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Grief, Bereavement, and Coping With Loss (PDQ®): Supportive care - Health Professional Information [NCI] - Children and Grief

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Ages 6 to 9 years

It is not unusual for children in this age range to become very curious about death, asking very concrete questions about what happens to one's body when it stops working. Death is personified as a separate person or spirit: a skeleton, ghost, angel of death, or bogeyman. Although death is perceived as final and frightening, it is not universal. Children in this age range begin to compromise, recognizing that death is final and real but mostly happens to older people (not to themselves). Grieving children can develop school phobias, learning problems, and antisocial or aggressive behaviors; can exhibit hypochondriacal concerns; or can withdraw from others. Conversely, children in this age range can become overly attentive and clinging. Boys may show an increase in aggressive and destructive behavior (e.g., acting out in school), expressing their feelings in this way rather than by openly displaying sadness. When a parent dies, children may feel abandoned by both their deceased parent and their surviving parent, since the surviving parent is frequently preoccupied with his or her own grief and is less able to emotionally support the child.[3,6]

Ages 9 years and older

By the time a child is 9 years old, death is understood as inevitable and is no longer viewed as a punishment. By the time the child is 12 years old, death is viewed as final and universal.[3,6]

Table 2. Grief and Developmental Stages

AgeUnderstanding of DeathExpressions of Grief
Infancy to 2 yearsIs not yet able to understand death.Quietness, crankiness, decreased activity, poor sleep, and weight loss.
Separation from mother causes changes.
2–6 yearsDeath is like sleeping.Asks many questions (How does she go to the bathroom? How does she eat?).
Problems in eating, sleeping, and bladder and bowel control.
Fear of abandonment.
Tantrums.
Dead person continues to live and function in some ways.Magical thinking (Did I think something or do something that caused the death? Like when I said I hate you and I wish you would die?).
Death is temporary, not final.
Dead person can come back to life.
6–9 yearsDeath is thought of as a person or spirit (skeleton, ghost, bogeyman).Curious about death.
Asks specific questions.
May have exaggerated fears about school.
Death is final and frightening.May have aggressive behaviors (especially boys).
Some concerns about imaginary illnesses.
Death happens to others; it will not happen to ME.May feel abandoned.
9 and olderEveryone will die.Heightened emotions, guilt, anger, shame.
Increased anxiety over own death.
Mood swings.
Death is final and cannot be changed.Fear of rejection; not wanting to be different from peers.
Even I will die.Changes in eating habits.
Sleeping problems.
Regressive behaviors (loss of interest in outside activities).
Impulsive behaviors.
Feels guilty about being alive (especially related to death of a brother, sister, or peer).
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