We generally view children as innocent and in need of protection. We like to imagine that we can shield them from experiencing the “real world” until much farther down the road, preferably until late adolescence/early adulthood. Sadly, this is not possible and even small children experience grief & loss in their short lives. While this is not the norm, most of us will know and interact with children and adolescents who are working to come to grips with some death/loss in their life. As such it is important to have an understanding of how children at every age experience death and respond to grief, so that we can be supportive to them.
Children who are 0-2 years of age (known as the sensorimotor stage of development & thinking, according to Piaget) have no concept of time or death. They have limited language skills to describe their feelings and reactions, as well an any explanations adult caregivers may provide. Death can be equated to being “all gone” and largely felt in the ways that it interrupts their daily schedule, environment and access to known caregivers. As such, children in this age range often respond to death/loss with increased clinginess and separation fears. They may be more irritable, tearful and throw tantrums. They may also exhibit a regression in already developed skills, including sleep and toileting. While these children may not be able to verbally express their own emotions, they do seem to be able to pick up on and respond/react to the emotions of caregivers. Helpful responses for this age group include: maintaining routines as much as possible, providing soothing activities, avoiding unnecessary changes/separations from caregivers and naming the emotions that the child seems to be experiencing. Children will often use toys, stuffed animals and puppets to play/work out their experience of death.
Children who are 3-5 years old (preoperational stage of development & thinking) tend to view death as temporary and will display magical thinking, such as death being reversible or stating that the individual who died will “come back”. They are often very curious about death & dying and will often ask questions that can strike the grieving adults in their life as cold or detached. Children will often retell about the death event and ask the same questions over and over about why the individual died. Like their younger counterparts, they may exhibit regression in already established behaviors and have disturbances in sleep and appetite. These children may express fears about being separated from caregivers. They may display alternately increased hyperactivity or fatigue, as well as anger. Children at this stage need support and continued maintenance of routine. They are much more able to understand brief, factual explanations of death. It is preferable to use terms such as “died”, “dead”, “heart stopped working” as opposed to “went to sleep” or “isn’t with us anymore”. Children will benefit from being able to know what to expect at funeral or memorial services and from being able to retell the story of how the person died. Books about death and grief, as well as artistic expressions (crayons, paint, clay, etc.) can help children express their grief. They may also want to hear stories about the deceased or look at old photos.
Children who are 6-9 years old (concrete operations stage of development & thinking) understand that death is not reversible but have vague understandings of the mechanism of dying. They tend to believe that death is external in the form of a “bogeyman”, ghost or angel. They may even associate nighttime with death. It is normal at this stage to express a fear of death or to think that death is contagious. They may also express ideas that death can be avoided by their behavior. Children in this age range may exhibit crying, high anxiety, exaggerated fears and/or separation anxiety. They may also have increased somatic complaints and be reluctant to go to school. School performance may decline for a time, along with self-esteem. They may be more irritable and aggressive or withdrawn. Helpful strategies at this age/stage include providing factual information and correcting any incorrect information/assumptions. Again, refrain from using cliches about death and use straightforward language to talk about what happened to the individual who died. Reassure them realistically and do not shy away from saying “I just don’t know” when appropriate rather than making up a response to their inquiry. Children at this stage need space to express their fears and emotions without judgement or punishment. They can benefit from mutual storytelling about the deceased, creating a memory book/collage, or watching videos with that person in them.
Children who are 10-12 years old (still in the concrete operations stage) have a realistic view of death. They understand that death is final and permanent, and that death is personal (can happen to them/cause difficulties for them). They tend to focus on how the death has changed their life. They may also express curiosity regarding the biological aspects of death. Children at this stage may express anger toward the deceased and/or a Higher Power. They may have separation anxiety/fear and express somatic complaints. They may have difficulties concentrating and thus a decline in school performance. Some children become more rigid/demanding, creating conflicts with peers. Support children at this age range by allowing expression of feelings and concerns, including venting and anger. Give honest and accurate information about death. Listen attentively and try to capture the emotion behind what is being said rather than how it is being expressed. Children at these ages will benefit from books about death, creating ways to remember the deceased and being able to tell stories/share memories.
Adolescents (ages 13-18; formal operations stage of development & thinking) are able to think abstractly and understand death as universal but distant from them. They will often question the “whys” of death and see death as an “enemy”. Adolescents tend to feel that they are immortal, hence we sometimes see an increase in risk taking & testing of their own mortality during grieving. They may express anger, aggression, depressed mood, guilt or lower self-esteem. They may have more somatic complaints and a decline in school performance. They may withdraw, become “preoccupied” with death, and have difficulties making/committing to long-term plans. Supportive adults can encourage communication and provide/maintain structure and rules. Modeling the expression of a range of emotions can be helpful. Friends are already important at this stage and will be a source of support and companionship during the grieving process. Adolescents may find comfort in journaling, poetry, photography and reading books about loss.
As you can see many of the expressions, needs and helpful outlets are similar across ages and stages, even if the child’s understanding at that stage differs. There are many resources to provide additional support and speak to specific situations that may arise as we walk young people through death and grief. The Dougy Center (The National Center for Grieving Children and Families) has many helpful articles for those across the lifespan. You can find them at dougy.org.