On Understanding and Helping Children Process Death

   Long before we realize it, children become aware of death.  They see dead birds, insects and animals lying by the road.  They may see death at least once a day on television.  They hear about it in fairy tales and act it out in play.  In reality, whether we as adults accept it or not, death is a part of everyday life and children, at some level, are aware of it.  The purpose of this paper is to help us as adults to be better informed of children's understandings of, and reactions to, death and to promote open and honest communication with children on the subject.

   Children can resolve losses as favorable as adults given the following conditions:

   1.  The child receives prompt and accurate information about what has happened and is allowed to ask questions and have them answered honestly.

   2.  The child participates in family grieving, and;

   3.  The child has the comforting presence of a parent or adult whom she trusts and an rely on in a continuing relationship.

    Many of us are inclined not to talk about things that upset us.  We try to put a lid on our feelings and hope that saying nothing will be for the best.  But not talking about something doesn't mean we are not communicating.  Children are great observers.  They read messages on our faces and in the way we walk or hold our hands.  We express ourselves by what we do, by what we say and, by what we do not do or say.

    When we avoid talking about something that is obviously upsetting, children often hesitate to bring up the subject or ask questions about it.  to a child, avoidance can be a message-- "if Mom and Dad can't talk about it, it must really be bad so I won't talk about it either".  In effect, instead of protecting our children by avoiding talk, we sometimes cause them more worry and also keep them from telling us what they think or how they feel.

    On the other hand, it isn't wise to confront children with information that they may not yet understand or want to know.  As with any sensitive subject, we must seek a delicate balance that encourages a child to communicate.  This balance involves:

    1.  Being sensitive to the child's readiness to communicate.

    2.  Providing brief and sensitive answers that are appropriate to the child's questions, answers that they can understand and that do not overwhelm them with too many words.

    3.  Listening to, accepting, and responding to the child's feelings.

    4.  Offering children honest explanations.

    5.  Not putting up barriers which may inhibit the child's attempt to communicate; for example, not putting off questions by telling them they're too young.

    6.  Examining our own feelings and beliefs so that we can talk as naturally as possible and appropriately share and model our feelings with children--even the upsetting ones--when the opportunity and time are appropriate.

     As adults do, children live in the world of their experiences.  As such, the most appropriate time to talk about death is when it is part of their experience.  The proper mood of communications, again, should be one of openness and honesty.  The important consideration for the adult in communication is that the child's feelings and experiences are quite different from his own and have to be judged accordingly.  The adult can then share life as far as it can be shared in understanding and give security to the child's life and love can be protected and nourished even in times of emotional stress and painful events.

    Each child is a unique individual.  Growing up is a unique individual experience.  When an event like death occurs, the child reacts in his own unique way.  He may act uninterested and unconcerned.  Or, he may seem over-whelmed.  His reactions may be very spontaneous and intense at one moment and then be placed on hold--"it's time to play now"--the next.  Whatever his attitude, it is the child's unique way of expressing herself and her feelings.  Any interpretation of the child's understanding of and reaction to death, has to be geared to the unique developmental characteristics, as well as, the psychological, social, spiritual and cultural background of the child.

    At the same time, however, studies show that children go through a series of stages in their understanding of and reactions to death.  The understanding and reactions which present at these stages are felt to be very normal and appropriate to the child's developmental level and his process of grief work. The chronological ages provided in framing these stages are meant to be general rather than specific.  Again, the child's unique developmental pace, his personal experiences, especially with death, as well as, the attitudes and explanations offered to the child by adults will temper his understanding and reactions to the reality of death.

    What follows is a very general listing of a child's typical understanding of, and normal responses to, death at the different developmental levels.  Also included are some adult response suggestions which may be helpful in facilitating the child's grief work.

UNDER AGE TWO

• No formal concept of death.

• Perception of differences between sleeping and waking may represent early development of appreciation of "being" and "non-being".

• Infants react emotionally to the loss of a significant person, especially a mother figure.

• At the later end of this period, death is thought to be understood as a separation from parents and the loss of parental comfort.

• Irritability, anger, anxiety, nervousness, physical problems and withdrawal may be seen.

• Infants and early toddlers live in the world of senses, feelings and immediate actions.  They need warmth and reassurances in simple and direct form; for example, being held, having a consistent care person and maintaining a routine - e.g. reading books, singing songs - are helpful responses tot he infant/toddlers needs.

 AGES THREE TO FIVE

• The child at this age is the center of his/her universe.  He is omnipotent.  His thoughts, feelings, wishes and actions can cause what happens to people.  As such, there is a heightened risk for inaccurate perception and confused understanding of situations and events.  Feelings of guilt can result.
• This is the age of "Magical Thinking".  Death is seen as a temporary departure of absence and, hence, reversible.  The child may exhibit thoughts that indicate she believe it is possible to come back to life.
• At the end of this period, there is an appreciation of removal from one kind of existence to another, for example, one becomes an angel when one dies.  At the earlier end of this stage, however, such abstractions are troublesome.
• The child may have a very matter of fact orientation.  Again, death is reversible and temporary.
• The dean have qualities of attributes of the living (e.g. community of dead underground).
• Sadness.
• The child can process grief well if supported and allowed to grieve.
• Bewilderment.  The child may have difficulty processing changes in relationships.
• Escape into play.
• Regression.
• Increased aggression.
• Attaches to substitute people.
• Can idealize loved one.
• Can show anger toward dead person as well as surviving adults.
• Confused by euphemisms (e.g. "going to sleep", we "lost" grandmom).  Children at this age tend to accept the literal meaning of words.
• To protect themselves, children may react to a less significant loss with more outward grief than to a loss of a very significant person.
• Behavioral reactions such as giggling, joking, and attracting attention may indicate the child's need to distance himself from his pain over the loss.
• Children need adult time and compassion.  Use real terms.  Repeat.  Clarify.  Ask the child her understanding if she show the desire to communicate.  Listen to words and feelings.

