Helping Children Cope with Grief
The death of a loved one can be a very difficult. The emotions you experience are far more intense than anything most of us have and will ever experience. Not only do you need to process your own grief but if children are involved you also have to help them process and cope with their grief. Children grieve differently than adults and each child and situation is unique. Often times they are still learning how to process and deal with these intense feelings. Providing them support and emotional outlets will help them travel through the stages of grief more effectively.
Children of all ages experience grief. They may grieve for different reasons and in different ways, but the emotions and feelings are still intense and need attention. It’s important to remember that guilt, abandonment, sadness, and anger are all common and normal reactions.
Children’s grief often times will resurface as they reach a new developmental level. Grieving again during these times is a normal healthy way for children to process what has happened.
There are a few basic aspects that will help support a child during the death of a loved one.
Understanding is one of the most important things we can do for a child during a difficult time. Making sure their feelings are acknowledged will help them know it is okay to react in a certain way. Let them know their feelings are important and validate those feelings. For example, saying “this is a difficult time and you may be very sad but it is okay to cry if you are sad.”
While acknowledging their feelings you can help them understand your feelings as well. Saying things like “you may see mommy and daddy cry or be mad but we are not mad or sad at you.” Make sure they know it is important and good to tell you how they are feeling and that crying is okay. Let them know that although we may be really sad right now it will get better.
Try to relate to them in a way they understand. Getting down to the child’s level and adding eye contact and touch will help them stay connected in the conversation. Utilize concrete simple words to explain what has and will happen. At times caregivers are hesitant to use the words such as died, death or dead but these words will be the easiest for a child to understand. It will also show them that it’s a topic that is okay to talk about. Using words with double meaning such as lost or passed on will create misconceptions about the loved ones death.
Remember the importance of play. A child will often process what they are feeling while playing. Even though it may seem odd for a child to want to play during these difficult times, it is normal and helpful for them to do so. Play is a good time to listen for misconceptions and help explain if you hear them so they have the accurate information.
Explain to a child what to expect about the death of a loved one. Tell the child why that person has died. Explain to them why the body stopped working. Make sure they understand that when someone is dead they do not feel pain, they will not get cold and they will not be hungry.
Be prepared to answer their questions. It’s okay if you do not always know the answers. In these cases it is okay to say “I don’t know the answer to that.” Some typical questions are what will happen to the body? Will they feel anything? Who will sit by me on the school bus? Use your belief systems to help guide your explanations such as “where will the body go.”
Children will often to process by asking questions. Sometimes this will happen at times we feel are inappropriate. Remember this is a normal way for them to process the information. Do not react negatively as it can make them feel like they did wrong and therefore hold emotions inside instead of expressing them. For example, your child may correct you when you tell the hostess how many chairs you need at the table by saying something like “we do need 4 but we used to need 5 but my brother Johnny died” or “we are all going to grandma’s but not Johnny he’s dead”.
If there is time to help the child make memories with the loved one encourage this interaction. Handprint art and memory photo books are easy ways to create a memory for a child to look back at when they miss their loved one.
Help the child feel connected. Let them say good bye to the person. Encourage them to draw a picture to leave by their bedside. If it is a sibling death let them pick one of the sibling’s favorite toys to bury with their brother or sister. Older children could write a letter or draw a picture to put into the casket.
Below are some additional tips regarding understanding, physical and emotional reactions and coping strategies within the different developmental levels. Even though your child may fit a particular developmental level you may aspects of other levels as well. It is not uncommon for a child to either be ahead in their level of understanding or regress due to the additional stress. Keep in mind that if a child has been a close part of the illness they may be a developmental level ahead as they have most likely already started processing some of the components.
These are guidelines, if you are in need of additional information or community resources please feel free to contact your local Children’s Hospital - Child Life Department, Chaplain, Pastor or School Counselor.
