Dr. Sarah (00:02):

Ever wonder what psychologist moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard. Because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations The three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

Hey everyone. So this week’s Beyond the Sessions episode is a heavy one, but it’s something that is really, really important. Just a heads up, we’re going to be discussing stillbirth and late term pregnancy loss. So if this is a topic that you feel might be too hard to hear or if you have little ears nearby, just be thoughtful about whether or when you listen to this one.


So here is the message that I got from Alex. Hi, Dr. Bren. I’m reaching out to let you know how much your episode on parenting through loss resonated with me. I recently lost twins at 22 weeks and have been trying to navigate the grief while also keeping my composure for my two and a half year old hearing from you and Dr. Brofman (because Shara came on this episode to talk about this) helped me feel less alone. Thankfully, I have support from a psychologist, but I’m struggling on how to address it with my son. I was wondering if you had any language or book recommendations on how to share this loss with my son. We shared with him early on that there were babies in my belly, but the last eight plus weeks have been riddled with medical concerns. So we haven’t been putting as much emphasis on it lately.


He hasn’t asked any questions, but we want to be sure that these babies are part of our family story and want him to know them too. I so appreciate any recommendations or insight. Thanks so much. So beyond offering some suggestions to Alex, I reached out to see if she’d be comfortable with me sharing her question on the podcast, and she said that she was very, very okay with it. She thought it was a really important topic, and she was hoping that in us talking about this and her story, that it would eliminate some stigma around the topic. So we have her blessing to have this conversation, and I agree with her. The more we talk about it, the more we are going to hopefully give people some support and comfort and also reduce some stigma around talking about this stuff. So Rebecca, do you have any thoughts about where we can start with this? Okay.

Dr. Rebecca (02:45):

Yeah. I mean, first of all, I want to send hugs to this listener and also applaud her for being open with her process with us because even that takes a certain level of vulnerability and I think this is not an uncommon experience and it’s one that hasn’t been talked about nearly as much as it needs to be generally. And so I think we’re doing the right thing by addressing it here. I would say a couple of things frankly about moving on to the toddler’s experience. One is that my guess would be the toddler knows already that these babies are no longer in mommy’s belly. And I think there’s a couple reasons for that. One, well, sort of the overarching reason is that toddlers are sponges and they are so tremendously tuned in to the people that they love, in particular, their caregivers, but also their environments more generally.


And there is no question in my mind that the environment that this toddler is in has changed substantially in the past eight weeks and has gone from a place of joy to a place of grief. And there have been many phone calls, there have been many whispers, there have been many tears wiped away and trying to be hidden. And there’s no question that this toddler senses that something is going on. And my advice would be that the sooner in general when these things happen that we can provide even the simplest narrative to toddlers or young children, the more likely we are to provide them with comfort during a difficult time. And so I understand and respect wholeheartedly how this hasn’t yet happened. I think oftentimes parents make the decision not to share things like this with their young kids, with the best of intentions. And yet I think when there’s all of this unprocessed emotion around them, it can be scarier and more difficult for toddlers.


And I wouldn’t be surprised. Again, not every child is the same, but I wouldn’t be surprised if they’ve seen some behavior change in their toddler in the past eight weeks, maybe more anxiety, more dysregulation, difficulties sleeping, because that’s often how toddlers manifest their discomfort. And I think a very simple explanation, right? Hey sweetie, do you remember how mommy had babies in her belly before? Those babies aren’t there anymore. They weren’t healthy enough to grow something like that. I mean, again, I don’t know what happened, but something that’s honest, that’s simple, that’s developmentally appropriate, then you pause, you see if there are questions I always add in if mommy’s been emotional to say, mommy’s been sad, and that’s okay. Mommy’s talking to grownups who are helping. We can go into kind of that in more detail about ongoing conversations, but providing a really simple explanation for what is happening I think is really important for toddler and young child wellbeing in these situations.

