Even if you don’t live in the Lake Norman area, I may be able to help: I offer throughout North Carolina, New York, and Florida.

If you are ready to take the next step with counseling for childhood social anxiety, you can reach out to me here to set up an appointment.

How Do I Talk to My Child About Counseling?

You know your child better than anyone, and lately, things just don’t seem right. Maybe you have noticed your child seems to be more worried than other kids her age. Or, you’ve been waiting to see if your child’s tantrums were just a phase, but they’ve stuck around long past the toddler years. After consulting with friends, the pediatrician, or “Dr. Google”, you’ve decided that child counseling could help. How do you tell your child you’d like her to see a therapist? It’s not a conversation most families have every day, which can make it feel awkward. In this post, I’ll share some tips from my experience as a children’s therapist on how to introduce therapy to your child in a positive way.

Common Concerns When Discussing Counseling

The most common concern I hear from parents is that their child will think something is wrong with them if they see a counselor. Views on mental health are changing quickly, but there can still be a stigma attached to getting therapy. The last thing a child struggling with anxiety, depression, or low self-esteem needs is another reason to feel different or “bad”!

Parents of younger children often worry about separation anxiety during sessions, especially if this is one of the issues bringing a child to therapy in the first place. Will it be too frightening for their child to meet with a therapist alone? What be done to help soothe their child’s fears?

When the child is a preteen or teen, there’s sometimes a worry that kids will “shut down” or not be receptive to attending therapy if it wasn’t originally their idea. Any suggestions from Mom or Dad might be viewed with suspicion by a teen or tween. How can we explain therapy in a way that encourages kids to keep an open mind?

If any of these worries sound familiar to you, congratulations! Your concerns are totally normal and you’re in the right place. Keep reading for some tips on how to handle this important talk with your child.

Don’t Bring Up Therapy in the Middle of a Fight!

There isn’t one right way to bring up the subject of therapy. However, there are a few that are…not so great! This is one to avoid. As frustrating as arguments with your child can be—especially if this is your millionth meltdown this week—don’t let this be the way your child learns about therapy.

Telling your child you’re sending them to a therapist between screams or from behind a slammed door virtually guarantees they’ll view therapy as a punishment. It increases a child’s feelings of shame and embarrassment, which won’t help them get better. What’s more, it can turn children off to the whole idea of therapy. They enter their first therapy session feeling resentful and not trusting the therapist to be on their side. That is a hard place to start.

Instead, wait until everyone is feeling good to start a conversation about therapy. This way, your child won’t connect going to a therapist with bad behavior. Avoid times of the day when you know you or your child will be stressed, tired, or hungry. A quiet evening after dinner or snack time after a good day at school is a great time for this discussion.

Describe the Problem as Belonging to Everybody

It’s often easiest to start the “counseling talk” by identifying the problem at hand. Even if your child is showing the most symptoms, it helps to acknowledge that parents have a role to play in therapy, too. This way, the child doesn’t feel like she’s a problem that needs to be fixed: everyone is in this together.

Try to describe the problems you’re seeing in a matter-of-fact, non-judgmental way. It helps to empathize with the emotions your child is feeling, even if the behaviors may be tough. Avoid making assumptions about why the problem is happening, if you aren’t totally sure, and stick to the what instead. If you think a child’s struggles were set off by a particular event, you can always “wonder aloud” about the possible connection.

For example, if your child is having anxiety about going to school, you could try saying: “I have noticed you have had a lot of stomach aches and worries lately, and they usually happen right before it’s time to get on the bus for school. It must be terrible to feel so nervous every day! I wonder if starting in your new school has been scary. I don’t always know the best way to help you with your worries.”

Once you’ve outlined the problem and how it’s affecting your family, you can move on to talking about therapy itself.

Explain What a Counselor Is to Your Child

Children need to know that a counselor is someone who can help them—and you—deal with their big feelings. They need to know that therapy is common and not something to feel ashamed of. In fact, we could all use counseling at some point in our lives!

When I meet younger children, I often describe myself as a “feelings doctor” even though I don’t have a doctorate degree. Most little kids are very familiar with going to their pediatrician’s office, so it’s a good comparison to make. If you have a cold or hurt your arm, a doctor can help you feel better. If your worries, sadness, or anger are bothering you, a feelings doctor can do the same thing. It’s important to explain that feelings doctors can’t give shots!

I tell older children that a therapist is an adult whose job is to be there to listen to them. A therapist is different than a teacher or parent, because they can’t give out punishments or make the rules. They are also different from a friend, because you don’t have to worry about offending your therapist or giving them a turn to speak in conversation. Therapists also keep what you say private, which is helpful and reassuring for older kids to know.

Talk About How Child Counseling Works

When describing child therapy, it helps to keep things simple. Sometimes, over-describing the situation only adds to the anxiety. You might consider something like this: “When you see your therapist, you can talk or play about anything you want. She’ll help you with your strong feelings and will keep the things you say private. She’ll also meet with me to help me understand you better.”

You can also prepare your child for what the therapy session will look like. If you’ll be meeting the therapist in person, describe where the office is and how it looks. Young children are often excited to know that there will be a playroom filled with toys! Tell your child where you’ll be during their session, for example, that you’ll stay in the waiting room nearby.

If you’ll be meeting online, explain how that will work to your child. Most kids are intimately familiar with Zoom these days, but they may still have questions about how much privacy they’ll have or who exactly will be on the call with them. You can pick out a quiet, private location for video calls with your child, and practice logging into the therapy platform together. Younger children may want to pick out a few toys or art materials to “show” their therapist on the first day.

