Losing a loved one is difficult, but explaining the loss to a child can present an additional challenge. Children cope with death better when they hear about the loss from a family member rather than a stranger. For this reason it is vital that family members understand how to give children news about the death of a loved one. It is important to be open and honest, at an age appropriate level, when explaining death to children. Though it may be tough, adults should use the words “death” and “dying” when talking to children. The use of these words shows that death is something that can be talked about. When children feel as if they can talk about death with their families, communication can be more open. Open communication and expression of emotions will help the child process and understand the loss more effectively.
Some of the normal grief responses that may be seen in children can include:
- Anxiety
- Sleep problems (including nightmares, not wanting to sleep in their own beds, and difficulty sleeping)
- Sadness
- Longing for the deceased
- Anger
- Acting out
- Physical complaints (like headaches or stomachaches)
It is important to remember that the loss of a loved one, and the grieving process, often occurs within the larger context of the family unit. If a family member dies, everyone in the family must grieve in their own way. When adults are grieving, children may not understand all of the emotions they see expressed. Children are often confused by their own feelings as well. When children are confused about their feelings, they may express this confusion by acting out. The acting out behaviors may be new for the child, or might be prior behaviors that escalate. If your child begins the act out it is best to provide a space for them to express their feelings (verbally or using art). It is also helpful to make sure the child has a consistent schedule and routine that they can count on. The predictability of a schedule (i.e., waking up, eating breakfast, going to school, coming home on the bus, doing homework, etc.) can help a child feel more grounded and safe after a loss. Children must feel comfortable and secure as adults grieve to allow them to go through their own process.
Remember, children learn most by the behaviors of adults around them. This means that they will respond to expressed emotions of adults, regardless of their age. Even toddlers can pick up when their parents are abnormally sad. Children may see their parents crying and ask what is wrong. Again, it is important to be honest about what is going on. It is ok to say that you are sad because you’re thinking of your loved one or something reminded you of the deceased (for example). Your children will learn by your example and will see that grief is a natural part of life.
There are many ways parents can help their children get through the grieving process. Children should be encouraged to express their feelings. When facing grief children need stability and they also need to be curious. Parents can provide this space for their children at home. Children can use play, art, music, and nature to express their emotions. Many children use these different outlets to communicate things they are not able to convey verbally. Parents can also help or encourage children to write a goodbye letter to their deceased loved one. This letter can help the child feel a sense of closure.
Remember, seeing a mental health professional for group and/or individual therapy can be a helpful and healthy way for children to process loss. Also, if you suspect your child is experiencing complicated grief, it is important to take them to see a mental health professional. Complicated grief is a psychological disorder that can greatly impair their life functioning.
Amazon.com offers a wide selection of books that may be helpful depending on the age of your child.
Here are some links that may be helpful:
http://kidshealth.org/parent/emotions/feelings/death.html
http://www.hospicenet.org/html/talking.html
As an additional reference, please see the chart that shows comprehension of death by age. This chart provides information about developmentally appropriate ways to help your child cope with death. It also shows some normal and abnormal reactions children have to death and grieving.
Birth-2 years of age
- At this age children have no cognitive understanding of death
- Grief reactions are possible and separation anxiety is a concern
- Infants and toddlers may regress developmentally and behaviorally
- Important to maintain routine and avoid separation from significant others in their life
- Be aware of the fact that the primary caregiver may not be as emotionally available to the child as normal. Others should try to provide extra nurturing and support to the child
Ages 2-6
- Children this age see death as temporary and reversible
- Remember that they interpret their world in a concrete, and often literal, manner
- May have magical thoughts about death
- Children at this age may think death is caused by thoughts, and that they could somehow be responsible
- Important to provide straightforward explanations and avoid euphemisms
- May need to remind them that their loved one will not return
- Children may ask a lot of questions, and may even repeat the same questions
- Children this age who lose a parent may seek attention from anyone, including strangers
Ages 6-8
- By this age they realize death is final/irreversible
- Children do not think death is universal or will happen to them
- Children might think of death as a character or person
- Children may express anger toward the deceased and/or those who they believe were unable to save the deceased
- Child often has fears about death
- May express concerns over safety of loved ones
- Make sure to give clear, realistic information
- At this age it is appropriate to invite child to funeral services (if they wish to attend)
Ages 8-12
- Children at this age have a more adult understanding about death – it is final, irreversible, and universal
- Can understand biological aspects as well as cause/effect relationships
- May have the tendency to intellectualize death as they are not as used to identifying and dealing with feelings
- Their ability to identify causal relationships may lead them to experience guilt
- To help identify emotions may want to introduce some typical emotional responses others have (i.e., some people feel sad, angry, or guilty)
- Child should be allowed to see dying patient (if applicable) and participate in activities surrounding death
- Child may develop a morbid curiosity about the dying process
Ages 12-18
- Adolescents have an adult understanding of death
- Developing abstract thinking so may engage in some existential thinking about death
- May reject adult rituals and support
- May think that no one understands them
- Some engage in high risk activities to test their own mortality
- Often have strong emotional reactions, but still can have difficulty identifying and expressing their feelings
- Important that adults allow their independence and access to peers
- Offer emotional support as needed
Normal
- Anxiety
- Sleep problems (including nightmares, not wanting to sleep in their own beds, and difficulty sleeping)
- Sadness
- Longing for the deceased
- Anger
- Acting out
- Physical complaints (like headaches or stomachaches)
Abnormal
- Longing and searching for deceased
- Preoccupation with thoughts of the deceased
- Purposelessness and feeling like their future does not matter
- Numbness and detachment from others
- Difficulty accepting death
- Lost sense of security and control
- Extreme anger or bitterness over death
- Behaviorally the child may
- Appear depressed
- Have difficulty carrying out normal activities/routines
- Withdraw from social activities
- Become irritable or agitated
References
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision ).Washington, D.C, American Psychiatric Association.
Davis, C.B. (1989). The use of art therapy and group process with grieving children. Issues in Comprehensive Pediatric Nursing, 12, 269-280.
Himebauch, A., Arnold, R.M., & May, C. (2008). Grief in children and developmental concepts of death #138. Journal of Palliative Medicine, 11 (2), 242-243.
Melhem, N.M., Moritz, G., Walker, M., Shear, M.K., & Brent, D. (2007). Phenomenology and correlates of complicated grief in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 26 (4), 493-499.
Salladay, S.A. & Royal, M.E. (1981). Children and death: guidelines for grief work. Child Psychiatry and Human Development, 11 (4), 203-212.
Willis, C.A. (2002). The grieving process in children: strategies for understanding, educating, and reconciling children’s perceptions of death. Early Childhood Education Journal, 29 (4), 221-226.
Tags: children coping with death, children grief symptoms, children grieving process, complicated grief in children, grief, grief in adolescents, grief in children