How to Talk to Children About Death After the Loss of a Loved One

By Bianka Soria-Olmos, D.O.

The last few weeks have been hard, to say the least. Although the new year brought hope that we would begin to look to a “return to normal” after one year of the COVID-19 pandemic, things haven’t felt so positive. It is only natural to yearn for what once was - allowing my kids to participate in group sports without the worries. To do in-person learning without the fear that we will receive an email indicating our child was exposed to the virus, and to go on a dinner date with my husband (to make up for the canceled date from last year as the lockdown and worries began).

In the last few weeks, losing my own grandmother to COVID-19 reminded me of all the families that have experienced a loss of a loved one in the last year. Although this happens routinely as part of the cycle of human life, I am reminded that there has been “extra” loss of life, and likely many more families impacted by loss than would have occurred otherwise.

The loss of a loved one is experienced at different stages for most. A difficult part of this process sometimes goes unnoticed but is worth highlighting. Being a parent and responsible with the difficult task of explaining death to a child in a way that is developmentally appropriate is not easy.

The best way to approach this situation is to be aware of how children understand death and this will help you pick the right thing to say. It’s important to remember that even young children who don't understand death will react to grieving parents. Older children will themselves grieve. Parents should support their children through this process in order to resume their lives without significant distress or interruption.

Children have a different understanding of the finality of death. Your approach to discussing death will depend on your child's level of understanding of four main concepts of death:

• Irreversibility (i.e., death is permanent)
• Finality (i.e., all functioning stops with death)
• Inevitability (i.e., death is universal for all living things)
• Causality (i.e., causes of death)

Babies and Toddlers

Infants and toddlers do not understand death but do sense what a caregiver may be experiencing. It is important to take care of yourself and progress through your own grief while maintaining routines that will help foster healthy progress through the life event.

Preschoolers

Preschoolers see death as temporary. They are concrete thinkers and usually see things for what they appear and hearing things literally. It is important to avoid euphemisms like, "She has gone to sleep," or "…traveled to the great beyond." Children at this age cannot understand these phrases and can sometimes even generate fears about traveling or sleeping. Be prepared for this age child to ask again and again where the deceased is and or when they will come back. Always answer with a clear message, which of course can be softened with the mention that the memories will remain. At this stage, children typically have a hard time talking about what they feel and their fears may come out at unexpected times such as during play.

School Age

School-age children begin to understand death as a final event but can have difficulties understanding it is universal. Make sure to offer clear, simple, and honest explanations about what happened and allow them to ask questions. Help them when they have difficulties finding the right words to explain their feelings. At this age, they may not understand the causality of death and they may personify death. Sometimes at this age, they may worry they will be left alone and begin to think about the death of a significant caretaker. Things that are important to do at this point include:

• Remind your child that not everyone who gets sick will die.
• Reassure them of your health.
• Let them know how many people in their life care for them.
• Support children to do things to reduce their anxiety and be sensitive that they may not want to talk or think about the deceased because it is too painful.
• Take care of yourself and make sure you have support.

Adolescents

Adolescents understand death the way adults do but can have difficulties or be resistant to expressing their feelings. They begin to think abstractly and this can cause some difficulties which can lead to risky behavior or even guilt about being alive. Supporting teenagers in finding healthy ways to express their feelings is very important.

Being aware of normal responses to death, as well as signs that they may need professional help, is an important part of supporting the grieving child. Younger children can revert to immature behaviors or angry outbursts. These typically are a result of unexpressed emotions such as frustrations or confusion. In school-age children, difficulties concentrating, sleeping, or physical complaints including stomachaches and headaches can occur. Teens often experience a wide range of emotions including sadness, anger, guilt, and helplessness. Teens may either withdraw or do the opposite, and engage in risky behavior.

This time is difficult for the entire family and it is important to take the time for yourself to deal with the grief. Kids of any age can sense the emotions of a caretaker and respond accordingly. If you ever have a concern that the child is experiencing extreme symptoms and/or the symptoms of grief are not resolving, ask your child’s pediatrician for help.