Grief, Bereavement, and Coping With Loss (PDQ®): Supportive care - Health Professional Information [NCI] - Children and Grief
Table 2. Grief and Developmental Stages
|Age||Understanding of Death||Expressions of Grief|
|Infancy to 2 years||Is not yet able to understand death.||Quietness, crankiness, decreased activity, poor sleep, and weight loss.|
|Separation from mother causes changes.|
|2–6 years||Death 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.|
|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 years||Death 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 older||Everyone will die.||Heightened emotions, guilt, anger, shame.|
|Increased anxiety over own death.|
|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.|
|Regressive behaviors (loss of interest in outside activities).|
|Feels guilty about being alive (especially related to death of a brother, sister, or peer).|
In American society, many grieving adults withdraw into themselves and limit communication. In contrast, children often talk to those around them (even strangers) as a way of watching for reactions and seeking clues to help guide their own responses. It is not uncommon for children to repeatedly ask baffling questions. For example, a child may ask, "I know Grandpa died, but when will he come home?" This is thought to be a way of testing reality for the child and confirming the story of the death.
Issues for grieving children
There are three prominent themes in the grief expressions of bereaved children:
- Did I cause the death to happen?
- Is it going to happen to me?
- Who is going to take care of me?[2,7]
Did I cause the death to happen?
Children often engage in magical thinking, believing they have magical powers. If a mother says in exasperation, "You'll be the death of me," and later dies, her child may wonder whether he or she actually caused the death. Likewise, when two siblings argue, it is not unusual for one to say (or think), "I wish you were dead." If that sibling were to die, the surviving sibling might think that his or her thoughts or statements actually caused the death.