When a loved one is lost to death, many things change; this also applies to children. Children are impacted by loss and death very differently than adults. Their manifestations of grief and reactions to the death can also be very different. Children will express their grief in a variety of ways and deal with death in many different ways, not necessarily in the same manner as adults. Some may appear to be entirely unaffected by the death.

For many children, their first real experience with loss occurs when a pet dies. For most children, the death of a family member is a new experience. Children may find new, unknown experiences to be confusing and frightening, consequently, most children do not know what to expect following the loss of a family member or friend. Responses to death will depend on their age, their prior experience(s) with death, the person's who dies, the circumstances surrounding the death and what happens after the death. Young children, in particular, may not understand what "death" means and may be confused or even frightened by the reactions of other family members.

No two children will respond exactly the same way to the death of a love one. Preschooler children have difficulty understanding that death is not temporary; they often see death as being temporary and reversible. This belief is reinforced by cartoon characters who "die" and then come back to life again. Children between the ages of five and nine begin to experience grief more like adults. They think more like adults about death, yet they still believe it will never happen to them or anyone they know. Children often believe that their thoughts, feelings and words have magical power. They may believe that they can "wish" someone back to life, or perhaps their angry feelings or hateful wishes, may have caused someone to die. Children need to be told that their thoughts do not cause people to die. Children may also make false assumptions about the causes of major events and assume soem degree of responsibililty for the death. These assumptions may include some sense that they were at fault for the event— including the death of a loved one. This can lead to very destructive and inappropriate feelings of guilt. It is important to immediately correct any misperceptions or distortions about the death.

Contributing to a child's shock and confusion at the death of a family member—brother, sister, or parent, grandparent—is the unavailability of the remaining adult family members, who may be so affected by grief that they are unable to cope with caring for the child. Children will look for answers, comfort and support from their parents, caregivers and other adults in their lives. The death of a loved one can profoundly affect a child's sense of security. In the case of traumatic death, the confusion and fear is even greater. In the face of any death, but particuclarly when faced with traumatic death, parents and caregivers often feel helpless in this role. While adults may not have answers to all the questions that a child may have about death, they can help the child to better understand the grieving process.

To help children cope with a death, parents, caregivers, teachers and other significant adults in their life must understand how they think about death and what has changed for them. The adults in a child's life also need to be aware of the normal childhood responses to death, as well as signs that a child is having difficulty coping with grief. During the weeks following the death, it is normal for some children to feel immediate grief, or hold onto the belief that the family member is still alive. This may be an adaptive coping mechanism in the short-term, but should not be allowed to persist into the long-term. Long-term denial of the death or avoidance of grief can be emotionally unhealthy and can lead to more severe problems later.

Signs of Grieving in Children & Adolescents
Children, like adults, may temporarily regress, having temper tantrums, becoming more dependent, being aggressive and having difficulty learning following a death. Sometimes the grieving child will take on the mannerisms of a dead family member or revert to joking and laughing, because he/she is unsure how to express his/her grief. Parents and teachers should refrain from punishing. It is important to remember the grieving children need more patience, touching, holding and reassurance.

The following lists some common ways children might respond to a death:

• Sadness
• Denial, shock and confusion
• Anger and irritability
• Inability to sleep
• Nightmares
• Loss of appetite
• Fear of being alone
• Frequent physical complaints such as stomachaches and headaches
• Loss of concentration
• Guilt over failure to prevent the loss
• Depression or a loss of interest in daily activities and events
• Acting much younger for an extended period or reverting to earlier behaviors (e.g., bedwetting, baby talk or thumb-sucking)
• Boisterous play
• Withdrawal from friends
• Sharp drop in school performance or refusal to attend school
• Excessively imitating or asking questions about the deceased or making repeated statements of wanting to join the deceased
• Inventing games about dying
• Humiliation or guilt over personal failure to prevent loss of life

Profound emotional reactions (e.g., anxiety attacks, chronic fatigue or thoughts of suicide)

• Use concrete terms when explaining death. Avoid terms such as "passed on" or "went to sleep" Children may not understand that these terms mean the person has "died."
• Answer their questions about death simply and honestly. Only offer details that they can absorb. Try not to overload them with information.
• Allow him/her to attend the funeral if he/she wants to but do not force it. Let him/her know what to expect at the funeral.
• Give the child alternatives for using his grief positively—drawing, other creative means of expression, writing letters, reading or writing poetry, stories.
• Make sure your child doesn't feel at fault.
• Give the child choices in what they do or don't do the remember the deceased. Allow the child to participate in the family rituals if he/she wants to—going to the funeral or cemetery, helping plan the ceremony, picking flowers, etc.
• Allow the child to talk about the deceased, but don’t push them to talk about their feelings.
• Be aware that children need time to grieve and be upset. Let them know you are available to listen when they are ready to talk. Provide reassurance and validate their feelings when they express them.
• The family's spiritual beliefs about death should be explained in simple terms. However, the child may not understand the meaning and although he/she can repeat what was said, he/she may not still not comprehend what death means.
• Children can be fearful about death. Give them a chance to talk about their fears and listen when they express their fears.
• Be patient. It may take them a long time to recover from their loss.
• Expect that their grief may recur throughout their childhood or adolescence. Strong reminders, such as the anniversary of a death, a birthday, or a celebration without the loved one may reawaken grief. Be available to talk.
• Children may even mourn the environment that existed before the death; they grieve the "changed" behavior. It can be helpful to keep to regular routines.

Hospice Foundation of America. Helping A Child Deal with Death. Available at: http://www.hospicefoundation.org/helping.htm.

National Mental Health Association. Helping Children Cope With Loss. 2001. Available at: http://www.nmha.org/reassurance/childcoping.cfm.

http://www.nmha.org/children/prevent/loss.cfm.

American Academy of Child and Adolescent Psychiatry. Fast Fact # 8. Children and Grief. Updated November 1998. Available at: http://www.aacap.org/publications/factsfam/grief.htm.

American Academy of Child and Adolescent Psychiatry. Fast Fact # 78. When a Pet Dies. September 2000. Available at: http://www.aacap.org/publications/factsfam/78.htm.

Perry BD, Rubenstein J. The Child’s Loss: Death, Grief and Mourning: How Caregivers Can Help Children Exposed to Traumatic Death. ChildTrauma Academy: Parent and Caregiver Education Series. Vol. 3 No. 1, August 1999. Available at: http://www.childtrauma.org/Loss2.htm.
Weathersby T. How Children Deal With Death "Helping a Child Cope." Available at:
http://dying.about.com/library/weekly/aa101197.htm.

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Children sense and experience loss and grief from a very young age.
Even infants can sense when something is amiss, someone is missing or something has changed.

Kirsti A. Dyer, MD, MS

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See the Emergency 911 Page for links to immediate resources
if you are feeling helpless, hopeless, overwhelmingly depressed, or suicidal.

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