By Chris Haring
Speaking openly about death and dying can be difficult for people of all ages, and engaging with kids about the end of life requires sensitivity and respect
Does anybody really like talking about death?
Even the most mature and level-headed adults can often struggle to speak candidly and openly about the practical realities of illness, death, and grief without shrouding their conversations in comforting euphemisms and metaphors. Thus, the prospect of broaching the topic with children can seem daunting, to say the least.
However, avoiding end-of-life conversations with kids, while done with the best intentions, can lead to confusion, fear, and even distrust in the long run. Thankfully, many professionals and organizations are attempting to provide resources not just for children, but for the adults in their lives who wish to guide them.
In a November 2022 post from the Children’s Hospital of Philadelphia (CHOP), bereavement experts Kelly Goldin, BS, CCLS, CTRS, and Elizabeth Spellman, MSW, LCSW, shed light on What Parents Need to Know About Explaining Death and Grief to a Child.
The authors, from CHOP’s Justin Michael Ingerman Center for Palliative Care and the Bereavement Program, emphasize the importance of creating a safe space where children of all ages can ask questions and express their feelings without judgment, while using direct language and tailoring explanations to their developmental level.
Although death is beyond the conceptual ability of infants and toddlers, they often react negatively to disruptions in routine, Goldin and Spellman say. Preschoolers cope with their limited understanding by engaging in “magical thinking” and reenacting death through play. Meanwhile, adolescents and teenagers who understand the finality of death express fears and struggle with existential questions.
No matter the child’s capacity level, however, the authors encourage adults to refrain from setting an agenda, allowing them to lead the discussion. Letting children share their thoughts and feelings and providing them with the space to process their emotions is essential, even if it means allowing moments of silence.
Unfortunately, death and dying will eventually affect us all, but each child’s exposure to the concept can vary tremendously. While many kids’ first death-related memory involves an elderly great-grandparent or family pet, some might experience the untimely loss of a parent or sibling at a tragically young age.
Regardless, it’s essential to remember that grief has no set timeline, and no two experiences will mirror one another. When a child is grieving, their primary caregivers should notify relevant individuals, like pediatricians or teachers, to ensure proper support.
By engaging in open and honest conversations with our children about death and grief, we not only help them navigate this challenging terrain but also empower them to become more compassionate and understanding individuals in the future. In doing so, we contribute to a world where discussions about end-of-life options, like medical aid in dying, can be approached with the same sensitivity that we employ when explaining death to a child.
For additional resources on grief support for children and caregivers, consider the following pages: The Dougy Center, National Alliance for Children’s Grief, Hospice Foundation of America, and Sesame Workshop. (Please note that Death with Dignity does not endorse or partner with these organizations.)
A complete account of Goldin and Spellman’s suggestions can be found here:
What Parents Need to Know About Explaining Death and Grief to a Child
Health Tip of the Week
Contributed by: Dr. Kelly Goldin, BS, CCLS, CTRS, Elizabeth Spellman, MSW, LCSW
Published: Nov 02, 2022
Death is a part of the circle of life. In recognition of Children’s Grief Awareness Day on Thursday, Nov. 17, we offer tips to help parents learn how to better recognize and help their children grieve if someone they know has died.
Children as young as infants and toddlers can sense when something around them has changed. In their own way, they grieve. Explaining death to children is not an easy task, especially when the death was of a family member or close friend.
With the best of intentions, adults often avoid talking about death around children as a way to protect them. In the long term, avoidance can create confusion, fear and sometimes even distrust.
Communication strategies for explaining death to a child
- Create a safe place for children to talk and ask questions.
- Gently, but directly, use the words death, dead and died within short explanations. Using euphemisms and vague language often creates fear in children. Phrases like “passed away,” “gone to sleep,” “he’s with grandma” or “she’s with the angels” do not explain in direct terms that their loved one has died. It can even instill fear in a child (of sleeping, of angels).
- Before answering a question, ask the child to clarify what they are seeking to get to the root of what they are asking.
- Be honest on a developmental level the child can understand.
- If the deceased was a regular part of their routine, explain why their grandparent won’t babysit or their aunt can’t pick them up after preschool anymore.
- Recognize that children will ask for information as they need it. Be mindful they need a balance of communication and play.
- Be mindful that children may repeatedly ask similar questions about death. This does not imply that you have explained death incorrectly, but rather that they continue to process the information. Be consistent in your messaging.
