Children and Grief (page 2)

By — NYU Child Study Center
Updated on Jul 9, 2010

Responses: Expected and expressed

We have come to expect certain reactions from children when dealing with death. Their fear, anger, sadness, and guilt are related to their:

  • ability to understand the situation
  • worry about others' physical and emotional well-being
  • desire to protect those who are living
  • reactions to changes in home life
  • changes in roles and expectations
  • feelings of being different, alone, isolated
  • sense of injustice
  • concern about being taken care of and about the future

Children express their grief by their:

  • behavior
  • emotions
  • physical reactions
  • thoughts

There are some predictable ways that children understand and respond to death at different ages.

Infants and toddlers: Before age 3

The very young have little understanding of the cause or finality of death, as illustrated by a belief that leaves can be raked up and replaced on a tree. They are most likely to react to separation from a significant person and to the changes in their immediate world. Toddlers are curious about where things go and delight in disappearance and reappearance games such as "peek-a-boo." Their distress at the changes in their environment following a death are displayed by:

  • crying
  • searching
  • change in sleep and eating habits

Preschoolers and young children: 3-5 years old

With language and learning comes an interest in the world and children this age are full of questions, often repeated. They try to use newly acquired information. A 4-year-old on the plane for the first time looks out the window and asks "We're in heaven -- where are all the people?" They focus on the details of death and may also personalize the experience, perhaps by incorrectly perceiving the cause as stemming from them. For them, being dead can mean living under changed circumstances, so even though a child has seen someone buried underground there may be concern for the person getting hungry. At this age death is equated with punishment. But it is also is seen as reversible; being dead means being still and being alive means moving. When playing cops and robbers, if someone is shot in "play," merely standing up makes you alive once again. Children this age are apt to be sad, angry, scared or worried and communicate these feelings in their:

  • tantrums, fighting
  • crying
  • clinging
  • regression to earlier behaviors (such as nightmares, bedwetting, thumb sucking)
  • separation fears
  • magical thinking that the person can reappear
  • acting and talking as if the person is still alive

Early school age children: 6-9 years old

Children this age have the vocabulary and ability to comprehend simple concepts relating to germs and disease. There is still a fascination with concrete details as a way to organize information. When asked what happens when someone dies, a 6-year-old replied, "like a special car comes and it picks them up.a special sort of station wagon what has no back seat on it." 2 They have a sense of the importance of, and contributing factors to, personal health and safety. Yet their emotions and understanding can be incongruent. Therefore we see their less sophisticated beliefs such as in the power of their own thoughts to cause bad things to happen. They also personify death, thinking that a "boogey man" can snatch people away. They are most likely to display:

  • anger
  • denial
  • irritability
  • self-blame
  • fluctuating moods
  • withdrawal
  • earlier behaviors
  • school problems such as avoidance, academic difficulty, lack of concentration

Middle school age children: Age 9-12 years old

By age 9 or 10 children have acquired a mature understanding of death. They know that: (1) it is a permanent state; (2) it cannot be reversed; (3) once you have died your body is no longer able to function; (4) it will happen to everyone at some time; (5) it will happen to them. This adult understanding can be accompanied by adult-like responses such as feeling a sense of responsibility, feeling different, being protective of others who have been affected, thinking certain emotions are childish or that they must put up a good front. The most common reactions are:

  • crying
  • aggression
  • longing
  • resentment
  • isolation, withdrawal
  • sleep disturbance
  • suppressed emotions
  • concern about physical health
  • academic problems or decline

Early teens and adolescents

Clearly able to understand the significance of death, teens' responses are directly related to developmental tasks. As they struggle towards independence, they may feel resentful and unsure of themselves, yet pressured to fulfill an adult role. They have a view to the future, question their own mortality, ask themselves "what if?", think about ways life is changed forever, or anticipate events that will be different than imagined such as a graduation or wedding. They may be afraid of exposing their strong feelings and thus they may be denied or ignored and replaced by teenage rebellion. Common reactions include:

  • numbing
  • anger
  • resentment
  • anxiety
  • guilt
  • sense of increased responsibility
  • self-involvement
  • risk-taking and acting-out behaviors
  • avoidance of feelings
  • distance
  • fear of death
  • appetite and sleep changes
  • physical complaint
  • academic decline or apathy

When to get help

Children and teens are at most risk for adjustment problems in the first year after the loss, with 10-15% at risk for problems, most likely in the form of depression . It is believed that the majority of children and teens have adjusted emotionally and returned to healthy functioning at school, home and with friends at one year. 3 However, some children develop more serious problems that warrant the attention of a mental health professional and some problems may emerge even two or more years later as different developmental tasks or life challenges are confronted. In particular, depending on the child's age and situation and the intensity, frequency, and interference of different symptoms, causes for concern include: 4

  • long-term denial and/or avoidance of the topic, lack of recognized response to the loss
  • sleep, appetite, weight change and/or disturbance
  • extended periods of sadness, loss of interest in activities, feelings of helplessness and hopelessness, inability to experience moments of joy, profound emptiness
  • vague and generalized feelings of guilt and depression, rather than sadness connected to the death
  • inability to respond to comfort, rejection of support
  • purposeful withdrawal from friends, loss of sociability
  • inability to sleep, loss of appetite, prolonged fear of being alone
  • prolonged rather than transient physical complaints
  • acting younger for a prolonged period
  • destructive outbursts
  • inappropriate euphoria
  • accident-proness
  • inappropriate/illegal behavior
  • decline in school performance, refusal to attend school
  • persistent anxieties about one's own death or illness
  • excessive grief, difficulty weeping or controlling weeping
  • acting or imitating the one who has died
  • repeated statements about the desire to join the deceased that suggest intent to cause self-injury rather than a just a longing to be reunited
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