Table 2.

Differences in Grief Responses by Age, Gender and Person. Modified with permission D. J. Wilkie, © 2001, D. J. Wilkie and TNEEL Investigators.²²

Age	Responses
Babies	May withdraw and stop eating, or be listless and fussing.
Toddlerhood	Toddlers’ sense of what they want guides how they see the situation around them. They believe that people can read their minds and that wishing for something will make it happen. Frequently, they will blame themselves for what does happen, including the death of a family member. Toddlers may not distinguish between going away and death. They may show their distress in nonverbal ways as agitated behaviors, body language or in dreams. Sometimes in play situation. Toddler may cry one moment and run outside and play in the next moment.
Preschool-Kindergarten Age	Children between the ages of 3–6 years begin to recognize their own behavior even though they may not be able to fully control their feelings and actions. By age 4, children may have a limited understanding of the word “death.” They may think the dead may come back to life. There is an interaction with the social environment. For example, if the mother died when the child was 2 years old and the father remarries, the child at the age of 4 feels cared for by this second mother but still may want to visit the grave of his mother.
Elementary School Age	Children are on a continuum of development, and they learn quickly not only about relationships but also how to read and develop more resources for themselves. These children are able to separate their point of view from that of others. Elementary school age children realize that there is a connection between events, that their father being sick led to his death. They have concerns as to who will take their father’s place. These children understand death as the cessation of functions. Death processes and funerals are very much on their minds. Older children know that death is universal. There can be emotional disturbances such as poor school performance, appetite changes, shortened attention span, depression, guilt and fear. They may complain of stomachache and other somatic symptoms. They frequently will not bring up their concerns.
Adolescence	This period of time is one of rapid cognitive, emotional and physical development. They act more independently and are able to think abstractly, to also recognize their own feelings and point of view as well as others’ feelings and points of view. Maintaining relationships and receiving approval from their peers are vitally important to them. When death occurs in the family, they can talk about their feelings. We see the differences between boys and girls at this time. Boys begin to contain their feelings and are less likely to talk about them, while girls do. Questions about death are natural and an integral part of an attempt to reach a new understanding of life. Initial response to death may be shock, confusion, depression, anger, fear, blaming, lethargy and guilt, which decrease over time. Acting out behavior such as driving fast or taking risks may be seen.
Gender
Feminine (conventional)	Sharing intense feelings with others, expressing feelings through crying, responding favorably to interventions that are traditional, affect-intensive strategies, e.g., open sharing of feelings and group support.
Masculine	Remaining silent, engaging in solitary mourning, “secret grief,” taking physical or legal action, becoming immersed in activity, exhibiting addictive behavior, seeking companionship (in line of support), using humor or other ways of expressing feelings (but managing anger and aggression)
Other Factors
Personal Factors	Past experiences with loss and completion of grief work, when in the life cycle the loss occurred, relationship with deceased, how loss occurred (sudden, expected, unexpected, preventable), health history (physical health, mental health, suicide attempts, life crises)