Children and grief

Nancy McEntire

The death of a loved one is a part of the life cycle that brings grief to children as well as to adults. According to the 2000 U.S. Census, 4% of single parents had been widowed; 13.9% of these households included children under the age of 12 (U.S. Census Bureau, 2001). In addition to the death of a parent, many children may also experience the death of a grandparent, sibling, or friend. Parents and teachers can play an important role in helping children deal with loss. This Digest discusses psychological tasks that appear to be essential to children's adjustment, how children understand death and react to the death of a loved one, and how parents and teachers can help children cope with loss.

Children's 'tasks' during mourning
The Harvard Child Bereavement Study (HCBS), co-directed by J. W. Worden, interviewed and tested 125 children between the ages of 6 and 17 and their families. Standardized instruments, such as the Smilansky Death Questionnaire and the Child Behavior Checklist, as well as interviews, were used in this study. Of these children, 74% had lost a father, and 26% had lost a mother. A similar group of 70 children who had not suffered such bereavement were similarly studied. Worden distinguished among four tasks of mourning for these children: (1) accepting the reality of loss, (2) experiencing the pain or emotional aspects of loss, (3) adjusting to an environment in which the deceased is missing, and (4) relocating the person within one's life and finding ways to memorialize the person (Worden, 1996, pp. 13-15). Christian (1997), a professor of early childhood education who worked with families with AIDS, observes that, unlike adults, some children may not realize that they can survive without the deceased parent. Baker and Sedney (1996), based on clinical experience and interviews, list early tasks of bereavement for children including self-protection or the need for assurance that they will be safe and cared for. Understanding the death, another task, requires the provision of information to these children on how or why the death occurred. Some experts believe that vague abstractions may leave a child believing that deceased parents could return if they wanted to do so (Corr & Corr, 1996, pp. 120-121). As they mature, experts agree, children need to be able to ask questions about the death repeatedly and to work through their developing understanding of such a major event (Christian, 1997).

How do children understand death?
Experts suggest that understanding death involves comprehending the concepts of irreversibility, finality, inevitability, and causality (Corr & Corr, 1996). A study of 50 children between the ages of 7 and 12 years explored the understanding of these concepts as affected by variables such as age, experience, and cognitive development (Cuddy-Casey et al., 1997). Based on experience gained from being counselors at the New England Center for Loss and Transition, Emswiler and Emswiler (2000) concluded that prior to age 3, babies may sense an absence among those in their immediate world and miss a familiar person who is gone, but they are unlikely to understand the difference between a temporary absence and death. A preschool child may talk about death but may still expect the person to come back. The National Center for Victims of Crime (NCVC) has pulled together the work of several professionals who work with grief in children. This group theorizes that before age 5, most children do not realize that all people, including themselves, will die. By ages 9 or 10, however, most children have developed an understanding of death as final, irreversible, and inescapable (Worden, 1996, pp. 10-11; NCVC, 2003).

How do children react to the death of a loved one?
In the HCBS study of children ages 6 to 17 who had lost a parent, children reacted with sadness and tears to the news. In most cases, the crying subsided or lessened over time, although 13% of children still cried daily or weekly even after a year had passed (Worden, 1996). Tears often were triggered by the sight of others crying. Bereaved children also became anxious over the safety of other loved ones or themselves. Many children in this study expressed guilt about remembered misbehavior or missed opportunities to express affection (Worden, 1996). Parents and teachers may observe outbursts of anger and acting-out behavior among children who have lost a loved one. Somaticization (physical complaints without a disease or physical basis to account for them) increased during the first year after the death of a loved one in 13% of the children studied (Worden, 1996). The number of children experiencing serious illness during the first year increased but fell to match the percentage of nonbereaved children during the second year. A similar pattern was observed in the number of accidents experienced by bereaved children (Worden, 1996).

How can parents and carers help?
Shaw (1999), a specialist in bereavement, trauma, and loss, suggests that parents and caregivers explain death to children in simple, age-appropriate terms, and points out that vague euphemisms may be confusing and frightening. She suggests that the adults avoid trying to suppress the child's tears or expressions of grief, help the child put feelings into words, and provide honest answers to questions. Children can be given the choice to attend the funeral or other memorial services. If children choose to attend, parents can prepare them beforehand for what they may see and hear, including the grief others may show. Parents can also help children find ways to honor and remember the deceased. Parents may need to reassure children that it is all right for them to resume normal daily activities as well as to play and laugh again (Shaw, 1999).

How can teachers help?
Hogan (2002) suggests that teachers can ease a bereaved child's return to school by offering immediate sympathy to the child, attending the funeral, and talking to the class about the death before the child's return. The teacher can be sensitive to the possibility that activities related to family may make the child uncomfortable. Holidays often bring renewed sadness, and teachers can help children cope with these times of renewed sorrow. The teacher may also mention that others have lost a loved one, so that the child feels less alone and different. Children who have lost a family member can be reassured that in time they will be happy again and that it is appropriate for them to play and have fun.

Signs that a grieving child needs extra help
The American Academy of Child and Adolescent Psychiatry (1998) cautions parents and teachers that, although most children grieve less over time, counseling might be considered if children exhibit several of these behaviors over an extended period:

Depression so severe that a child shows little interest in daily activities
Inability to sleep, eat normally, or be alone
Regression in behavior to that of a less-mature child
Imitation of the deceased person
Repeatedly wishing to join the deceased
Loss of interest in friends or play
Refusal to attend school or a persistent and marked drop in school achievement

Conclusion
The death of a parent or loved one during childhood can have profound and lasting effects (Harris, 1995). Further research on the long-term effects of various interventions is needed. The literature suggests that although adults cannot shield children from the sorrow caused by the death of a loved one, they can guide and comfort them through the process of mourning.