AGES SIX TO EIGHT YEARS

•  Much of what pertains to the pre-school age period also pertains to children in this age group.  However, these children have a deeper understanding of death in the concrete sense.  They attempt to ascribe a more comprehensible meaning to the event by personifying death as a "devil", "God", "ghost", or "bogeyman".
• They still associate misdeeds or bad thoughts with causing death and can feel intense guilt and responsibility for the event.  However, because of their higher cognitive abilities, they respond well to logical explanations and can comprehend the figurative meaning of words more than younger children.  It is still important for adults, however, to clarify the meaning of statements and to repeatedly ask the child what they think.
• Death is associated with grief for anticipated (or actual) separations from a loved one.
• Death is associated with fear when seen as punishment for wrong acts.
• Death is seen as accidental.  It is caused by something "outside" happening to someone else.  It is not a natural live-cycle event.
• Children at this age are beginning to conceive the finality of death, but their understanding remains incomplete.
• Children may develop a fantasy relationship with the dead person in an attempt to keep them alive.
• Due to feelings of "helplessness" and "lack of control" children may act our either behaviorally or verbally in an attempt to defend against the insecurities which arise with their increasing comprehension of the realities of death.
• Children may engage in compulsive care giving activities and attempt to be perfect to compensate for guilt feelings.
• Children may identify with the dead person - try to be like them - as a way of keeping them alive.
• The meaning of death begins to take on a more social dimension during this age.  Concerns about the consequences of death on the lives of the living arise.  Children may be overly concerned about their parents health and well-being at this age.

AGES NINE TO TWELVE

• Through this time, children are developing the understanding of death as irreversible, universal and persona.  In the beginning, death can neither be denied nor accepted.  During the earlier latency years, there is more of an interest in the tasks of living.  The concept of death develops from the concept of life.  by the end of this period, having developed the intellectual concepts of time, causality and space, death is seen with a near adult understanding.
• School-aged children have fears of mutilation and personal injury.  They may externalize these by focusing on the "gruesome" details of dying and death.  Externalizing equals control.
• This aged child may have an interest in post death services, such as wakes, funerals and burials.  Again, these are attempts to establish control.
• Abstractions such as heaven are still somewhat uncertain but, less difficult.
• Children at this age may want adults to bring up the subject as death's gravity is frightening to them and, also, they worry about, and may want to avoid upsetting their parental figures.
• Disturbances in sleep, school work and friendships, increasing anxiety and distress, regression and irritability may all surface as the child becomes aware of her own mortality and the mortality of her loved ones.  She is now capable of projecting into the future.
• In a protective manner, children may show a delayed reaction to loss.
• The child may develop phobic reaction/fear of death.
• Children at the later end of this stage are developing a fragile independence.  They may not open up to parents or be desperate to discuss their feelings.  a teacher, friend or another "outsider" may be the best resource for the child.
• Allow grief to ebb and flow; expect and allow problems; examine the why rather than the details of a behavior -  sadness, anger, fright, loneliness, guilt and even happiness are normal reactions to loss.  Respond with patience and compassion; set rules (e.g. can be angry, but, can't be destructive in actions); differentiate between appropriate feelings/ fears and inappropriate behaviors.  Don't say don't but, show behavioral alternatives.

ADOLESCENCE:  AGES THIRTEEN TO EIGHTEEN

• Death comes to be recognized as a final and irrevocable biological event; yet, due to adolescent egocentricity, it is accompanied by disbelief in the possibility of one's personal death.
• Adolescents are still influenced by remnants of magical thinking and are subject to feelings of guilt and shame.
• Adolescents can have much difficulty in coping with death.  While having an adult understanding, they are least likely to accept the cessation of life, particularly their own.  Their rejection of death is understandable developmentally because the adolescents' tasks are to establish an identity by finding out who they are, what their purpose is, and where they belong.  Any suggestions of being different or non-being is a tremendous threat to the answer to such questions.
• Adolescents strive for group acceptance and independence from parental constraints.  As a result, they rely on peer rules and beliefs for personal direction and reject opposing parental demands.  Should they feel isolate from the peer group because "death" has made them "different", they may feel and be very alone.
• Adolescents' reactions to death straddle the transition from childhood to adulthood.  While some teenagers are able to cope with death by expressing appropriate emotions, talking about loss and resolving their grief, others may appear undisturbed by the event, extremely angry or unusually silent and withdrawn.  Denial, delayed reaction, the repression of feelings, depression and somatic symptoms are not uncommon when death enters the adolescents lifespace.
• Interactions with adolescents should be structured to allow for a sense of self control and independence.  They should convey to the adolescent the adults true concern for their physical and emotional welfare.
• Adolescent questions should be answered honestly, treating them as mature individuals, and respecting their needs for privacy, solitude and personal expressions of emotions such as anger, sadness and fear.
• Adolescence may move from non-acceptance to acceptance.  Most, eventually find talking helpful.  some work through their loss by engaging in care giving behaviors.
• Adolescents lack the experience if the adult world.  The adult can offer the adolescent his most constructive encounters with death.  In turn, the adult can receive the advantages of the youths fresh quest for understanding.
• Provide the adolescent with space, availability and support, honesty and openness, genuineness and love.

  Written by Martin John Lawson, MSW, Grand View Hospital, Sellersville, PA for the Crossroads Program.