Coping With Death: How To Help Your Bereaved Child

McKenzie Pediatrics 2009

The death of a loved one is perhaps one of the most stressful events that a child can experience. It is a time of a powerful emotional upheaval. Infants, children, adolescents, and parents all sense that power and respond in different, highly personal ways.

Successful grieving after the untimely death of a loved one is an extremely difficult task for anyone. There is no one right way to grieve. Grief is a process, and not an event. How, and how long, children grieve may be entirely different than how their parents grieve; parents must take care not to impose their own grieving timeline and expressions onto their children.

The emotions of a bereaved child are varied and unique, and not as neatly characterized as what occurs in adults. The child will also be surrounded by adults in the midst of their own grief, adults who will likely be uncertain and confused as to how to respond in a supportive manner to the child.

The child’s understanding of death and expressions of grief are influenced by her developmental level, her experiences with death, her relationship to the deceased, and by the family’s cultural and religious beliefs. Chronologic age alone is not a reliable indicator of how a child will deal with death.

But it is the reactions of the surviving family members that are the most important factors determining how children cope with death. How parents and caregivers themselves grieve, and how they understand and guide a child’s grieving process, plays the largest role in a child’s successful grieving. Understanding how children conceptualize death within the context of their developmental level is crucial.

Children Younger Than 2 Years: Very young children are in the sensorimotor stage, using their senses and developing motor skills to learn about the world. They express feelings primarily through their behavior. Although children this young do not understand death, they can sense both separation and the emotions of those around them who are experiencing loss. In response, children may withdraw, decreasing their activity, responsiveness, or appetite, or may become irritable.

In the case of loss of a parent, very young children will immediately sense something amiss. The sudden absence of a parent causes of clear biological reaction. This can be quickly remedied if the other parent, or another caregiver, assumes primary responsibility for the young child’s care. Passing an infant or toddler from caregiver to caregiver, however, may cause anxiety, irritability, or even withdrawal, and may lead to long term attachment disorders.

Toddlers, sensing the anxiety and sadness in their environment after a death, will require frequent, large doses of loving care: holding, cuddling, and stroking. Explanations of death are meaningless. What one does is far more important than what one says to a child this young.

Children Ages 2 To 6 Years: During this stage of childhood, children’s cognitive understanding of death evolves, but they do not yet have the capability to think logically. Initially, children use the word “dead” to mean “not awake” or “not around”. They often confuse death with sleep, or with being away, and believe that death is temporary. Viewed through their limited conception of time and death, bereaved children may expect the deceased to be alive again soon. They may even wonder in what activities the dead can still engage (Can Rover still eat?),

Therefore, it’s best to explain death in physical, concrete terms; for example, “His heart stopped beating and no one can make it start again. We won’t be seeing him move or talk anymore.” For children raised in traditions that believe in an afterlife, concepts such as heaven may be difficult for them to grasp. They will see a discrepancy between burial of the body and the description of “going home”, or “going to heaven”. While young children probably cannot grasp this idea, parents might address this distinction as “the part that we loved, the part that smiled, laughed, and loved us, is the part that has gone to heaven.”

Children at this stage sense the sorrow of others and respond by mimicking or crying or being consoling. Because children in this stage lack full understanding of what can cause death, and that death is irreversible, they may use magical thinking or ask specific questions for which there may be no real answer.

Magical thinking, the belief that thoughts can cause actions, may lead to guilt and fear. The child may believe that Rover is dead because he was mad at the dog earlier for eating his crayons. If the child appears to be wondering about what caused the death and his potential role in it, it is important to provide reassurance with simple, straightforward explanations directed at correcting misconceptions.

Children 2 to 6 years will also have a great need for physical nurturing after a death in the family. If it is a parent who has died, the other parent or another caregiver (a grandparent, for instance) must quickly assume primary care, and give the child the security of knowing who will care for them.

Children this age are learning to express themselves verbally, but are most effective in expressing themselves through play. Allow children to play act out traumatic events with their toys or dolls or stuffed animals – by admonishing such play acting, you will stifle their grief, and it will likely eventually find other, less productive or more harmful outlets.

