Remembering Our Children

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The Grief Process at Different Ages

Siblings: Children and Grieving

Although grief is a process we all experience, children and teens tend to express their grief in unique ways that depend on their individual temperament and age. Children always benefit from consistency, and this is particularly true after a loss. Things may be tumultuous, but routine, structure, and reassurances help smooth the way.
There is no right or wrong way to help children deal with grief. However, by understanding how children of different ages understand what is happening and the behaviors that might result, it will be easier to talk and play with your child in ways that promote understanding and healing. Your words will help, but the most important thing is how you behave. Children need reassurance in the form of accepting love. By sharing your grief, you are the role model, anchor, and loving guide for your child in this journey. It can be difficult to do this at a time when you may be struggling to find your own way, but the following information might make the task a little less daunting.

The Grief Process at Different Ages
Preschool Age Children:
*For children this young, life and death are not concepts they can fully understand, but they will know the family routine is different.
*They might not respond to the death unless it is a primary caregiver.
*Behaviorally they might cry, display anger, cling, or withdraw.
What might help: Loving care, touching, cuddling, etc.

4 to 6 Year Olds:
*Grief reactions at this age often are misinterpreted because children may not on the surface, seem to be affected by the loss. This is not true. Children grieve through their play and imaginative expression.
*This age group frequently believes that death is temporary and can be reversed. You might hear things like, “My sister will come back from Heaven tomorrow.”
*Provide simple answers to their questions—try not to offer more information than asked for. Be clear and honest, and sensitive to the language used. Be prepared for unusual questions! Help them find words to express their feelings.
*Promote conversations about the loved one.
*Tears are good, don’t be in rush to stop them. Tears can help wash away grief.
*There may be more tears, anger, confusion, regression, guilt, fear of being alone, and changes in eating and sleeping patterns.
What might help: Reassure children they will be taken care of. Emphasize that they are
not to blame—nothing they said or thought caused the death. Hug and love
them.

6 to 9 Year Olds:
*This age group begins to understand the irreversibility of death, though they may try to keep the relationship alive.
*Behavioral reactions include: fearfulness, withdrawal, crying, panic, fear of dying, anger, changes in sleeping and eating patterns, belief that something they thought or did caused the death, sadness, and regression.
*This age group may over-estimate the power of their thoughts and wishes.
What might help: Provide reassurances that they are not to blame and that someone will take care of them. Give lots of hugs and provide explanations and answers to their questions. Encourage active participation in the family’s mourning and grieving. Explain that they will always have feelings, but they will not always be so intense all of the time.

9 to 11 Year Olds:
* At this age there is a more mature concept of death.
*Children at this age may believe that they caused the death because of something they said, thought, or wished.
* They often want details of what happened and why.
*They may seek reassurances about how things will be.
*Some children may have preoccupation with morbid thoughts.
*It is common that children at this age experience regression in cognitive thinking.
*Their behavioral reactions may include: anger, fear of death or personal harm, sadness, anxiety, dreams, regression, changes in eating and sleeping, crying, shock, aggression, and problems in school.
What might help: Provide comfort, support, and reassurance. Listen to what is being said and provide clear, honest explanations. Include the child in family discussions and decisions.

Adolescents:
*Most adolescents are cognitively able to understand that death is universal, inevitable, and irreversible, but still lack a total view of life.
*They may need support in understanding their emotions and how to verbalize their feelings.
*Adolescents can feel guilty about what they could have done to prevent the death.
*They may have increased awareness of parent’s feelings and vulnerabilities.
*Peer support and other supportive adults can be very important; parents need to encourage these interactions.
* Behavioral reactions may include: risk-taking activities, self-destructive behaviors, drug/alcohol use, anxiety, sadness, depression, isolation, changes in eating and sleeping patterns, fear, denial, suicidal thoughts, acting out, and withdrawal from peers and school.
What might help: Listen to their fears, thoughts, and concerns—have honest and open discussions. Provide comfort, support and reassurances. Include them in family discussions and decisions.

If you worry about how well your child is coping, below are some signs that indicate your child might benefit from outside help (from the American Academy of Child and Adolescent Psychiatry; No. 8 (9/89)):
*Inability to sleep, loss of appetite, prolonged fear of being alone.
*An extended period of depression in which the child loses interest in daily activities and events.
*Acting much younger for an extended period.
*Excessively imitating the dead person; repeated statements of wanting to join the dead person.
*Withdrawal from friends.
*Sharp drop in school performance or refusal to attend school.

Article contributed by Dr. Kate Eastman, Psy.D, LCSW and Dr. Elizabeth Samenfeld-Spect, MA, LCPC, LAMFT from The Jason Program, a pediatric palliative care program located in Maine. www.jasonprogram.org