Understanding the Childhood Grief: What Should We Tell the Children?

Children will grief when they experience loss of a loved one and parents consoling the child is a part of the circle of life. Although informing the child about the death of a family member has been primarily left to the responsibility of parents, they often avoid communicating with their children about the death of a loved one. This is because the parents are often unaware about how, what, and when the child should be told. This editorial offers tips to help parents learn how to better recognize and help their children grieve if someone they know has died.

Children as young as infants and toddlers can sense when something around them has changed.[1,2] In their own way, they grieve. Explaining death to children is not an easy task, especially when the death was of a family member or close friend. With the best of intentions, adults often avoid talking about death around children as a way to protect them. In the long term, avoidance can create confusion, fear, and sometimes even distrust.

Communication strategies for explaining death to a child[3,4,5]

• Create a safe place for children to talk and ask questionscan expect and what to do for different.

• Gently, but directly, use the words death, dead, and died within short explanations.

• Using euphemisms and vague language often creates fear in children.

• Before answering a question, ask the child to clarify what they are seeking to get to the root of what they are asking.

• Be honest on a developmental level the child can understand.

• If the deceased was a regular part of their routine, explain why their grandparent would not babysit or their aunt cannot pick them up after preschool anymore.

• Recognize that children will ask for information as they need it.

• Be mindful they need a balance of communication and play.

• Be mindful that children may repeatedly ask similar questions about death. This does not imply that you have explained death incorrectly, but rather that they continue to process the information.

• Be consistent in your messaging.

• Identify fears and misconceptions, offer reassurance and provide opportunities to create legacy items to help children remember deceased loved ones.

• Often, this is not one talk, rather an ongoing conversation as your child processes information.

• Remember, it's OK if you do not have an immediate answer.

• It is important for adults to use reflective listening skills and, if you do not know, say, “I don't know the answer to that, but I will try my best to find out.”.

• It's alright to cry.

• Showing children your emotions can help to normalize the range of feelings but be careful to maintain balance..

• Share your memories or thoughts out loud with children..

What to avoid while communicating with a child[6,7]

• Setting an agenda

• Doing all the talking

• Not allowing silence

• Focusing too much on your own emotions

• Offering too many medical details

Death, grief and developmental stages[8,9]

If you are concerned about talking about death with your child, you are not alone. By talking to your child, you can learn what they do and do not understand about death and help them with any fears or worries they have by providing information, as well as comfort and reassurance.

When explaining death or grief, it is important to consider your child's capacity to understand the concepts. Generally, here is what you can expect and what to do for different age groups:

A. Infants/toddlers

Concept of death-will not understand death, but will respond to changes in their routine that death causes

Grief response: irritability, respond to emotions of adults and caretakers

Signs of distress: regression, changes in eating or sleeping patterns.

Possible interventions: Reestablish routine, comfort, touch, and hold infant or toddler

B. Pre-schooler (ages 3 to 5)

Concept of death: “engage in magical thinking,” view death as reversible or temporary

Grief response: may ask questions about the death repeatedly, may reenact death through play

Signs of distress: regressions, bedwetting, separation anxiety, sleep disturbances

Possible interventions: answer questions honestly, use age-appropriate language to explain death. If your child is including death in their play, support them through this process.

This will help you better understand how the child is coping with the death and can help you clear up any misconceptions they may have.

C. School age (ages 6 to 9)

Concept of death: engage in “magical thinking,” associate death with old age, personify death (for example, a ghost, bogeyman, grim reaper)

Grief response: may regress emotionally or behaviorally, aggressive behavior (especially in boys), may be curious about death and what causes death

Signs of distress: regression, nightmares, violent play, tries to take on the role of the person who died

Possible interventions: give children an opportunity to participate in memory-making activities, share stories of the person who died, model appropriate grief responses

D. Pre-adolescent (ages 9 to 12)

Concept of death: understand that death is final and that it will happen to everyone including themselves, some may view death as punishment

Grief response: finality of death creates anxiety, fear the death of other people they love, want to know details of how the death happened

Signs of distress: regression, problems in school, withdraw from friends, extreme weight loss or gain, suicidal thoughts

Possible interventions: offer constructive “venting” alternatives like sports or exercise, give as much factual information regarding the death as possible.

E. Adolescents (ages 13 and up)

Concept of death: understand death cognitively, struggle with spiritual beliefs surrounding death, search for meaning behind the death, understand possibility of their own death

Grief response: may act out, may express that “life is not fair,” may prefer to discuss feelings with their friends, may develop an “existential” response

Signs of distress: intense anger or guilt, poor school performance, long-term withdraw from friends, opposition or defiance

Possible interventions: sharing your own experiences with loss, explore religious/spiritual beliefs with them.

Explaining funeral services and burial preparation to a child

When preparing for these conversations, consider what exposure a young person has already had with funerals or memorial services. Anticipate questions like, why do we have services? What will the body look like? Explain the purpose of the service and any religious significance. If the service is a celebration of someone's life, explain that as well. In closing your conversation, offer the child the choice to participate or not. If the death was a person close to the child, perhaps allow them to help with planning the service, such as picking out photographs for a collage board or video stream.[8,9]

Conclusion

Although informing the child about the death of a family member has been primarily left to the responsibility of parents, they often avoid communicating with their children about the death of a loved one. This is because the parents are often unaware about how, what, and when the child should be told.

Primary care physicians, social worker, teachers, and psychologist counseling can help grieving families respond to the children's needs, given their developmental stage, relationship to the deceased, and the circumstances of the death.