Children and Grief
Grief and Developmental Stages
Infants
Ages 2 to 3 years
Ages 3 to 6 years
Ages 6 to 9 years
Ages 9 years and older
Issues for grieving children
Interventions for Grieving Children
Explanation of death
Correct language
Planning rituals
References and resources for grieving children
At one time children were considered miniature adults, and their behaviors
were expected to be modeled as such.[1] Today there is a greater
awareness of developmental differences between childhood and other developmental stages
in the human life cycle. Differences between the grieving
process of children and that of adults are recognized. It is now believed that the real issue
for grieving children is not whether they grieve, but how they exhibit their
grief and mourning.[1]
The primary difference between bereaved adults and bereaved children is that intense
emotional and behavioral expressions are not continuous in children. A child’s
grief may appear more intermittent and briefer than that of an adult but in
fact usually lasts longer.[1-3] The work of mourning in childhood needs to be addressed
repeatedly at different developmental and chronological milestones. Because
bereavement is a process that continues over time, children will revisit the
loss repeatedly, especially during significant life events (e.g., going to
camp, graduation from school, marriage, and the birth of their own children).
Children must complete the grieving process, eventually achieving resolution of grief.
Although loss is unique and highly individualized, several factors can
influence a child’s grief. These factors include the child’s age, personality, stage
of development, previous experiences with death, previous relationship with the
deceased, the environment, the cause of death, patterns of interaction and
communication within the family, stability of family life after the loss, how
the child’s needs for sustained care are met, availability of opportunities to
share and express feelings and memories, parental styles of coping with stress,
and the availability of consistent relationships with other adults.[2-4]
Children do not react to loss in the same ways as adults and may not display
their feelings as openly as adults do. In addition to verbal communication, grieving children may employ play, drama, art,
school work, and stories.[5] Bereaved children may not withdraw into
preoccupation with thoughts of the deceased person; they often immerse
themselves in activities (e.g., they may be sad one minute and then playing
outside with friends the next). Families often incorrectly interpret this
behavior to mean the child does not really understand or has already gotten
over the death. Neither assumption may be true; children's minds protect them from
thoughts and feelings that are too powerful for them to handle. Grief
reactions are intermittent because children cannot explore all their
thoughts and feelings as rationally as adults can. Additionally, children often have
difficulty articulating their feelings about grief. A grieving child’s
behavior may speak louder than any words he or she could speak. Strong
feelings of anger and fear of abandonment or death may be evident in the
behaviors of grieving children. Children often play death games as a way of
working out their feelings and anxieties in a relatively safe setting. These
games are familiar to the children and provide safe opportunities to express
their feelings.[1,2]
Grief and Developmental Stages
Death and the events surrounding it are understood differently depending on the
age and developmental stage of the child.
Infants
Although infants do not recognize death, feelings of loss and separation are
part of a developing death awareness. Children who have been separated from
their mothers and deprived of nurturing can exhibit changes such as listlessness, quietness,
unresponsiveness to a smile or a coo, physical changes (including weight loss),
and a decrease in activity and lack of sleep.[6]
Ages 2 to 3 years
In this age range, children often confuse death with sleep and can experience
anxiety. In the early phases of grief, bereaved
children can exhibit loss of speech and generalized distress.[3,6]
Ages 3 to 6 years
In this age range, children view death as a kind of sleep: the person is alive, but in
some limited way. They do not fully separate death from life and may believe that the deceased continues to live (for instance, in the ground
where he or she was buried) and often ask questions about the activities of
the deceased person (e.g., how is the deceased eating, going to the toilet,
breathing, or playing?). Young children can acknowledge physical death but
consider it a temporary or gradual event, reversible and not final
(like leaving and returning, or a game of peek-a-boo). A child’s concept of
death may involve magical thinking, i.e., the idea that his or her thoughts can
cause actions. Children may feel that they must have done or thought something
bad to become ill or that a loved one’s death occurred because of some personal
thought or wish. In response to death, children younger than 5 years will
often exhibit disturbances in eating, sleeping, and bladder or bowel
control.[3,6]
Ages 6 to 9 years
It is not unusual for children in this age range to become very curious about death,