Understanding / Physical and Emotional Reactions / Coping StrategiesInfants / ~ Do not understand death
~ Reacts to the separation from caregivers while they work on processing their own grief
~ Feed off the feelings of their caregivers / ~ Crying
~ Clinging
~ Crankiness
~ Restless / ~ Provide love and comfort as much as possible
~ Maintain their routine as much as possible
~Use consistent caregivers if possible
~ Utilize those who offer to help
(example - spend time with the infant while someone provides you with a meal)
~ Try to spend time each day with the infant
Understanding / Physical and Emotional Reactions / Coping Strategies
Toddlers
And Preschoolers / ~ Death is reversible and not permanent. They may think the person will return
~ Death can be seen as punishment for bad behaviors
~ They are egocentric. They believe they are involved in everything. They may feel they caused the illness themselves by wishes, thoughts or behaviors
~ They may think they will catch the illness
~ They believe that people will live underground if buried
~ Have difficulty expressing emotions verbally and will typically express them physically / ~Crying
~ Clinging
~ Restless
~ Temper Tantrums
~ May not be interested in what is happening
~ Separation from caregivers may amplify
~ May regress in behaviors such as bedwetting, thumb sucking, or baby talk
~ May talk about the death often and at times we feel are inappropriate (example – at grocery store with clerk, at restaurant with hostess)
~May use dramatic play to reenact what they believed happened / ~ Talk to them about what has or is going to happen
~ Use simple, concrete language
~ Be honest
~ Talk about end of life services such as funerals, lots of people being in the house, etc.
~ Do not use words with double meanings such as passed on, sleeping, etc.
~ Encourage those around you to use the same language
~Use dead, death and died.
~ Try to maintain routines as close as possible. If others are helping out tell the child who will take them where
~Maintain consistency in behavioral limits and expectations
~ If possible do memory making to help with coping (handprint art, memory boxes, etc.)
~ Preschoolers may benefit from local child focused support group
Understanding / Physical and Emotional Reactions / Coping Strategies
School Age / ~ Aware that death happens. At 5-9 years they believe it’s possible but only for others. At 9 years and up they believe it can now include them. .
~ Begins to understand that death is universal and irreversible – that they will not come back.
~Understands it is real and permanent
~ Can tell the difference between things that are living and nonliving
~ If from an illness make sure they are aware they cannot catch it / ~ Crying
~ Headaches
~ Stomach Aches
~ Fatigue
~ May have separation anxiety that they have not had recently (especially for longer separations)
~ May blame others for what happened
~ May act out or withdrawal in school
~ May see slips in school grades and attention
~ May not display emotions externally
~ Exhibits more anger and guilt emotions / ~ Give simple, honest explanations
~ Be a good listener
~Model positive coping
~Ask open ended questions
~ Make sure they know their feelings are important
~ Explain that it is okay to feel a certain way and that everyone may feel different
~ May not react until things begin to settle
~ Give permission for positive expression. It’s okay to cry or not to cry, punch a pillow, etc.
~Give opportunity to say Goodbye
~ Encourage to attend funeral but understand if the child does not want to participate or go
~ Encourage memory making (art, handprint poems, memory books, plant a tree etc.
~ May benefit from local child focused support groups
Understanding / Physical and Emotional Reactions / Coping Strategies
Teens / ~ Thinks more like an adult
~ Ability to think more abstractly, likes to know what happened to the body (heart stopped beating, lungs stopped breathing)
~ Can understand life is fragile
~Understands life is fragile and death is permanent
~ Worry about not fitting in with peers, may need help knowing what to say to peers / ~ Will try to assume adult roles (make them understand it is not their role)
~ May display more anger
~Moody
~ Partake in risk taking behaviors
~May prefer to confide and talk with peers rather than their caregivers
~ Teens may voice negative comments regarding cares and decisions made for the / ~ Encourage open and honest communication
~Provide all information you can that they are requesting
~Include them in decision making when possible
~ Discuss role changes within the family
~ May benefit from talking with school counselor
~ Encourage memory making (letters, items to leave in casket, memory photo books etc.)
~ May benefit from local child focused support groups
Nikki Walker MS, CCLS
References
Bell, Jacque. (1986) What Do I Tell The Children.
Thompson, Richard. (2009). The Handbook of Child Life A Guide for Pediatric Psychosocial Care.