Children's books on death and grief
Those who work with grieving children often use literature such as that recommended by Corr (2000) and others (Children's Books on Death and Dying, 1997). These recommended titles include the following books:

Adler, C. S. (1993). Daddy's Climbing Tree. New York: Clarion Books. A father is killed in a hit-and-run accident.
Anderson, Leone. (1979). It's O.K. to Cry. Illus. by Richard Wahl. Elgin, IL: Child's World. Two brothers grieve the death of an uncle.
Bartoli, Jennifer. (1975). Nonna. Illus. by Joan Drescher. New York: Harvey House. A family deals with a grandmother's death.
Jones, Penelope. (1981). Holding Together. New York: Bradbury Press. Sisters help each other through the illness and death of their mother.
Stiles, Norman. (1984). I'll Miss You, Mr. Hooper. Illus. by Joe Mathieu. New York: Random House. Big Bird mourns the death of Mr. Hooper. Contains notes for parents.
Viorst, Judith. (1971). The Tenth Good Thing about Barney. Illus. by Erik Blegvad. New York: Antheneum. A child learns about death through the loss of a pet.
Wolfelt, Alan. (2000). Healing Your Grieving Heart: 100 Practical Ideas for Kids. Ft. Collins, CO: Companion Press. Children 6-12 who have had a loved one die find ideas to help with the grief.

More information
American Academy of Child and Adolescent Psychiatry. (1998). CHILDREN AND GRIEF. Facts for Families Fact Sheet #8 [Online]. Available: http://www.aacap.org/publications/factsfam/grief.htm.
Baker, J. E., & Sedney, M. A. (1996). How bereaved children cope with loss: An overview. In C. A. Corr & D. M. Corr (Eds.), HANDBOOK OF CHILDHOOD DEATH AND BEREAVEMENT. New York: Springer.
CHILDREN'S BOOKS ON DEATH AND DYING. (1997). University Park: Pennsylvania State College of Agricultural Sciences. Available: http://www.penpages.psu.edu/penpages_reference/28507/28507 2304.html
Christian, L. G. (1997). Children and death. YOUNG CHILDREN, 52(4), 76-80. EJ 544 923.
Corr, C. A. (2000). Using books to help children and adolescents cope with death: Guidelines and bibliography. In K. J. Doka, LIVING WITH GRIEF (pp. 295-314). Washington, DC: Hospice Foundation of America. ED 438 948.
Corr, C. A., & Corr, D. M. (Eds.). (1996). HANDBOOK OF CHILDHOOD DEATH AND BEREAVEMENT. New York: Springer.
Cuddy-Casey, M., Orvaschel, H., & Sellers, A. H. (1997, August). A SCALE TO MEASURE THE DEVELOPMENT OF CHILDREN'S CONCEPTS OF DEATH. Paper presented at the annual meeting of the American Psychological Association, Chicago, IL. ED 414 532.
Doka, K. J. (Ed.). (2000). LIVING WITH GRIEF: CHILDREN, ADOLESCENTS, AND LOSS. Washington, DC: Hospice Foundation of America. ED 438 948.
Emswiler, M. A., & Emswiler, J. P. (2000). GUIDING YOUR CHILD THROUGH GRIEF. New York: Bantam Books.
Harris, M. (1995). THE LIFELONG IMPACT OF THE EARLY DEATH OF A MOTHER OR FATHER. New York: E.P. Dutton.
Hogan, N. (2002). Helping children cope with grief. FOCUS ON PRE-K & K, 15(1), 3-6.
National Center for Victims of Crime (NCVC). (2003). GRIEF: CHILDREN [Online]. Available: http://www.ncvc.org/gethelp/griefchildren/.
Shaw, H. (1999). Children and grief: How parents can help in times of loss. PARENT AND PRESCHOOLER NEWSLETTER, 14(2), 1-2.
Shriner, J. A. (1996). YOUNG CHILDREN'S UNDERSTANDING OF DEATH [Online]. Columbus: Ohio State University Extension. Available: http://ohioline.osu.edu/hyg-fact/5000/5165.html.
Thomason, N. D. (1999). “Our guinea pig is dead!": Young children cope with death. DIMENSIONS OF EARLY CHILDHOOD, 27(2), 26-29. EJ 584 450.
Tu, W. (1999). USING LITERATURE TO HELP CHILDREN COPE WITH PROBLEMS. ERIC Digest. Bloomington, IN: ERIC Clearinghouse on Reading, English, and Communication. ED 436 008.
U.S. Census Bureau. (2001). TABLE FG6. ONE-PARENT FAMILY GROUPS WITH OWN CHILDREN UNDER 18, BY MARITAL STATUS, AND RACE AND HISPANIC ORIGIN OF THE REFERENCE PERSON: MARCH 2000. Washington, DC: Author. Available: http://www.census. gov/population/socdemo/hh-fam/p20-537/2000/tabFG6.txt
Worden, J. W. (1996). CHILDREN AND GRIEF: WHEN A PARENT DIES. New York: Guilford. ED 405 133.

This feature is an ERIC Digest.