asking very concrete questions about what happens to one’s body when it stops
working. Death is personified as a separate person or spirit: a skeleton,
ghost, angel of death, or bogeyman. Although death is perceived as final and
frightening, it is not universal. Children in this age range begin to compromise,
recognizing that death is final and real but mostly happens to older people (not
to themselves). Grieving children can develop school phobias, learning
problems, and antisocial or aggressive behaviors; can exhibit hypochondriacal
concerns; or can withdraw from others. Conversely, children in this age range can
become overly attentive and clinging. Boys may show an increase in
aggressive and destructive behavior (e.g., acting out in school), expressing
their feelings in this way rather than by openly displaying sadness. When a
parent dies, children may feel abandoned by both their deceased parent and their
surviving parent, since the surviving parent is frequently preoccupied with his or
her own grief and is less able to emotionally support the child.[3,6]
Ages 9 years and older
By the time a child is 9 years old, death is understood as inevitable and is
no longer viewed as a punishment. By the time the child is 12 years old,
death is viewed as final and universal.[3,6]
Grief and Developmental Stages
Age
|
Understanding of Death
|
Expressions of Grief
|
Infancy to 2 years |
Is not yet able to understand death. |
Quietness, crankiness, decreased
activity, poor sleep, and weight
loss. |
Separation from mother causes changes. |
2–6 years |
Death is like sleeping. |
Asks many questions (How does she go to the bathroom? How does she eat?). |
Problems in eating, sleeping, and bladder and bowel control. |
Fear of abandonment. |
Tantrums. |
Dead person continues to live
and function in some ways. |
Magical thinking (Did I think something or do something that caused the death? Like when I said I hate you and I wish you would die?). |
Death is temporary, not final. |
Dead person can come back to life. |
6–9 years |
Death is thought of as a person or spirit (skeleton, ghost, bogeyman). |
Curious about death. |
Asks specific questions. |
May have exaggerated fears about
school. |
Death is final and frightening. |
May have aggressive behaviors
(especially boys). |
Some concerns about imaginary
illnesses. |
Death happens to others; it will not happen to ME. |
May feel abandoned. |
9 and older |
Everyone will die. |
Heightened emotions, guilt,
anger, shame. |
Increased anxiety over own death. |
Mood swings. |
Death is final and cannot be changed. |
Fear of rejection; not wanting to
be different from peers. |
Even I will die. |
Changes in eating habits. |
Sleeping problems. |
Regressive behaviors (loss of
interest in outside activities).
|
Impulsive behaviors. |
Feels guilty about being alive
(especially related to death of a
brother, sister, or peer). |
In American society, many grieving adults withdraw into themselves and limit
communication. In contrast, children often talk to those around them (even
strangers) as a way of watching for reactions and seeking clues to help guide
their own responses. It is not uncommon for children to repeatedly ask
baffling questions. For example, a child may ask, “I know Grandpa died, but
when will he come home?” This is thought to be a way of testing reality for
the child and confirming the story of the death.
Issues for grieving children
There are three prominent themes in the grief expressions of bereaved children:
- Did I cause the death to happen?
- Is it going to happen to me?
- Who is going to take care of me?[2,7]
Did I cause the death to happen?
Children often engage in magical thinking, believing they have magical powers.
If a mother says in exasperation, “You’ll be the death of me,” and later dies,
her child may wonder whether he or she actually caused the death. Likewise,
when two siblings argue, it is not unusual for one to say (or think), “I wish
you were dead.” If that sibling were to die, the surviving sibling
might think that his or her thoughts or statements actually caused the death.
Is it going to happen to me?
The death of a sibling or other child may be especially difficult because it
strikes so close to the child’s own peer group. If the child also perceives
that the death could have been prevented (by either a parent or doctor), the
child may think that he or she could also die.
Who is going to take care of me?
Because children depend on parents and other adults for their safety and
welfare, a child who is grieving the death of an important person in his or her
life might begin to wonder who will provide the care that he or she needs now that the person is gone.
Interventions for Grieving Children
There are interventions that may help to facilitate and support the grieving
process in children.
Explanation of death
Silence about death (which indicates that the subject is taboo) does not help
children deal with loss. When death is discussed with a child, explanations
should be kept as simple and direct as possible. Each child needs to be told
the truth with as much detail as can be comprehended at his or her age and
stage of development. Questions should be addressed honestly and directly.
Children need to be reassured about their own security (they frequently worry
that they will also die or that their surviving parent will go away).
