Children’s understanding of death

Newborn to 3 years

• Can sense the emotions around them
• Grief may be evident in changes in routine or irritability

3 to 6 years

• Think death is reversible, magical thinking
• Difficulty handling abstract concepts, such as heaven
• Process grief through play
• Regression
• May ask questions repeatedly

7 to 9 years

• Fear death is contagious
• May be fascinated by it
• May have difficulty expressing feelings verbally
• Continue to have difficulty with abstract concepts

10 to 13 years

• Fragile independence, fluctuating between dependence/independence
• May not ask questions
• Delayed reactions to grief
• Somatic symptoms
• Concerned with how their world will change

Children’s Grief Reactions

Following is a list of common grief responses and a summary of caregiver techniques that have been found to be helpful for helping children manage these responses. Like adults, every child responds differently to a loss and so a child may not exhibit each behaviour.

Shock, Disbelief, Indifference:

Immediately following the death, it is common for people to be in a state of shock and disbelief. The loss does not seem real or possible, and these feelings can last for a few days or a few months. Shock may be expressed as indifference. The child’s feelings of grief may be too much to accept at the present and so they distract themselves with other things and seem indifferent to the loss.

How you can help:

Shock and indifference are a temporary protective mechanism that helps the child cope with the overwhelming pain and emotions associated with loss. Do not become upset if a child seems not to react to a loss. It is very common for school aged children to want to jump back into school and old routines to help them cope. Make yourself available to the child for support but do not push lengthy discussions about their feelings. Instead communicate an openness to listen and a willingness to discuss any questions or concerns a child may have. Communicating your own thoughts and feelings about the loss can help spark conversations and help children identify their own feelings. Children can not sit with intense emotions for too long and so typically they only focus on their grief for short chunks and then turn their focus onto something else. Expect to hear similar questions repeated as the child strives to understand all that has happened.

Separation Anxiety and Fear:

Children may become more anxious and fearful. It is common for them to become more dependent, and easily upset when separated from a primary caregiver.

How you can help:

When separation anxiety arises, it is important to reassure the child that they are safe and the caregiver is safe. Separation anxiety arises because the child’s sense of safety and security has been shaken and they are afraid of bad things happening to other people they love. Sticking to old rules and routines can help to re-establish a sense of safety, as can reassurance of their own and others’ well-being.
Children benefit from quality time when they are grieving. They are seeking out ways to comfort and soothe themselves. Adults can help by being a little more patient and making themselves available to the child for a little extra attention and affection if desired by the child. Help children identify realistic and unrealistic fears and develop strategies for managing anxiety provoking experiences.

Anger and Acting Out:

Anger is a common response to loss and children can lash out and/or generally act out in ways they had not previously.

How you can help:

Recognize that the anger is being fueled by hurt and fear. The child may be acting badly to push people away to avoid being hurt again. The child may be so overwhelmed by their emotions that hurting others is the only way to express their hurt. Whatever the reason for their anger, adults need to remain present and calm, and help the child to find appropriate ways to express that emotion. Model and help the child to find physical outlets – hitting a pillow, ripping up paper, running, throwing a ball against a wall – to release energy. Set limits and boundaries, and communicate that it is okay to feel mad, but it is not okay to be mean or hurt others.

Withdrawing:

 Grieving a loss takes a lot of energy and it is common for people to have a hard time focusing, concentrating and remembering information. Socializing with others takes a lot of energy and focus and children may appear distracted or “quiet” when around others.

How you can help:

Some children just need a little extra “quiet time” to help them to cope when they are acutely grieving. Although children seek out distractions, they may become more easily overwhelmed when they have a number of activities scheduled in a day, so it is best to schedule less and give more time for completing homework and other tasks. Children sometimes also withdraw because they feel “different”. They have experienced a loss that their  peers may not have experienced. In these cases, arranging for a child or teen to join a bereavement support group can be very beneficial to help them find peers who they can relate too. For information on local support groups, contact one of the Patient and Family Support Counsellors at 604-988-3131 ext. 4701. 

