Death is a concept that is extremely difficult for a child to understand. Grieving adults are often confused and unsure how to respond supportively. Most children require many explanations and have many questions regarding death. "What happens when people die? Where do they go?" are among the most common.

Discussing death is extremely difficult for many adults. It requires recognition that death is a natural process for all people. Children may have problems visualizing death. They develop fears about what happens after death, what death feels like, what would happen to them if their parents died. Parents should attempt to openly discuss death with their children if they ask about it or if the situation requires.

Death should be discussed honestly and in language that children can understand at their stage of development. A child's concept of death varies with age, and this must be taken into consideration.

Age 0-2 years:

• Sees death as separation or abandonment
• No cognitive understanding of death
• Despair from disruption of caretaking

Age 2-6 years:

• Often believe that death is reversible, temporary
• May perceive death as a punishment
• Magical thinking that wishes come true (such as guilt that they had negative feeling toward the person who died, and that was the cause of death)

Age 6-11 years:

• Gradual understanding of irreversibility and finality of death
• Concrete reasoning with ability to comprehend cause and effect relationship

Age 11 years or older:

• Understands that death is irreversible, universal, and inevitable
• Has abstract and philosophical thinking

Family members should know that showing feelings, such as shock, disbelief, guilt, sadness, and anger are not only normal, but helpful. Sharing these feelings as well as memories of the person who has died with the child reduces the child's sense of isolation. Children need lots of reassurance that they will be loved and cared for by a consistent adult. They also must be assured that they did not cause the death, nor could they have prevented it.

Grief is a process that unfolds over time. The initial shock and denial may change into sadness and anger that can last from weeks to months. Some children seem to show no emotional response to death, which can be disconcerting to family members. Some normal behaviors include:

• Shock
• Crying
• Sadness
• Anger
• Guilt
• Increased clinginess
• Disobedience
• Lack of interest in school
• Sleep difficulties
• Decreased appetite
• Temporary regression to more childish behavior
• Physical complaints

Signs of a problem or disorder include:

• Long-term denial
• Repeated crying spells
• Disabling depression
• Suicidal thoughts
• Persistent anger
• Persistent unhappiness
• Social withdrawal
• Severe separation anxiety,
• Delinquency or promiscuity
• Decline in school performance
• Persistent sleep problems
• Eating disorders
• Long-term avoidance of feelings

Have your child seen by a doctor, mental health specialist, or clergyperson if he or she exhibits any of these signs.

RECOMMENDED BOOKS ABOUT BEREAVEMENT

Young Children:

The Dead Bird, by Margaret Wise-Brown. Addison-Wesley, Reading MA, 1958 (3-5 years)

When Dinosaurs Die: A Guide to Understanding Death, by Laurene Krasny Brown and Marc Brown. Little Brown, Boston, MA, 1996 (4-8 years)

Accident, by Carol Carrick, Seabury Press, New York, NY, 1976 (6-8 years)

Older Children:

A Taste of Blackberries, by Doris B. Smith. Thomas Y. Crowell Co, New York, NY, 1973 (8-9 years)

The Magic Moth, by Virginia Lee, Seabury Press, New York, NY 1972 (10-12 years)

Beat the Turtle Drum, by Constance C. Greene. The Viking Press, New York, NY, 1976 (10-14 years)

Guidlines for Caregivers:

Lifetimes: The Beautiful Way to Explain Death to Children, by Bryan Mellonie and Robert Ingpen. Bantam Books, New York, NY, 1983

Straight Talk About Death With Teenagers, by Earl A. Grollman. Beacon Press, Boston, MA, 1993

How Do We Tell The Children? Helping Children Understand and Cope with Separation and Loss, by Dan Schaefer and Christine Lyons. Newmarket Press, New York, NY, 1993.

Related topics:
Fetal death
SIDS
Death among children and adolescents