Looking for a Child Counselor in Davidson, NC?

I live and work in the Lake Norman area, just north of Charlotte, North Carolina. If you’re in my neck of the woods, I specialize in working with preteen anxiety and trauma at my Davidson child therapy office. If you aren’t local to Charlotte, I also work with kids throughout New York, North Carolina, and Florida using online CBT and play therapy. And no matter where you live, my coping skills courses are available to access and use at home.

Want to see if we might be a good fit? Feel free to drop me a line to ask questions about what to expect in therapy, or to schedule an intake appointment.

Does My Child Have Generalized Anxiety Disorder?

If you’ve been spending what feels like an overwhelming amount of time talking through your child’s worries, you might be wondering about Generalized Anxiety Disorder. It’s a pretty common mental health disorder, but it can sometimes be tricky to spot. Unlike other forms of anxiety, kids with generalized anxiety aren’t dealing with one specific fear. Instead, many day-to-day events can be the source of their worries. Today I’ll be writing about the signs and symptoms of Generalized Anxiety Disorder (GAD), and how you can help your child with anxiety.

When Does Worrying Become a Problem?

As uncomfortable as it feels, anxiety is a healthy emotion to have. If we never felt anxious, we’d have no inner voice letting us know when a situation is potentially dangerous. Kids are still learning about the world, so it makes sense that they’d be on high alert in new situations. It’s totally normal, age-appropriate, and even healthy for kids to worry sometimes.

Very young children usually worry about being away from their parents. By preschool, fears of animals, monsters, and the dark become more common. Grade schoolers often worry about more complex, “real world” fears like germs, serious illness, natural disasters, and kidnapping.

Kids with generalized anxiety worry about these common topics, too, but the nature of their worrying is different. While many kids might focus on a single worry for a few weeks or months and eventually move on, kids with GAD seemingly worry about everything.

They have a laundry list of worries, both big and small. Parents of kids with GAD may notice that their child’s stress level seems out of proportion to the actual situation, and it’s hard get that stress under control. The worry these kids experience is so intense that it affects their sleep, and can even lead to physical problems like tension headaches and fatigue.

Symptoms of Generalized Anxiety Disorder

Therapists use specific criteria to diagnose mental health problems like anxiety and depression. Here are the symptoms we look for when diagnosing Generalized Anxiety Disorder:

• Excessive worrying and anxiety about a variety of topics, events, or activities. The worrying has to happen most days, and last at least 6 months.

• The worries are very difficult to control—the child can’t easily shift away from them.

• The anxiety affects the child physically or mentally in at least one of the following ways:

  • Feeling on edge

  • Fatigue

  • Trouble concentrating

  • Irritability

  • Body aches, or muscle tension

  • Problems falling or staying asleep

• The anxiety (or the physical and mental problems it causes) get in the way of a child’s day-to-day life, and make it harder to participate in activities at school or home.

• There isn’t a more obvious reason for the worrying, such as a recent trauma.

Signs of Generalized Anxiety Disorder in Children

Here are a few more signs that might suggest generalized anxiety is to blame for your child’s worries. If your child is struggling with GAD, you might notice:

• A lot of time spent worrying about things that could happen in the future, whether or not they seem very likely to happen.

• Frequent complaints of headaches, tummy troubles, or other problems that don’t seem to have a medical cause.

• Your child seems to worry more often and more intensely than other kids of the same age, and has a harder time setting his worries aside.

• As soon as one worry gets resolved, another seems to rise up to take its place. The worries shift rapidly from topic to topic.

• Your child is extremely worried about bad things happening to herself or to you, even if you’ve never been in a dangerous situation before.

• Mildly stressful events at school cause major anxiety, for example, a test, big project, or a competitive game.

How Parents Can Help Kids with Generalized Anxiety

Kids who have generalized anxiety need help to relax, so they can ease their muscle tension and sleep more peacefully. Parents can help their kids develop healthy coping skills to relax the body and mind, like mindfulness, deep breathing, and progressive muscle relaxation. Trying one of these skills out one time might help a little bit, but kids with GAD will likely need daily practice in order to see results.

We know that sleep has a big impact on mental health, and sleep-deprived kids (and adults) are more prone to anxiety and depression. Kids with generalized anxiety can fall into a vicious cycle, where the anxiety causes poor sleep, and the poor sleep causes even more anxiety. Using relaxation skills at bedtime can help kids get in the right mindset to drift off—muscle relaxation and guided visualizations are especially helpful for this.

These skills will be even more helpful if they’re part of a “settling routine”: a simple ritual you and your child share each night. The repetition of the same routine sends a signal to your child’s brain that it’s time to unwind and go to bed.

Start Child Counseling in New York, North Carolina, or Florida

So, you’re noticing some signs of generalized anxiety in your child…where do you start looking for help? For some fast relief while you’re looking for a therapist or considering next steps, consider teaching your child some coping skills to deal with anxiety. My online course, Worry-Free Tweens, was designed especially for kids ages 8-12 and their parents. In it, you’ll find step-by-step directions for both you and your child on how to manage anxiety, panic, and overwhelming worries at home.

Kids who have been anxious for a long time may need more than a few coping skills to get back on track. Counseling can help kids stop the endless cycle of worry and learn to feel more in control of anxious thoughts. Younger children can work through their fears and practice coping skills through Play Therapy, while older kids can develop lifelong tools for anxiety management with Cognitive Behavioral Therapy.

I love working with anxious kids and tweens in my Davidson, NC office. Not within driving distance? I also provide online counseling services, and can see kids in New York and Florida remotely, too. If you’d like to get started, or you have any questions, feel free to reach out to me here.