discussing death with childrenDefinition
Death is an inevitable part of life. While many people are uncomfortable talking about this, especially to children, everyone must one day learn to handle death.
A person can help a child deal with a death by talking with the child and listening to fears, worries, and concerns. Because a child's age and level of maturity affect how death is viewed, any discussion of death can be tailored accordingly.
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Years ago, death was an inescapable part of life. Even very ill people were cared for at home by family members. Most deaths occurred at home. Today, older people often live apart from their families in nursing homes or retirement communities. Usually, deaths no longer occur at home, but rather in hospitals, nursing homes, or extended-care facilities. One result of this is that many people do not know how to talk to children about death. Many even wonder if such a discussion should take happen at all.
When a death occurs in a family, children need help from their parents and other caregivers to make sense of it. Allowing a child to verbalise concerns, thoughts, fears, and questions will help in the grieving process. A child's ability to understand death varies according to his or her developmental age. The child's understanding of death changes and becomes more realistic as he or she progresses through the normal stages of development.
Infants and toddlers up to 3 years old have no real understanding of death. They react behaviourally to changes in routines and the emotional responses of adults who are grieving over a death. They may experience separation anxiety if away from their usual caregivers, who may be preoccupied and busy with hospital visits or funeral arrangements.
Children 3 to 5 years old do not distinguish between fantasy and reality. They see death as temporary and reversible. Often, they talk as though the deceased person is only gone for a while and is likely to come back soon. Children this age are egocentric and see themselves as the centre of their world. They may believe that they somehow caused the death or view it as a punishment. They may think of death as contagious and worry that they or their parents might die, too. Before they can understand an explanation, they may need to hear it a number of times. Answers to questions need to be brief, simple, and repeated when necessary. If feelings of guilt are expressed, the child should be reassured that he or she did not cause the person to die.
Children 6 to 10 years old believe death is real and permanent. But they cannot yet comprehend their own mortality. Children this age may view death as a violent thing. They may not accept that death could happen to them or anyone they know, although they are starting to realise that people they know will die.
Children 11 to 13 years old begin to understand death as real, final, and universal. They start to grasp that death could happen to them or their family members. This may be the root of the separation anxiety and school phobia that some children show at this age. As they start to develop a more realistic understanding of their world, the biological aspects of illness and death and details of the funeral may interest them. Children this age may see death as a punishment for poor behaviour. They also may worry about who will care for them if a parent or caregiver dies. They need reassurance that they will continue to be cared for and loved.
As adolescents 14 to 18 years old mature, they think more abstractly. Children this age come to a more mature, adult stage in understanding death. They see that the ageing process leads to death and may view death as an enemy. Despite this, adolescence is marked by risk-taking behaviour that seems to deny the teenager's own mortality. At this age, children need someone to use as a sounding board for their emotions.
It is not unusual for adults to feel they should protect younger children from the reality of a loved one's death. An adult may tend to go along with a child's fantasy that the deceased is "sleeping" or "on a long journey." But such explanations may confuse and even frighten a child who is trying to understand the death of a loved one.
When talking to children about death, parents and other adults should keep the following information in mind:
If a family member is seriously ill or dying in a hospital or nursing home, children should be encouraged to visit. Visiting may help keep them from feeling isolated. It may also help dispel frightful fantasies they might have about the hospital or nursing home. Often, such fantasies are worse than reality.
- Explanations and words should be tailored to the child's developmental level. Explanations should be direct, simple, and honest. Words such as "dead" and "death" should be used and discussed.
- Children often need to talk again about issues relating to the death of a loved one in the past. As children mature and reach new developmental stages, their thought process becomes more sophisticated. They may want to "rework" a death to integrate it at their new level of understanding.
- Parents should think twice about the desire to protect a child from their own grief. A parent may feel that somehow the child "will not be able to handle it." Often these perceptions have more to deal with the adult's difficulty in dealing with grief. It is important for the child to be able to ask questions about death and the grieving process, such as "Why is mummy crying?" or "Will I ever see Grandpa again?" The child should receive honest, factual answers. "mummy is feeling very sad that Grandpa has died." "No, Grandpa has died and will never come back, but we can continue to keep him in our memories." This helps the child clearly understand what is going on and aids his or her own grieving process.
- It is important to realise that children need to grieve, too. Shielding them from the reality of death merely delays their understanding of it. It may also slow down the healthy resolution of a significant loss in their lives.
Children 7 years old or older should be encouraged to attend the funeral and take part in family mourning. However, they should not be forced to do so. The family should use good judgement about whether it is appropriate for younger children to attend. If a younger child does not attend the funeral, a means of saying good-bye should be offered, such as a visit to the grave.
Although parents may be wrapped up in their own grief and busy with funeral arrangements, they should try to find time to spend with their children. A parent should clarify with a child what is going on, reassure them that they and the family are okay, and stick to routines as much as possible. Children should be told in advance of changes in routines, separation from parents, or expectations that they will participate in family mourning.
Bereavement affects children in special ways. Because of the intense personal involvement and implications, dealing with death is difficult for children and adults alike. Accepting the death of a loved one takes a long time, usually months to years. It is important to support family members in their grieving. Eventually, this helps people to reach a healthy resolution.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 31/1/2005
Potential conflict of interest information for reviewers available on request