- Identify fears and misconceptions, offer reassurance and provide opportunities to create legacy items to help children remember deceased loved ones. Often, this is not one talk, but rather an ongoing conversation as your child processes information.
- Remember, it’s OK if you do not have an immediate answer. It is important for adults to use reflective listening skills and, if you don’t know, say, “I don’t know the answer to that, but I will try my best to find out.”
- It’s alright to cry. Showing children your emotions can help to normalize the range of feelings but be careful to maintain balance. Share your memories or thoughts out loud with children.
What to avoid while communicating with a child
- Setting an agenda
- Doing all the talking
- Not allowing silence
- Focusing too much on your own emotions
- Offering too many medical details
Death, grief, and developmental stages
If you are concerned about talking about death with your child, you are not alone. By talking to your child, you can learn what they do and do not understand about death and help them with any fears or worries they have by providing information, as well as comfort and reassurance.
When explaining death or grief, it’s important to consider your child’s capacity to understand the concepts. Generally, here’s what you can expect and what to do for different age groups:
- Concept of death — will not understand death, but will respond to changes in their routine that death causes
- Grief response — irritability, respond to emotions of adults and caretakers
- Signs of distress — regression, changes in eating or sleeping patterns
- Possible interventions — reestablish routine, comfort, touch, hold infant or toddler
Pre-schooler (ages 3 to 5)
- Concept of death — “engage in magical thinking,” view death as reversible or temporary
- Grief response — may ask questions about the death repeatedly, may reenact death through play
- Signs of distress — regressions, bedwetting, separation anxiety, sleep disturbances
- Possible interventions — answer questions honestly, use age-appropriate language to explain death. If your child is including death in their play, support them through this process. This will help you better understand how the child is coping with the death and can help you clear up any misconceptions they may have.
School age (ages 6 to 9)
- Concept of death — engage in “magical thinking,” associate death with old age, personify death (for example, a ghost, bogeyman, grim reaper)
- Grief response — may regress emotionally or behaviorally, aggressive behavior (especially in boys), may be curious about death and what causes death
- Signs of distress — regression, nightmares, violent play, tries to take on the role of the person who died
- Possible interventions — give children an opportunity to participate in memory-making activities, share stories of the person who died, model appropriate grief responses
Pre-adolescent (ages 9 to 12)
- Concept of death — understand that death is final and that it will happen to everyone including themselves, some may view death as punishment
- Grief response — finality of death creates anxiety, fear the death of other people they love, want to know details of how the death happened
- Signs of distress — regression, problems in school, withdraw from friends, extreme weight loss or gain, suicidal thoughts
- Possible interventions — offer constructive “venting” alternatives like sports or exercise, give as much factual information regarding the death as possible
Adolescents (13 and up)
- Concept of death — understand death cognitively, struggle with spiritual beliefs surrounding death, search for meaning behind the death, understand possibility of their own death
- Grief response — may act out, may express that “life is not fair,” may prefer to discuss feelings with their friends, may develop an “existential” response
- Signs of distress — intense anger or guilt, poor school performance, long-term withdraw from friends, opposition or defiance
- Possible interventions — sharing your own experiences with loss, explore religious/spiritual beliefs with them
Explaining funeral services and burial preparation to a child
When preparing for these conversations, consider what exposure a young person has already had with funerals or memorial services.
Anticipate questions like, why do we have services? What will the body look like? Explain the purpose of the service and any religious significance. If the service is a celebration of someone’s life, explain that as well.
In closing your conversation, offer the child the choice to participate or not. If the death was a person close to the child, perhaps allow them to help with planning the service, such as picking out photographs for a collage board or video stream.
More helpful tips
In addition to the death of a loved one, children will also grieve when they have experienced loss in other ways, including divorce, moving away from their friends, starting a new school or the death of a pet.
Remember: there is no timetable on grief. Parents may want to notify their child’s pediatrician, daycare or school about a death so others who care about their child can also be on the lookout for any regression or strong signs of grief that are not being addressed.
Kelly Goldin, BS, CCLS, CTRS, is a bereavement coordinator, and Elizabeth Spellman, MSW, LCSW, is a bereavement and palliative care social worker, both with the Justin Michael Ingerman Center for Palliative Care and the Bereavement Program at Children’s Hospital of Philadelphia.