Death is a concept that is 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?" and "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 may develop fears about what happens after death, what death feels like, or 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
• Has no cognitive understanding of death
• Feels despair from disruption of caretaking

Age 2 - 6 years:

• Often believes that death is reversible, temporary
• May perceive death as a punishment
• Engages in magical thinking that wishes come true -- may feel guilt for negative feelings toward the person who died, and think that was the cause of death

Age 6 - 11 years:

• Shows gradual understanding of irreversibility and finality of death
• Demonstrates 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 and memories of the person who died 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 clinging
• 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

Take your child to a doctor, mental health specialist, or clergyperson if any of these signs appear or persist.

RECOMMENDED BOOKS ABOUT BEREAVEMENT

• Accident by Carol Carrick (ages 6 - 8)
• Beat the Turtle Drum by Constance C. Greene (ages 10 - 14)
• The Dead Bird by Margaret Wise-Brown (ages 3 - 5)
• The Magic Moth by Virginia Lee (ages 10 - 12)
• A Taste of Blackberries by Doris B. Smith (ages 8 - 9)
• When Dinosaurs Die: A Guide to Understanding Death by Laurene Krasny Brown and Marc Brown (ages 4 - 8)

GUIDELINES FOR CAREGIVERS

• How Do We Tell The Children? A Step-by-Step Guide for Helping Children Cope When Someone Dies by Dan Schaefer, Christine Lyons, and David Peretz
• Lifetimes: The Beautiful Way to Explain Death to Children by Bryan Mellonie and Robert Ingpen
• Straight Talk About Death With Teenagers by Earl A. Grollman

RELATED TOPICS

• Death among children and adolescents
• Fetal death
• SIDS

Levetown M. Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information. May 2008. Pediatrics. 121: 5;1441-e1460.