Children's Understanding of Death

Children's understanding of Death is provided by Hospice of Southeastern Connecticut Bereavement Program. This chart is meant to be used as a guideline and not a checklist. All children develop at different rates and it is important to remember that the parents know their own child the best.

E-mail me, attention, Jay Mihalko, your comments and ideas on this area to: sidsnet1-at-sids-network-dot-org

Newborn to Three Years

Child's Perception: Infant/Toddler can sense when there is excitement, sadness, anxiety in the home; can sense when a significant person is missing, presence of new people

1. No understanding of death
   
2. Absorbs emotions of others around her/him
   
3. May show signs of irritability
   
4. May exhibit changes in eating, nursing patterns, crying, and in bowel and bladder movements
   
5. Depends on nonverbal communications; physical care, affection, reassurances

Providing Support:

1. Keep normal routines and structure whenever possible
   
2. Be verbally and physically affectionate and reassuring
   
3. Provide warm, loving caretaker when parent is not available
   
4. Exhibiting healthy coping behaviors

Three to Six Years

Child's Perception: Child thinks death is reversible; temporary, like going to sleep or when a parent goes to work; believes that people who die will come back

1. "Magical thinking"; believes their thoughts, actions, word caused the death; or can bring
   deceased back; death is punishment for bad behavior
   
2. Still greatly impacted by parent's emotional state
   
3. Has difficulty handling abstract concepts such as heaven
   
4. Regressive behaviors; bed wetting, security blanket, thumb sucking, etc.
   
5. Difficulty verbalizing therefore acts out feelings
   
6. Increased aggression - more irritable, aggressive play
   
7. Will ask the same questions repeatedly in efforts to begin making sense of loss
   
8. Only capable of showing sadness for short periods of time
   
9. Escapes into play
   
10. Somatic symptoms
    
11. Hungers for affection and physical contact, even from strangers
    
12. Connects events that don't belong connected
    
13. May exhibit little anxiety due to belief that deceased is coming back

Providing Support:

1. Keep normal routines and structure whenever possible
   
2. Provide opportunities to play, draw
   
3. Read books on death & loss with child
   
4. Help to verbalize feelings and fears
   
5. Help to identify feelings and reactions
   
6. Be honest and tell a child if you do not have an answer
   
7. Explain in specific, concrete language - not euphemisms; explain what has happened
   giving specific explanations about physical reality of death
   
8. Gently confront magical thinking
   
9. Make sure child does not feel responsible for the death
   
10. Be tolerant of regressive behaviors
    
11. Modeling healthy coping behaviors
    
12. Avoid clichés; "At least you have another brother", "You can always get a new pet"
    
13. Use specific, concrete words - not euphemisms; Avoid "Mommy has gone to sleep", "God has taken Grandpa"

Six to Nine Years

Child's Perception: Child begins to understand the finality of death; some do and some may not

1. Sees death as a taker or spirit that comes and gets you
   
2. Fear that death is contagious and other loved ones will "catch it" and die too
   
3. Fascinated with issues of mutilation; very curious about what body looks like
   
4. Connects death with violence and may ask, "who killed him?"
   
5. 3 categories of people. who die: Elderly, handicapped, klutzes
   
6. Asks concrete questions
   
7. Guilt - blames self for death
   
8. May worry how the deceased can eat, breathe, etc.
   
9. Continues to have difficulty expressing feelings verbally
   
10. Increased aggression
    
11. Defends against feeling helpless
    
12. Somatic symptoms
    
13. School phobia (especially if single parent)
    
14. Continues to have difficulty comprehending abstractions such as heaven, spirituality

Providing Support:

1. Talk with child
   
2. Ask questions
   
3. Make sure child' does not feel responsible in any way
   
4. Identify specific fears
   
5. Provide opportunity for play, drawing, art
   
6. Normalize feelings & fears
   
7. Address distortions & perceptions
   
8. Be honest and tell a child if you do not have an answer
   
9. Help to cope with impulse control
   
10. Help them share bad dreams
    
11. Help them with positive memories of the deceased
    
12. Model healthy coping behaviors
    
13. Avoid clichés; "Don't worry, things will be O.K.", "You're such a strong boy/girl"
    
14. Use specific, concrete words - not euphemisms; Avoid "Grandma went to sleep and is
    now in heaven", "Grandma was very sick and the sickness made her die"

Nine to Thirteen Years

Child's Perception: Child's understanding is nearer to adult understanding of death; more aware of finality of death and impact the death has on them

1. Concerned with how their world will change; with the loss of the relationship, " Who will
   go with me to the father-daughter banquet?"
   
2. Questions have stopped
   
3. Fragile independence
   
4. Reluctant to open up
   
5. Delayed reactions - at first seems as if nothing has happened, then grief reaction
   May show strong degree of affect
   
6. Beginning to develop an interest in rituals (spiritual affects of life)
   
7. Disrupted relationships with peers
   
8. Increased anger, guilt
   
9. Somatic symptoms
   
10. School phobia
    
11. Self conscious about their fears (of own death, remaining parents)

Providing Support:

1. Encourage discussion of their concerns
   
2. Provide & encourage expressive experiences such as writing or drawing
   
3. Address impulse toward acting out and allow opportunity to identify their feelings
   
4. Allow for regressive behaviors
   
5. Be honest and tell a child when you do not have an answer
   
6. Gently relieve child from attempts to take over adult responsibilities
   
7. Model healthy coping behaviors
   
8. Avoid clichés; Avoid "You must be strong so I don't have to worry about you", "Big boy's don't cry"

Thirteen to Eighteen Years

Adolescent's Perception: Adolescent has adult understanding about death

1. Death is viewed as an interruption. Death is an enemy
   
2. Bodily changes emphasize growth and life. Death is a contrast
   
3. Increased vulnerability due to many other changes and losses simultaneously occurring
   
4. A sense of future becomes part of their psychology
   
5. Increased risk taking in effort to reduce anxiety or to defy fate
   
6. May intellectualize or romanticize death
   
7. May act indifferent to death of someone close as a protection against feelings
   
8. May show full range of affect or almost no affect
   
9. Wants to grieve with her/his peers not adults
   
10. May need permission to grieve
    
11. Suicidal thoughts
    
12. Represses sadness, feels anger, depression
    
13. Escapes; drives fast, uses drugs or alcohol sexually acts out
    
14. Denial - tries not to think about it, doesn't want to talk about it
    
15. Difficulty with long term plans
    
16. Somatic symptoms
    
17. Questions religious/spiritual beliefs

Providing Support:

1. Don't assume they can handle themselves and their problems without help, support
   
2. Be available, but don't push
   
3. Help them find peers who will support their feelings
   
4. Or find other trusted adults
   
5. Give permission for regression
   
6. Be honest and say when you do not have an answer
   
7. Assist in relieving adolescent of burden of adult responsibilities
   
8. Help impulse control toward reckless behavior
   
9. De-romanticize death
   
10. Discuss feelings of helplessness
    
11. Model healthy coping behaviors
    
12. Avoid clichés; "You've got to be strong to help your mother"; "You seem to be taking this so well", "Now you're the man of the house"

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