Death and Dying
The death of a loved one is a time of powerful emotional upheaval. Infants, children, adolescents and parents all sense that power and respond in different, highly personal ways. Achild’s understanding of death and expression of grief are influenced by his developmental level, his experiences with death, and the family’s cultural and religious beliefs.
Children younger than 2 years of age are in a “sensorineural” stage, meaning they use their senses and developing motor skills to learn about the world. They are able to express feelings through their behavior. Although children this age do not understand death, they can sense both separation and the emotions of those around them who are experiencing loss. Children may withdraw, decrease their activity, responsiveness, or appetite or may become irritable.
Children aged 2 to 6 are in a “preoperation” stage; they may start to understand the concept of death but do not yet have the capability to think logically. They may initially use the word “dead” to mean “not alive.” They may confuse death with sleep or being away, and believe that death is temporary. They may wonder if the dead can still participate in normal activities (Does Rover still eat?) They sense the sorrow of others and respond by mimicking crying or being consoled. Because children in this stage lack full understanding of what can cause death and that death is irreversible, they may use magical thinking or ask specific questions for which there are no real answers.
Magical thinking is the belief that thoughts can cause actions. Such thinking may lead to guilt or fear. If your child appears to be wondering what caused the death, and his potential role in it, it is important to provide reassurance with simple, straightforward explanations directed at correcting misconceptions.
The specific questions children ask stem from their intense curiosity about death, even when they have not personally experienced the death of someone they know and love. Some children may ask repeatedly when a deceased loved one is coming back. These questions are part of the struggle for consistency and understanding of the permanence of death.
As children move into the concrete operational stage around age 6, they develop logical thinking about the physical world and become more verbally communicative about their thoughts. Occasionally a child will develop an almost morbid interest in dead things, the symbols of death, and the biological aspects of death. By this age, children realize death is final. They may have heightened behavioral reactions such as school phobias, hypochondriacal concerns, aggressive and destructive behaviors, withdrawal or separation anxiety. Throughout this stage, children move from thinking that death only happens to “others” (especially older people) to an awareness that they, too, will die. By the age of 9 or 10, children’s use of the word “dead” approximates adult understanding of the term as final, universal, and potentially happening to them.
Adult understanding of death can be described as four major concepts: irreversibility, nonfunctionality, universality, and causality. Irreversibility is the understanding that death is permanent and is a necessary concept for detaching from the deceased and mourning to occur. Nonfunctionality is the realization that life-defining body functions cease on death. Difficulty grasping this concept may lead to a preoccupation with the physical suffering of the deceased. Causality relates to things dying as a result of physiologic malfunctions, and universality is the understanding that all living things die. If children do not comprehend these concepts, they may rely on magical thinking, view death as punishment, or develop excessive guilt.
As children enter the teenage years, and the formal operational stage of development, abstract thinking allows them to question the existential implications of death. The grieving teen often asks the question “why not me?” in an attempt to reconcile the death of a loved one or friend. Teens may also attempt to confront or deny death as if it were an adversary. As such, high-risk behavior that “challenges mortality” may occur as the egocentric teen thinks about the unlikelihood of his or her own death.
Parents often want to “protect” their children from the pain and suffering of loss. This is well-intended, but may prevent the child form communicating and processing their own grief. Some children may want to be more involved than others- there is no right or wrong answer. Offer the child age-appropriate means of being involved in the rites of death, such as writing a letter to a deceased grandparent, and allow them to participate or decline. Regardless of the child’s level of interaction, they sense the changes occurring around them. It is important to maintain as much of the child’s regular routine as possible (bedtime, regular meals, school.)
Questions about children’s attendance at funerals are common, and again, there s no right or wrong answer. Children can be given the option of attending services, but this should be an informed decision, made after receiving information about what they may see or hear. When children attend a service, make sure a supportive, familiar person is available to answer questions, hug them, or take them out of the service if necessary for distraction.
Regardless of funeral attendance, it is important to include children in commemorating and memorializing the loss. Include children in the sorting and saving of possessions- an opportunity to remember, use the deceased person’s name, recall happy times, and remember disappointments. Being able to cope actively and find something positive even in difficult situations helps children adjust.
Psychiatrist Kubler-Ross introduced the concept of stages of grief- denial, anger, bargaining, depression, and acceptance. These states can occur in any order and frequently recur many times as an individual moves toward acceptance of the inevitability of death. Grief is an ongoing process, continues across development, and may occur in “waves.” Children within the same family or of similar ages may have different styles of grieving, and grieving parents may be experiencing overwhelming grief themselves, making it difficult to support and help their child/children. If this is your experience, do not hesitate in asking your pediatrician for help.
Suggested Reading and Websites:
www.nylgriefguide.com/exchange_default.asp (a booklet to help adults help a grieving child)
Book Recommendations for Death and Grieving:
When someone VERY Special Dies, Marge Heegard
Remembering Crystal, Sebastian Loth
The 10th Great Thing About Barney, Judith Viorst
Freddie the Leaf, Leo Buscaglia
The Invisible String, Patrice Karst
When a pet dies: www.aacap.org/cs/root/facts_for_families/when_a_pet_dies
Explaining to children the passing of a pet:
Helping an autistic child understand the death of a loved one: www.autism.org.uk/living-with-autism/at-home/death-bereavement-and-autism-spectrum-disorders.aspx