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Children and Grief

Understanding Death

Children experience death and grief in a variety of ways depending on their age, their understanding, and their preparation.  In general, children tend to have a better understanding of death, and therefore ability to cope, if they have open communication with a trusted adult, age appropriate information on death, and a safe and healthy expression of emotion.

A young child's concept of death can be developed through talking about and pointing out examples of death in every day life: a dying plant, a dead insect, or a pet that has died.  Older children, even if they have not experienced a death in their family, have a better understanding of its meaning through exposure in books, media, and their own social circles.

Stages of Grief

For a child, grief can be separated into three different phases. Throughout all the stages, good, honest, supportive communication makes a difference in a child's ability to cope.

Stage 1:  Early Response — it is common for a child to exhibit denial, shock and numbness during this phase. They may immediately return to their play. They may continue to ask when their parent will be back. They may ask the same questions repeatedly. 

Stage 2:  Acute Grief — this is the primary grief response and includes a wide range of emotions including sadness, anger, guilt, fear, regression, physical symptoms, and depression.  Children typically have three common questions related to the death of a parent. The remaining parent or other close adults should directly provide answers and reassurance to these questions even if the child is not verbalizing them out loud: 

  • Did I cause the death to happen?
  • Will I die too?
  • Who will take care of me?

Children need to be given constant, direct and supportive reassurance to these questions before and after the death of a parent.

Stage 3:  Adjustment — the child learns to accept the reality of the death and the reorganization and reestablishment of their life following the death.  It is common for children to continue to grieve as they hit different developmental milestones that hold significance for them (e.g. birthdays, holidays, graduations, onset of puberty/dating etc).

Telling Your Child

If there is a chance that a loved one may die, children should be told that this is a possibility. Although a parent's instinct may be to “protect” the child from this knowledge, it can actually be more harmful for the child to feel the undercurrents of stress, sadness, and anxiety within their family without being included in what is happening.

One way to begin this discussion is to ask the child what they know or understand about their parent's illness.  After allowing the child to put their understanding into their own words and listening carefully to what he or she says, the child can be given basic information.  It is important to talk to a child in a calm and gentle way, and not to give too much information that they will not be able to understand. 

It is perfectly acceptable to express sadness or tears as that is natural part of the circumstances.  You might say to a child, “The doctors and nurses are trying their hardest to make mommy better, but the cancer might be even stronger.  If the cancer is stronger, mommy will get weaker and sicker and she might die.” 

Allow the child to share any feelings or concerns that they may have. Do not be surprised if the child is only able to have a brief conversation before returning to their normal activities. Make sure they understand that they can talk about their feelings, ask questions, or share their concerns whenever they have them.  Be honest and don't make promises that are not within your control to keep (“I promise everything is going to be okay.  Daddy is strong and he won't die.”)  A more honest and supportive promise can be made that would replace these false assurances.

Promising to tell a child if anything changes regarding the parent's condition, provides the child with a clear sense of being included and not kept wondering. Research suggests that children given specific information about their parent's illness experience lower levels of anxiety than children who are not informed.

After the death occurs, a child should be told as soon as possible.  It is important to use terms that the child can understand and to avoid terms that could be confusing such as, “passed away, “ “resting peacefully,” “taken by God.”  Share your own feelings about what is happening and include the child as much as they want in preparations.

Saying Goodbye

Children need to be given an opportunity to say goodbye to a parent who is dying. Unlike a traumatic, unexpected death, a death from an illness such as cancer allows the family members time to prepare emotionally for the death of a loved one.

Children can be encouraged to write letters, draw pictures, make presents (e.g. bracelet, picture frames etc), and visit with the dying parent. Encouraging the child to do this will give them the opportunity to bring closure or resolution in a way that may not be possible after the death has occurred.

They may feel the need to apologize for things they have done, express what they will miss, tell the parent how they feel about them, or talk to the parent about their feelings.  Providing multiple opportunities for this to occur is a good idea, since children may not be ready to do this if only asked one time.  

Normalizing Emotions

Sadness is often the most common emotion that people associate with death and grieving. However, it is clearly not the only emotion that people experience. 

A child needs to understand and be told that is absolutely normal to have other feelings about a parent dying. Being able to express their feelings and being supported and listened to can enhance a child's ability to cope with the strong and overpowering feelings associated with death.

Typical feelings associated with death include:

