Handbook for Mortals : Enduring Loss : Children’s understanding of death

If few of us know how to honor grief with an adult, or to handle our own losses, how much harder it is to help a child through the process. Children do grieve, deeply and over time. Their experience and expression of grief may be different from an adult's, but it will be no less painful or severe. Like adults, children benefit from attention and love. They may need solitude and companionship, someone to talk to, and someone to cry with. Sharing the reality of what is happening allows children to begin to understand, to cope with, and to integrate the experience of loss into their lives.

What to expect and how to help

Maturity, of course, does not happen according to fixed age categories. Each child has his or her own timetable.

Within the first year of life, the infant is able to feel separation and a sense of loss. Creating a warm, safe environment, physical support, holding, hugging, rocking, and reassurances of personal safety ("We’ll be here to take care of you.") counteract the confusion and restore some security.

The preschool child, two to five years old, thinks death is temporary and reversible, something like a round trip. "Mommy is dead and will be coming home soon." Death (and illness) may be seen as contagious but also avoidable. Children imagine bogeymen, angels, skeletons, and devils that might take away bad people or those who are too old or too sick or too slow to outrun or outsmart death.

The school-age child observes death as the end of bodily life, final and universal. Even though older children and adolescents know it can happen to them, they believe it to be the remotest of possibilities and are prone to challenges and risk-taking behaviors. Children who "grow up with the loss" ordinarily re-examine and re-integrate that loss at each developmental level. When the loss is significant, the grown person will often still revisit her loss at significant milestones in life -- marriage, graduations, births, and so forth.

Very young children may not be able to talk about their grief. Instead, they may show it by acting out, reverting to more babyish behavior, clinging, or withdrawing. Because they have no way to make sense of death and dying, loss of someone close can be quite confusing.

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Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.
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