Death is a concept that is difficult for a child to understand. Grieving adults are often confused and unsure how to respond supportively. Most children require many explanations and have many questions regarding death. "What happens when people die?" and "Where do they go?" are among the most common.
Discussing death is extremely difficult for many adults. It requires recognition that death is a natural process for all people. Children may have problems visualizing death. They may develop fears about what happens after death, what death feels like, or what would happen to them if their parents died. Parents should attempt to openly discuss death with their children if they ask about it or if the situation requires.
Death should be discussed honestly and in language that children can understand at their stage of development. A child's concept of death varies with age, and this must be taken into consideration.
Age 0 - 2 years:
Sees death as separation or abandonment
Has no cognitive understanding of death
Feels despair from disruption of caretaking
Age 2 - 6 years:
Often believes that death is reversible, temporary
May perceive death as a punishment
Engages in magical thinking that wishes come true -- may feel guilt for negative feelings toward the person who died, and think that was the cause of death
Age 6 - 11 years:
Shows gradual understanding of irreversibility and finality of death
Demonstrates concrete reasoning with ability to comprehend cause and effect relationship
Age 11 years or older:
Understands that death is irreversible, universal, and inevitable
Has abstract and philosophical thinking
Family members should know that showing feelings such as shock, disbelief, guilt, sadness, and anger are not only normal, but helpful. Sharing these feelings and memories of the person who died reduces the child's sense of isolation. Children need lots of reassurance that they will be loved and cared for by a consistent adult. They also must be assured that they did not cause the death, nor could they have prevented it.
Grief is a process that unfolds over time. The initial shock and denial may change into sadness and anger that can last from weeks to months. Some children seem to show no emotional response to death, which can be disconcerting to family members. Some normal behaviors include:
Lack of interest in school
Temporary regression to more childish behavior
Signs of a problem or disorder include:
Repeated crying spells
Severe separation anxiety
Delinquency or promiscuity
Decline in school performance
Persistent sleep problems
Long-term avoidance of feelings
Take your child to a doctor, mental health specialist, or clergyperson if any of these signs appear or persist.
RECOMMENDED BOOKS ABOUT BEREAVEMENT
Accident by Carol Carrick (ages 6 - 8)
Beat the Turtle Drum by Constance C. Greene (ages 10 - 14)
The Dead Bird by Margaret Wise Brown (ages 3 - 5)
The Magic Moth by Virginia Lee (ages 10 - 12)
A Taste of Blackberries by Doris B. Smith (ages 8 - 9)
When Dinosaurs Die: A Guide to Understanding Death by Laurene Krasny Brown and Marc Brown (ages 4 - 8)
GUIDELINES FOR CAREGIVERS
How Do We Tell the Children? A Step-by-Step Guide for Helping Children Cope When Someone Dies by Dan Schaefer, Christine Lyons, and David Peretz
Lifetimes: The Beautiful Way to Explain Death to Children by Bryan Mellonie and Robert Ingpen
Straight Talk About Death with Teenagers by Earl A. Grollman
Levetown M. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics. 2008;121:e1441-e1460.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.