Health & Parenting

Key points

• Children see loss and death in different ways as they grow and develop. Tailor your help according to your child's age and emotional development.
• How you learned to deal with loss will affect how you help your child. Think about what helped you when you lost something as a child.
• Don't try to keep grieving a private affair. Ask child care providers, teachers, and school counselors to help your child express his or her feelings, concerns, and misconceptions.

The ways children express grief are usually different from the way adults express it. Children are not always able to use words to express their feelings. Instead, they often express them through behavior. Even children who are able to express themselves verbally may not always be able to express the many, sometimes conflicting, emotions they have. Children may:

• Become very quiet or very talkative. They may become overactive.
• Have temper tantrums, angry outbursts, or refuse to obey adults.
• Have difficulty getting along with other children.
• Return to younger behaviors, such as wetting the bed after they have been dry for months or years.
• Cling to adults and want extra time and attention.
• Have difficulty completing school work. Their grades may drop.

How children express grief usually depends on how they perceive the loss (including death). Each child's perception of loss varies according to age and emotional development. In general:

• Children younger than age 2 cannot understand the meaning of losses such as death of a family member. When a loss occurs, they know that something is different, but they do not know what it is. Because they are sensitive to the feelings of adults, they may become more fussy than usual.
• Children between the ages of 3 and 6 often think that any major change in their lives is a result of their actions or wishes. This is called magical thinking. These children often feel responsible for any loss that occurs. If they see a loss as a threat, they may think that they are being punished for something. If people leave them (such as in divorce), they may feel abandoned and scared. These children may react to loss by being afraid to be alone or to leave the people they love. They may not want to sleep alone at night and may refuse to go to day care or school. Other ways that children this age may express feelings of grief are by developing eating, sleeping, or toileting problems.
• Children between the ages of 6 and 10 do not always fully understand events that occur in their lives. They may understand only part of what is going on around them and they may invent conclusions or draw the wrong conclusions about things they do not understand, resulting in misconceptions about what is happening. They may develop fears, such as fear of death.
• Children between the ages of 10 and 12 start to understand loss (including death) the way adults do. They see death as permanent and irreversible. They are curious about what and how things happen. For example, if they have been affected by a hurricane, they may want to learn how hurricanes develop. If a person close to them dies, they may want to know how bodies are prepared after death, what the rites and rituals of burial mean, and what happens to a person after he or she dies.

The way parents and other caregivers help a child who is grieving often lays the foundation for how the child will react to losses as an adult.

It's important to help a child grieve because:

• Their feelings are real. It is important for adults to acknowledge that each child has unique feelings after a major loss.
• Their feelings need to be expressed. Children who do not express their feelings may develop other problems, such as behavior problems or physical illnesses.
• Their concerns need to be addressed. Each child's concerns after a major loss differ, depending on the child's age and emotional development. For example, after the loss of a parent, a young child may ask who will take him or her to school. It is important for adults to listen to a child's concerns and answer any questions or concerns.
• Their misconceptions need to be clarified. Children often do not know why losses occur. They may think that they caused the loss or that they are being punished for something they did. Correcting such misconceptions may relieve a child's anxiety and fear.
• Information needs to be shared. Sometimes parents and other caring adults think it is best not to tell children what is happening after a loss. Not telling children about a major loss may cause them to develop unrealistic fears and concerns. Children may also feel insecure because they know the adults are not being honest. Not telling a child that a loved one has died may prolong the child's grief.

Before you try to help your child deal with a loss, examine your own thoughts and feelings about loss, particularly about death. Recall your first experience with loss. What helped you deal with it? What was not helpful to you? This is especially important if you experienced your first major loss when you were a child. Remembering your experience may help you recognize and understand your child's feelings. Also, the things that helped you may also be helpful to your child.

Tell other significant adults in your child's life about his or her recent loss. Child care providers, teachers, and school counselors may also be able to help your child work through his or her grief.

Here are some steps for helping children during the grieving process:

1. Provide safety and security. To express their feelings related to loss, children need an adult who makes them feel safe and secure. Consider your child's personality and his or her comfort level in talking about feelings and concerns.
2. Consider the child's emotional development. Consider the child's age and emotional development so that you can explain loss and death in a way that he or she will understand. See emotional considerations for children of different ages for ideas.
3. Make a plan. Think about how and when to approach your child. For ideas, see general guidelines for helping children who are grieving.
4. Use an activity. Activities create different ways for children to express their feelings related to loss. Try an activity that fits your style and your child's developmental level. If one activity does not work, try another one. Some suggestions include the following:
   • Read books or watch video tapes. Books and video tapes can help children understand the concept of loss and death. Ask a librarian about books and videos for children your child's age. After reading the book or watching the video, talk with your child about the story and especially about his or her feelings.
   • Make up stories. Storytelling lets you and your child change what happens in the story. Your child can change sad and gloomy feelings to more positive ones that provide warmth and comfort.
   • Draw pictures. Drawing pictures of feelings may be easier than talking about them. Ask your child to draw a picture of what is happening to him or her. You can also draw a picture of what is happening to you. After finishing your drawing, explain what you drew and ask your child to explain his or her picture. You can use drawing pictures along with storytelling to help your child deal with grief.
   • Play or act. Acting out feelings through play can be very helpful for some children. You can use stuffed animals, puppets, or other toys to act out what is going on. Sometimes it is easier for a child to allow a favorite stuffed animal to speak for him or her; it may be easier for a young child to talk with the animal, either alone or with an adult present, than to talk directly with an adult.
5. Evaluate the activity. Observe your child during and after the activity. What emotions did your child express during the activity? What emotions did your child express afterward? Talk with your child about these emotions. Let your child know that all feelings are normal. Clear up any misconceptions he or she has.

Practice one of the activities above in the presence of another adult. After the activity, ask the adult to evaluate the effectiveness of the activity for your child.

Now that you have read this information, you are ready to help a child who is grieving.

Talk with a health professional

If you have questions about this information, take it with you when you visit your health professional. You may want to use a highlighter to mark areas or make notes in the margins of the pages where you have questions.

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