Dr. Emily (06:25):

Yeah, I mean, I couldn’t agree more. I think the thing that comes to mind when you’re saying that Rebecca is toddlers and young children, they fill in the gaps and so they’ll fill it in with their child imagination, their fantasies, their developmentally egocentric. So they might fill it in with their own feelings, thoughts, and worries. And so I think it’s always best to dispel that with the grownup version of that, which doesn’t have to not be emotional, but it’s more contained. I think, to your point, Rebecca, if you haven’t done it right away, it’s never too late. I do think it’s important for you to be in the right emotional headspace as well, to be self-regulated, to have processed this with another adult. But then yes, I think as soon as timely possible to sort of the less time in that a child fills in that gap with their own thoughts and imaginations the better.

Dr. Sarah (07:37):

And I think to that point too, one of the things that I often recommend when you’re talking to little kids about death is to be very clear and specific and accurate in your language, like developmentally appropriate, but also very specific kids, their abstraction is not great like language abstraction. So if you say, oh, they’re not with us anymore, or they’re gone or they’re lost, we lost the baby, which is how grownups sometimes refer to death, that can be very confusing for a little child, I would use the word they died or they’re not alive anymore or they’re not going to be born if they never were born. I think we have to kind of get comfortable with using the word death and dying with our kids because it’s an important word to feel safe around and actually trusting that our kids can handle that. Because another thing to remember is just from a linguistic standpoint, kids are concrete.


So we want to use very specific and concrete words. We as adults are also very abstract in our thinking. And so we often have over the course of many, many, many years come to have words represent much more complex and bigger ideas. And that’s a normal part of language development. But we got to remember that for us, we might have a ton of associations with the word death or dying that we have built up over the many, many years we’ve been on this earth. Our kids haven’t, which is actually a good thing in this situation when we say, Ugh, this is really hard to talk about. We’re talking about death or someone died for a child. That just means what it means and it’s just actually the more we can kind of show up with those words, being safe is I think kind of important. And remembering too, that using euphemistic language can make a kid really kind of scared If the baby’s gone or lost, could I be lost? Could we find them and could they come back? It’s just too confusing. So just something to keep in mind.

Dr. Rebecca (09:56):

I couldn’t agree more. And I’ve actually seen various young kids with anxiety that we can actually then trace back to parents using language like lost and they get very clingy because, well, you lost the baby. I don’t want you to lose me. I’ve actually seen that happen. And I would actually go one step further is that oftentimes even the word died doesn’t mean a lot to a young child. And to explain what you mean, so to say something like, the babies are no longer in mommy’s tummy, they died, they didn’t grow. Their hearts had started beating and then stopped beating their legs were getting longer and stopped getting whatever you need to say. You don’t have to go on and on. But even, I know we’re not talking about this right now, but talking about death of older people with kids talking about the parts of their body that stop working is a way to make it concrete for them and also not to confuse it with other language they might hear every day.


So saying that someone got sick, well, I got sick yesterday and I couldn’t see my patients. I had a cold. That’s a very different kind of sick than the kind of sick that leads to dying. And so when you talk about body parts that stop working or things growing in your body that aren’t supposed to be, there’s no risk that you’re going to unintentionally use that language at a different time. And so I guess I’ll just end with that word. I think that’s what we’re all saying is how intentional we need to be with our language. Even as nitpicky as it may seem with all of us saying, use this word, don’t use this word. We don’t usually get that didactic, but in this case, I think it’s important to just recognize how important being intentional is.

Dr. Sarah (11:55):

Right? And I think just to remind and reassure people that you can do this right? You do not need to have a lexicon, but sit down before you talk to your kid, think for a moment what it is you really want to communicate to them and then just kind of even write it out I think is sometimes helpful because then you can sort of see what it sounds like when you read it back to yourself, which I also recognize might be very, very hard and painful if you yourself are in a period of profound grief. But if we’re talking about you’re ready to talk to your kids and you want to do it in an intentional way, I would do this exercise of writing out what you want them to know and then kind of running through it and being like double check. Is there anything that needs to get a little bit more granular, a little bit more specific, a little bit more clear?