Children 4 to 6 years of age might even ask specific, even painful and repeated questions that stem from their immense curiosity about death. These questions are part of the struggle for consistency and understanding of the permanence of death. As painful as it might be to receive these questions, answer them patiently, and never make the child feel as if she cannot ask them.

Invite children at this stage to be present at the funeral, memorial service, or scattering of ashes. Although they should be encouraged to attend, children should never be forced. Likewise, they should not be required to view, kiss, or touch the deceased, although it is perfectly all right if they wish to do so. It is important for children to say goodbye in their own way.

Children Older Than 6 Years: Much of what was discussed in the section on 2 to 6 year olds applies to older children, as well. However, by this age, children recognize that death is final. Possibly because of this realization, grieving children can have heightened behavioral reactions. Children may develop school phobias, hypochondriacal concerns, aggressive and destructive behaviors, withdrawal, or separation anxiety. Early recognition, followed by the seeking of professional mental health counseling, is crucial to successful grieving and to the child’s long-term mental health.

Children 6 years and older will have developed logical thinking about the physical world, and become more verbally communicative about their thoughts. Some children even go through phases of almost morbid fascination with dead things, the symbols of death (for instance, skeletons or graveyards), or the biological aspects of death.

Throughout this stage, children move from thinking that death only happens to “others” (especially older people) to an awareness that they, too, will someday die. By the age of 9 to 10 years, children’s

use of the word “dead” approximates adult understanding of the term as final, and universal. By adolescence, the ability to think abstractly allows them to question the existential implications of Death: the grieving teen often asks the question, “Why not me?” or may attempt to confront death as if it were an adversary. As such, high-risk behaviors that “challenge mortality” may occur.

Myths Surrounding Children & Grief Misconceptions Truths & Facts About Grief Young children do not grieve; they do not understand what has happened.

All children grieve; even the very young know when those around them are upset. Children must be protected from suffering, loss, and pain to maintain their innocence.

All children experience loss and need help in learning ways to deal with it. Children cannot be isolated or protected from death. Children will be bewildered by being with a loved one who is dying.

The experience will help a child understand and make sense of their experience. Nothing is or should be hidden from them. They can learn that dying and death are a part of life. Children are traumatized by their last encounters with a dying person.

Children will value the opportunity to spend time with their loved one during his or her last days and weeks. Encourage only good memories; happy times will be overshadowed by the experience of watching a loved one die. Getting rid of reminders of the death helps.

Children can learn through their participation in the death of a loved one. They will feel nothing was hidden from them. It is not wrong to think about the person who died or to have bad memories. Memories about the death process are part of the grief process. Children should be protected from seeing a loved one die. Going to the funeral would just upset them.

Not being included in family rituals could be more upsetting. It helps to see how adults grieve. Children may otherwise resent their exclusion. Their involvement will assist with theirs and others grieving. Adults know better about whether or not to allow a child to participate in a funeral.

Children can benefit from helping to plan and by attending the funeral, including allowing them opportunities for questions and learning from the emotional reactions of adults. They can benefit from the support of others displayed at funerals to help overcome the feeling of isolation. Never force a child to participate against their will, or exclude those wishing to be included. Children do not feel grief the same or as much as adults.

Everyone grieves in his or her own way, depending on circumstances, developmental level, and life experiences. Expressions of grief may be different but still as intense. This is healthy and usual. Once a child is angry or shows guilt, that should be the end of it.

Grief is a process, not steps. The same feelings may resurface repeatedly, as each aspect of loss is realized. It is morbid to want to touch or talk about the body. This is normal for children. It is a good way to say

“goodbye” and make death real. When they have grieved once, it should be over. Children can resolve grief quickly.

As they develop, children will re-grieve losses in light of new understanding. Grief has no time limits. Adults must be careful to say the “right” things. There are no right answers, only honest ones. Talking

about death and grief acknowledges a child’s grief and dispels fears/misunderstandings. Use terms like “passed away”, & “gone to heaven” These are misleading for children and may confuse or

frighten them. “Dead” and “dying” are better. Talking about death will upset a child. They are already upset; this is a normal part of the

grieving process. By not talking about death, it suggests that it is wrong to mention the person who died, that there is something bad about them or their death, or that no one cares.