Oct. 24, 2001 -- Although it is not uncommon for people of any age to be faced with the death of a loved one, kids cope with grief differently than adults and need help from parents and pediatricians to understand and come to terms with death and dying.
When they lose a loved one, adults often start feeling the effects right away. Children, however, typically have delayed reactions that may begin with shock or denial and evolve over weeks or months into sadness and anger. Like adults, the grief process should end with acceptance and return to normal activities, but for children, it can be a long process.
Since parents often turn to pediatricians for advice when a family member or other loved one dies, doctors should evaluate the child's responses and tailor the explanations about death and dying to concepts that are appropriate for the child's age, Mark L. Wolraich, MD, tells WebMD. Wolraich is the past chairman of the American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health.
"One has to be aware of the developmental level of the child," says Wolraich, who is also professor of pediatrics and director of the division of child development at Vanderbilt University, in Nashville, Tenn. "An explanation of death has to be geared to what their developmental level in terms of understanding is going to be." Here are some age-related things to keep in mind:
- Very young children under 2 have little understanding of death and may perceive it as separation or abandonment.
- Children 2 to 6 are likely to think of death as temporary or reversible, often viewing it as a punishment and thinking they can wish the person back to life.
- Between ages 6 and 11, children gradually become aware of the finality of death but have difficulty understanding that everyone, including themselves, eventually dies.
- After age 11, most children have developed higher reasoning that helps them understand that death is irreversible, universal, and inevitable and that all people, including themselves, must eventually die at some time, although they tend to view that time as far off in the future.
Parents also need to be reassured that a child's anger and displays of emotion are normal and are part of the grieving process. Parents also should be encouraged to continue with family routines and discipline and to assure a child that he or she did not cause the death, nor could the child have prevented it.
Parents should consult with their child's pediatrician if grief is prolonged and may be referred for counseling if necessary. Signs of inappropriate grief include avoidance of feelings, repeated crying spells, suicidal thoughts, social withdrawal, and decline in school performance.
Although the events surrounding the death of a loved one can be traumatic for people of any age, funeral or memorial services may help children understand the finality of death. However, the pediatrics committee advises that if a child is going to attend or participate in such services, they should be prepared beforehand about what to expect. If it is clear that they may be upset by the experience, they should be given the option of not going.
Wolraich says while cultural traditions and family wishes should be respected, it is generally recommended that children under 5 or 6 not attend wakes or funerals. However, children of all ages should be encouraged to commemorate the loss in some manner, such as drawing pictures or planting a tree in the individual's memory.
To aid the grieving process, child psychology experts recommend the following books:
- The Dead Bird, by Margaret Wise-Brown (for ages 3 to 5);
- When Dinosaurs Die: A Guide to Understanding Death, by Laurene Krasny Brown and Marc Brown (for ages 4 to 8);
- The Magic Moth, by Virginia Lee (for ages 10 to 12);
- Beat the Turtle Drum, by Constance C. Greene (for ages 10 to 14).