Are there places in this dialogue that I’m leaving room for their inaccurate interpretation of what I’m saying or them inserting to Emily’s beautiful description, they fill in the blanks. Where are the blanks that they might then insert? And I think so that’s one thing that I would tell parents to do. And the other thing is I think it’s important to remember after we tell them another blank that we want to fill in, that we want to assume their mind’s going to go to, is that going to happen to me? Because like Emily said, children are very egocentric, and if something happens to somebody, they will always almost consciously or unconsciously have the question, well, will this happen to me? And so I think it’s also important to acknowledge that piece and say, this is not going to happen to you. You don’t have to worry about this happening to you. Or, I mean, obviously in the context of a baby not being born and this is not going to happen, you don’t have to worry about this happening to you or some other sort of reassurance that they are safe and they are okay. Or

Dr. Rebecca (13:58):

I would also add in, this isn’t your fault, because I’ve seen a lot of toddlers say, oh, was it because you picked me up and you said you weren’t allowed to pick me up? I mean, that’s not a two and a half year old language. That’s more of a three and a half year old. But that idea of you accidentally kicked mommy’s belly or you had a tantrum and mommy got upset being very clear this was going to happen anyway. This has nothing to, this had nothing to do with you and it had nothing to do with me. Sometimes this happens. I think I would clarify that. The other thing, just two other things I always talk about with parents when these questions come up. One is it’s okay if you cry when you are delivering the news to your child. Ideally, you’re not wailing in a puddle if you still can’t say it without that, I would have someone else maybe be the one to tell your toddler, but if you cry, get emotional, that’s fine. Just name that again. You don’t say like, oh, there’s something in my eye. You can say I’m crying. This is sad for me. I’m okay and I’m crying that message. And then similarly, to have no expectations about your child’s response,


Your child may laugh. Sometimes when kids get nervous, they laugh. And then parents double down on the serious messaging instead of, okay, you’re laughing right now. You can ask me any questions later. Let’s go do some. Or a kid may say, okay, can I have something to eat? Absolutely, let’s go get some goldfish. It doesn’t often look like this incredibly poignant exchange. Say what you need to say, be clear, be short. I was just one other thing I would add. Be short. Use as few words as you can while being clear and don’t think of it as a one and done. It’s going to be an ongoing thing and a conversation you may need to have. Many times your child may ask the next day, wait, are the babies in your tummy? They need to hear again. You need to say it again. Kids take time to process. They don’t necessarily understand permanence depending on their age. And so you remind them it’s not a, don’t you remember we talked about this yesterday? It’s no more. They’re not being born again. These are ongoing conversations and your kid is going to have different responses over time.

Dr. Sarah (16:29):

And then to that same point, while we want to be really prepared for all kinds of unexpected responses, and maybe it’s disinterest, maybe it’s a lot of anxiety and lots of questions, maybe it’s, can I have a snack? But then we also want to be mindful of these sort of later these, what’s the word I’m looking for? Not secondary, but seemingly unrelated changes in their behavior that are perhaps how they are actually processing it. So just how, in your examples, Rebecca, that child didn’t give you the, oh, wow, I’m so sad. I’m so scared. This is really hard. I’m grieving response for very little kids, that’s not going to be a verbal, that exchange, it’s going to come out in their body, it’s going to come out in their sleep, it’s going to come out in their behaviors, it’s going to come out in separation anxiety, which again is normal to be expected, probably will not last forever, and is something that isn’t a sign that something’s wrong.


It’s really just a sign that they’re working something out. You also might see it in their play, like them revisiting themes in their play over and over and over again. That might be very directly obviously related to what happened. It might be very indirect, but you might see themes kind of being repeated over and over and over in the play for a while, which again, there’s nothing you need to do about it, but it’s good to notice because sometimes, again, remember, we’re grieving. We’re potentially healing physically. We are under a tremendous amount of our own stress and grief, and so our bandwidth is going to be very low. And when our kids are behaving in ways that are really kind of unpredictable or destructive or dysregulated or overwhelming to us on a good day, we can kind of have a lot of impatience around that.


Understandably. We also want to have some grace for ourselves that we could even have more. And so it’s the more you can kind of anticipate that things are going to be real messy for a while or could be real messy for a while, the more we can go into that being like, ah, okay, I kind of think I know why this might be happening. And so just to take it less personally, to not kind of be as reactive and to sort of give your kid permission to work through stuff a little bit more and yourself permission to have a lot more feelings about it, but perhaps create some space.