A child’s questions should be answered, and the child's processing of
the information should be confirmed.
Correct language
Although it is a difficult conversation to initiate with children, any
discussion about death must include proper words (e.g., cancer, died,
or death). Euphemisms (e.g., “he passed away,” “he is sleeping,” or “we lost him”)
should never be used because they can confuse children and lead to
misinterpretations.[3,8]
Planning rituals
After a death occurs, children can and should be included in the planning of and
participation in mourning rituals. As with bereaved adults, these rituals help
children memorialize loved ones. Although children should never be forced
to attend or participate in mourning rituals, their participation should be
encouraged. Children can be encouraged to participate in the aspects of
funeral or memorial services with which they feel comfortable. If the child
wants to attend the funeral (or wake or memorial service), it is important that
a full explanation of what to expect is given in advance. This preparation
should include the layout of the room, who might be present (e.g., friends and
family members), what the child will see (e.g., a casket and people crying), and
what will happen. Surviving parents may be too involved in their own
grief to give their children the attention they need. Therefore, it is often helpful
to identify a familiar adult friend or family member who will be assigned to
care for a grieving child during a funeral.[8]
References and resources for grieving children
There is a wealth and variety of helpful resources (books and videos) that can
be shared with grieving children.
- Worden JW: Children and Grief: When a Parent Dies. New York, NY: The Guilford
Press, 1996.
- Doka KJ, ed.: Children Mourning, Mourning Children. Washington, DC: Hospice
Foundation of America, 1995.
- Wass H, Corr CA: Childhood and Death. Washington, DC: Hemisphere Publishing
Corporation, 1984.
- Corr CA, McNeil JN: Adolescence and Death. New York, NY: Springer Publishing
Company, 1986.
- Corr CA, Nabe CM, Corr DM: Death and Dying, Life and Living. 2nd ed.,
Pacific Grove: Brooks/Cole Publishing Company, 1997.
- Grollman EA: Talking About Death: A Dialogue Between Parent and Child. 3rd
ed., Boston, Mass: Beacon Press, 1990.
- Schaefer D, Lyons C: How Do We Tell the Children?: Helping Children
Understand and Cope When Someone Dies. New York, NY: Newmarket Press, 1988.
- Wolfelt A: Helping Children Cope with Grief. Muncie: Accelerated
Development, 1983.
- Walker A: To Hell with Dying. San Diego, Ca : Harcourt Brace Jovanovich, 1988.
- Williams M: Velveteen Rabbit. Garden City: Doubleday, 1922.
- Viorst J: The Tenth Good Thing About Barney. New York, NY: Atheneum, 1971.
- Tiffault BW: A Quilt for Elizabeth. Omaha, Neb: Centering Corporation, 1992.
- Levine JR: Forever in My Heart: a Story to Help Children Participate in
Life as a Parent Dies. Burnsville, NC: Mountain Rainbow Publications, 1992.
- Knoderer K: Memory Book: a Special Way to Remember Someone You Love.
Warminster,Pa: Mar-Co Products, 1995.
- de Paola T: Nana Upstairs and Nana Downstairs. New York, NY: GP Putnam’s
Sons, 1973.
References
-
O'Toole D, Cory J: Helping Children Grieve and Grow: a Guide for Those Who Care. Burnsville, NC: Compassion Books, 1998.
-
Corr CA, Nabe CM, Corr DM: Death and Dying, Life and Living. 2nd ed. Pacific Grove, Calif: Brooks/Cole Publishing Company, 1997.
-
Fitzgerald H: The Grieving Child: A Parent's Guide. New York: Fireside, 1992.
-
DeSpelder LA, Strickland AL: The Last Dance: Encountering Death and Dying. 4th ed. Palo Alto, Calif: Mayfield Publishing Company, 1996.
-
Goldman A: ABC of palliative care. Special problems of children. BMJ 316 (7124): 49-52, 1998.
[PUBMED Abstract]
-
Burnell GM, Burnell AL: Clinical Management of Bereavement: A Handbook for Healthcare Professionals. New York: Human Sciences Press, Inc., 1989.
-
Worden JW: Children and Grief: When a Parent Dies. New York: The Guilford Press, 1996.
-
Kastenbaum R: Death, Society, and Human Experience. Boston: Allyn and Bacon, 1995.
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