Guilt and Regret

Children have wonderful imaginations but sometimes this creativity can cause children to think they have more power then they really do. Guilt feelings exist when the child mistakenly believes that some thought or action of theirs contributed to the death of their loved one. Guilt or regret may be expressed as a child acting “too good”.

How you can help:

If you suspect guilt, remind the child of why the person died (e.g.: the cancer kept growing and grandpa’s body could not get better) and let the child know that there was nothing that the child or anyone else did to cause the death. Help them to find ways of expressing regrets through writing letters or thank you / I love you / goodbye cards to their loved one.

Helping Children Cope with Grief:

Remember the acronym CHILD for Do’s and Don’ts of helping children cope with grief:

C – CONSIDER: Consider the individual child: grief has no respect for age.

H – HONESTY: Use the “D” words: death, die, dying. It is okay not to have all the answers.

I – INVOLVE: Let the child know what is happening and involve the child, as much as is possible.

L – LISTEN: Let the child take the lead: let the child talk through what is on their mind. Let the child know it’s okay not to want to talk about it anymore for a while. Give the child outlets for expressing their grief, through art, drawing, play, writing, poetry, stories, hammering. Be attuned to magical thinking involved in the child’s explanation of the death. Correct such perceptions to allay guilt and prevent inappropriate grief reactions.

D – DO IT OVER AND OVER AGAIN: Appropriately share your grief. Children do best when they have permission and role models for their grief work. They need to see an honest expression of emotion from adults, accompanied by explanations and reassurance.

What is “dead?”

How do you explain death? Ask the child, “what is life?” and then when a list has been generated (e.g. “I know I am alive, because I can dance”), add that when all that is gone, ceases to work, that is death.

Supporting Bereaved Children

One of the most important things to remember is that everyone in the family grieves differently. Children grieve in ways that reflect their developmental understanding, previous experience with loss and the support and information available to them. Children learn from you, so include them in your grief process. Show and tell them how you are feeling and what you do with your own grief. This helps them to understand their feelings and how to express them.

Children are concrete in their thinking. Use simple, specific, and clear language.

Children are repetitive in their grief and may ask questions repetitively. Listen and support their searching. Answer repetitively, keep telling the story.

Young children tend to generalize situations. They need to study the world in their own time and learn to accommodate new truths on their own. Allow them to express themselves and support trying out things.

Children grieve cyclically. Each time a child gains a new developmental ability, they reintegrate the important events of their lives, using the newly acquired processes.

Children are physical in their grief. As younger children get older, they are more able to express themselves in words.

• Encourage movement and active play as language
• Reflect their play back to them, verbally and physically
• Make a space for them to freely explore their grief with their bodies

Children need choices. Death is a disruption in their lives. This topsy-turvy feeling can be lessened if the children have some say in what they do or don’t do to commemorate who dies, and to express their feelings about the death. Whenever possible offer choices, i.e. viewing the body or going to the hospital/ funeral (or not). Offer children pictures and possessions of the deceased as a way of supporting this process.

A child’s feelings. Children’s feelings are their allies to help pay attention to the loss and lead to understanding the death.

Permanence and Impermanence of Death in Children’s Thinking.  It is important to remember that younger children’s perception is oriented in the senses. It is concrete, short range and based on what they feel in the present. As children become older, they begin to grasp the concept of death. They begin to understand that the person will never come back because they are dead, just by hearing the word dead. Abstract thinking develops more in depth with the onset of adolescence; sometimes leading to philosophic pondering, sometimes appearing like depression, as the meaning of the event is investigated.

Books on Grief for Children:

“When the Wind Stops” by Charlotte Zolotow & illustrated by Stefano Vitale
“The Fall of Freddie the Leaf” by Leo Buscaglia
“When Dinosaurs Die: A guide to understanding death” by Laurie Krasny Brown and Marc Brown
“Tear Soup: A recipe for healing after loss” by Pat Schwiebert & Chuck DeKlyen, and illustrated by Taylor Bills
“Bear’s Last Journey” by Udo Weigelt and illustrated by Cristina Kadmon
“Badger’s Parting Gifts” by Susan Varley
“When Someone Dies” by Sharon Greenlee and Illustrated by Bill Drath