  1. Sadness — Children grieve in multiple ways and differ from child to child. A child may express sadness outwardly, through crying or sobbing, or inwardly bywithdrawal and quietness.  Emotional pain can be exhibited through physical or behavioral changes such as disrupted sleeping or eating patterns, loss of concentration, or physical complaints (e.g. headaches, stomach aches etc). Sadness or depression associated with the grieving process differs from a clinical depression in a child in that it is 'time limited' and recedes in intensity over time (six to 24 months).  If depressive symptoms last longer than thisand/or become increasingly intense, the child may need professional counseling and/or evaluation for antidepressant medication
  2. Loneliness — Children will miss the person that has died, and they will also miss activities that they commonly did with the person who died.  Rituals or behaviors which were done exclusively by the parent that died should be discussed with the child to see if there is a way that activity could be done by someone else.  This is not meant to “replace” the person that has died, but rather to minimize the number of things that the child has to lose in his or her life.
  3. Shock or denial — A child may deny that death has occurred. They may resume their normal activities and continue to ask about the parent that has died.  They may show no feeling at all initially.  If this occurs, it is helpful to answer the child directly and honestly and allow them some time to adjust to the reality of what has happened.
  4. Anger — Anger is a normal, expected part of the grieving process.  It occurs in adults and children alike.  A child may be angry at the parent that has died, at the parent who remains, at their siblings, at God, at the doctor etc.  Like other emotions, children need to be told that it is okay for them to feel angry. You can help normalize this for them by explaining that you feel angry sometimes too.  Helping them talk about their anger, express it verbally or through art or drama, can assist the child's overall coping skills.
  5. Relief — A child may feel relief that the parent's suffering is over. If the child had a more difficult relationship with the individual, he or she  may feel relief when that person dies. If the child's life has been turned upside down due to a parent's illness, he or she may feel relief that the illness is over in hopes that their life will be normal again. 
  6. Guilt — Like anger, guilt is a common and often misunderstood emotion related to grief.  It is quite common for children to feel responsible for the death of a parent.  A child sees himself as the center of the universe. Due to the egocentricity of their thinking, it is quite normal for the child to inaccurately perceive that they are to blame. A child may develop significant guilt around this false belief. They may believe that a certain bad behavior caused the illness. They may be guilty regarding some of their thoughts or feelings during the course of illness. Adults can unwittingly add to these false beliefs through statements made to a child during periods of intense stress and emotion. Sometimes, a parent may make a rash statement as part of their own stress and sadness reaction, that will carry tremendous emotional weight for a child.  Statements like, “You need to be a really good boy so that mommy can get better.”, “If you keep waking daddy up, he won't get the rest he need to get well” can take on enormous proportions in a child's mind if death occurs.  Children need to be repeatedly told that they were not in any way responsible for the illness or death of a parent. Guilt may also arise in a child who feels temporary happiness or enjoyment during the immediate grieving period.  It is important for the child and the family members to understand that this is a natural part of a child's grief response.
  7. Fear — After losing a parent, a child may express fear of numerous things. They may be afraid of dying, afraid of their other parent dying, of falling to sleep, of separation from or abandonment by other family members. Fear is a normal reaction to loss and should be dealt with openly and honestly.  Simple reassurances that the child is healthy, that there will always be someone to take care of them, that everyone feels afraid and it is okay are all responses that may help the child slowly overcome his or her fear.

Funeral, Memorial Services, and Viewing the Body

When a parent dies, viewing the body and attending the memorial service may be helpful ways for the child to understand what death actually means. In general, it is important for children to be given a choice in their participation in these events and to be given specific, age-appropriate descriptions of what they might see and experience at each stage. 

Children should never be forced to touch or view the body. They should be given a choice with an accompanying explanation of what to expect.  “Mommy's body will be in casket which is a special box that someone is buried in. She'll be wearing her favorite clothes. There will be many people there, and they may be crying and upset because they are going to miss mommy too. You can touch her body if you want to, but it will feel a little different.”

You may want to consider arranging a separate time for them to view the body when there are fewer people around so the child feels more comfortable. Children cope better when they are given a chance to emotionally and mentally prepare for an event. If it is something new for them, they are unable to do this unless they are given adequate information in a kind and supportive way that will help them understand what will happen. 

A child might be encouraged to place a special gift in the casket as part of saying goodbye—a letter or a symbolic gift may provide them with something to say to the deceased as a way of bringing some closure to the dying process.

If the family opts for cremation rather than a burial, most mortuaries and crematoriums can arrange for a special viewing for the family. 

The same tenets hold true regarding having children visit a gravesite. It can be an important tool for them to understand and cope with death, but it should be offered as a choice. Once again, they should be given a clear explanation of what they will see and what they might expect when visiting a cemetery.                     

Summary

The death of a parent is probably the single most traumatic event a child will experience.  There is no way to protect or shield them from pain and grief, however there are loving ways to support them through this process that will strengthen their ability to cope with this loss.  The following key points summarize the most important things to consider:

  1. Tell your child immediately when the death occurs.
  2. Explain the death in ways the child can understand using the correct words “died,” “dying,” “dead” and avoid using euphemisms like “sleeping peacefully” or “passed away.”
  3. Express your own feelings openly and don't be afraid to talk about them with the child. This will help them understand what is happening and feel more comfortable about expressing their own feelings.
  4. Don't expect your child to grieve like you do. Each child needs to be able to express their feelings in their own way and according to their own timeline.
  5. It is important to really listen to what a child is saying. Respond calmly to their questions and make sure you understand exactly what they are asking. You may need to ask a few clarifying questions in order to understand exactly what the child's question is.
  6. Keep structure and routines as much as possible. Being in a familiar environment and routine may help the child's sense that their life is going to continue despite the trauma and grief associated with the death.
  7. Help your child say goodbye to the dying parent throughout the process.  Visiting the dying parent in the hospital, talking to them, writing letters, drawing pictures, making gifts, going to the gravesite, and even talking to the, out loud once the parent has died are all ways that a child says goodbye.
  8. Reassure the child that their whole range of feelings is normal and help them find ways to express their emotions, concerns, and questions. Be open to talking and sharing your own feelings. 
    Reassure the child that their life will continue and that their needs will be met.
  9. Take care of your own needs so that you can also take care of your child's needs.
  10. Be aware that as children move through different developmental stages, their grief, sadness, and questions may resurface as a result of changes that they are experiencing. This is normal and should be handled in the same loving and supportive way.

Credits: Medic Publishing Company, PO Box 943, Issaquah, WA  98027

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