Children Grieve, Too
By Beth Vaughan Cole, Ph.D., APRN

Discussing death and dying is frequently very difficult for adults. This difficulty is enhanced as adults try to talk about death to children. In an attempt to protect children from the emotional upheaval and complex implications of death and dying, adults often ignore children or give them poor or inaccurate information. When death and dying are not discussed with children in ways they can understand, children may be seriously harmed. The following comments are given to help adults address issues of death and dying with children.

Obviously the first issue in discussing death and dying with a child is to recognize children will understand such profound issues differently based on their age and development. What you would say to a four-year old is not what you would say to a ten-year old. Young children 3-5 years old will not understand the permanence of death clearly. They might believe that the person who has died will come back in a few days. Therefore it is important to clearly state that the person has died and will not be coming back. Phrases such as "Grandpa has gone to sleep, " or, "Grandma has gone on a long vacation," will be very confusing to children. Helping children understand that to live a body needs to breathe, sleep and wake up, and eat. When the body can no longer do these things, the body dies.

School age children will understand the permanence of death better than a younger child. If the person who died had a lingering illness, hopefully there will have been opportunities for a child to discuss the impending death with a caring adult. When a school age child experiences the death of a significant person in his/her life, it may impact their school work and their relationships to others. A school age child may be equipped to understand the emotional impact of death, but still be confused about her/his own emotional responses. Feelings of anger and resentment toward the dead person for leaving is not unusual. Feelings of abandonment and anxiety may come forward. Sadness and sorrow may be natural responses to the death of a loved one. But to a child these feelings of sadness may be overwhelming and confusing. Sometimes children's behavior may become difficult. Children will carefully watch the adults around them to see how to grieve "the right way." Having someone to talk to about the loss is very important.

Listening to a child's account of a death is very important. Without correct information, children will create their own interpretations of death. One little boy thought that his brother had died because he turned eight. He did not understand that his brother had died of leukemia. Therefore, when the little boy approached the age of eight he became very upset and distressed, thinking it was his turn to die.

Often, a parent is so upset about a death, that he/she can't talk clearly with their children about death. In addition, children can be very protective of their parents at a very young age. Knowing that talking about the dead person makes their parent cry, the children will not bring up their own distress or confusion about death. This leaves children more vulnerable and isolated in their sorrow.

Obviously talking about death in the abstract (such as a character on TV who has died) versus talking about the death of a family member or close friend will be different. Parents can use the abstract experiences to talk with children about death. Again, ask the children what they know and understand about death. At this time an adult can correct any misinformation.

Children may deal differently with grief than adults. In order for the healthy part of a child to grow, while dealing with difficult issues like grief, a child may appear not to grasp the death of a loved one and all the implications. Children appear to grieve in spurts. They may ask the same questions over and over. They may ask a profound question about a death in one minute, then run out to play the next. They are integrating the experience as best they can.

It is very important that a child be given permission to play and resume childhood activities after the death of a loved one. Play is how children master their environment and integrate the knowledge they have learned. A parent, who is deeply grieving the recent death of a parent, spouse, or a child, may be unable to provide a warm, nurturing environment for children. While unable to do this themselves, parents can turn to friends or other family members. After the death of her sister in a car accident, a seven-year old little girl was very hesitant to engage in any playful activities. Her parents were extremely sad. Many months later, with the help of an understanding adult, the girl reported, "I can be happy as well as sad." The child had learned one of life's profound lessons.

This brief commentary identified four major issues in understanding and addressing children who are grieving. One, approach the child on her/his level by age and development. Second, give the child accurate information about death, and don't ignore them when they experience the death of a family member or close friend. Third, children grieve differently than adults. They may do it in spurts, exaggerations and with repetition. Finally, children may need permission to continue the normal tasks of childhood. They may need permission to be happy in the face of deep sadness.

Each child, like each adult, will integrate death and dying in his/her own way. Understanding that children approach death with undeveloped knowledge, incomplete physiology, and inadequate resources, should provoke adults to carefully attend to the needs of children who have experienced the death of a family member or close friend. The major activities that adults can provide are listening to children's perceptions of death, giving accurate and compassionate information, and supporting children to be happy as well as sad.

Written by Beth Vaughan Cole, Ph.D., APRN
University of Utah College of Nursing
Director of Caring Connections: A Hope and Comfort in Grief Program

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