Dr. Emily (19:05):

I think that’s great. I just wanted to add one quick thing that I think echoed what you guys were talking about, which is it might just not feel good too. These conversations, we don’t expect you to say, oh, and I nailed that and that felt great. To your point, Rebecca, of it’s okay to cry. It’s okay to say this is hard and this feels icky, and I think that it might just not feel good. And you can accept that and still deliver the message. There’s no perfect time and you don’t have to be perfectly prepared. I think the idea of this might just be hard. And then the other thing is, Sarah, to tag onto what you were just saying is I do like to tag those a little. Even if label when children are having, if you notice those secondary behaviors, even if it’s something like, Ugh, a lot has been going on. I see you’re having a hard time. Just because it labels it and contains it for them. And again, it doesn’t personalize it to just them, which children tend to do. I’m just a bad kid or I’m having a tantrum. We recognize that things have been a little tough around here. You must be having a hard time too,

Dr. Sarah (20:16):

Helping them connect the dots. They might not realize that their behavior is also related to their grief. And to be able to help them make that link in an appropriate way,

Dr. Emily (20:26):

It doesn’t have to be a lot.

Dr. Rebecca (20:30):

I just have two other quick tags. We’re all tagging different things, which I kind of love. But the first about just Emily, piggybacking on what you said about the conversation that you don’t have to wait for the perfect time. I think that’s so true what you’ve said, because parents will do what we do for grownups, which is like, let’s sit at the table. There’s something I need to tell you. And that’s not how kids, even older kids have conversations. So you can do it while you’re playing. You’re building with magnet tiles, you’re drawing, you’re not necessarily looking at each other. That’s a good time to have a conversation. And then the other thing I just wanted to say that I think is very important is back to the play idea, which is that sometimes grownups will in a well-intentioned way, interrupt that kind of play. They’ll say something like, no, no, no. What happened to those babies in mommy’s bellies? Very serious. We don’t play about that. Or No, no, no, that’s not appropriate. That game is not appropriate. And actually kids work through their feelings and their understanding of complicated, difficult events by play.


I remember very well when my son had a giant covid clinic with all of his stuffed animals in his room, and some of the animals were dying and some of them weren’t dying. And it was so tempting to say, oh God, can we not play about this? This is awful. And yet it was how he was understanding. And so letting our kids play out because it gives us information as to what they’re going through. And it also is their way of making sense of these things.

Dr. Sarah (22:13):

And it’s a nice point for us, the parent, when we observe it, one, we want to notice it, make sense of it for ourselves, not interrupt their play, but then when the play is sort of over, it’s a good cue to us that they might be ready to process something. So if you had a child who, when you try to bring it up verbally, they don’t want to talk to you, they kind of change the subject or get really uncomfortable and they’re telling you, I’m not ready. And so if they keep showing you through their play that they’re processing it and you see certain things come up, it could be an in, right? I think parents are sometimes looking like, how and when do I talk about this with my kid? Who doesn’t want to talk about this?


It might be like, okay, they just sort of finished playing with these jaws, I might say. And again, that’s not the time for the, now we can have the serious sit down conversation, here’s my window. It’s more like you’re trying to make sense of what happened, I think with the babies. That makes sense. And that’s it. You’re just, again, Emily, to your point of when you’re seeing the tantrums, sort of helping them connect the dots, this might be related to the hard time we’re all having. Same thing for the play. You might be working through some thoughts on that. And then if you ever have any questions, you can talk to me. I’m always here, whatever. But it helps them, again, not in the middle of it because we don’t want to interrupt that process, but afterwards, this moment of facilitating that pause and that reflection and that kind of making sense of, and integrating a little bit and making, connecting those dots for them just a little bit, right?


We don’t overdo it, but these little moments of, ah, that might be a way that you’re dealing with what’s going on. That makes sense. Okay. And then we’ll move on unless they want to keep going, but you’re planting those seeds, you’re nourishing that connection and integration. It’s a very hard topic to talk about. So I’m glad that we were able to put our heads together and kind of come up with some strategies. I hope these are helpful for people. And if you’re going through loss, our hearts are with you.

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in this new series Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.

✨We want to hear from you! Go to https://drsarahbren.com/question to send us a question or a topic you want to hear us answer on Securely Attached – Beyond the Sessions! ✨

123. BTS: How can I tell my toddler that I had a miscarriage?