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This PowerPoint was created by child life specialists on the Child Life Council’s
Professional Resources Committee as a resource for use by professionals in the
field.
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It may be used to educate multidisciplinary team members and students in your
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Please refer to the speaker notes
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rich in detail!
Our Thanks to:
The Child Life Council’s Professional Resources
Committee, who provided the template to help in the
creation of this presentation for our audience.
Bereavement Support for Children
This presentation provides a basic overview of some of
the most common reactions, concerns and
misconceptions children experience when faced with
bereavement, specific to each age group.
Please remember:
Every child, and every loss, is unique.
Key Points
• Children experience the world through play.
• Children will “self-dose” the amount of information
they can handle.
• “Meet the family where they are!”
• Provide open and honest information.
• Use the words death, dead and dying.
• Reassure children that the death is not their fault.
Age Groups
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Infants (birth - 12 months)
Toddlers (12 - 36 months)
Preschoolers (3 - 5 years)
School Age Children (6 - 12 years)
Adolescents (13+ years)
Infants (birth-12 months)
How they understand death:
o Death is experienced as a separation.
o Changes in routine threaten an infant’s sense of
security.
Key points in the hospital setting :
o Infants mirror the emotional state of adults.
o Stranger anxiety commonly occurs at 8 to 15 months
of age.
o Separation anxiety commonly occurs at 10 to 18
months of age.
Infant patients
What to tell caregivers:
o Maintain the infant’s routine.
o Meet immediate physical needs.
o Provide extra snuggles.
Materials/Services:
o Offer a legacy item.
o Offer to sit with the infant while family takes a break.
Warning signs of poor coping:
o Watch for disruption of attachment bonds.
o Watch for signs of depression in the adults.
Infant visitors
What to tell caregivers:
o Maintain the infant’s routine.
o Meet immediate physical needs.
o Provide extra snuggles.
Materials/Services:
o Offer a legacy item.
Warning signs of poor coping:
o Watch for disruption of attachment bonds.
o Watch for signs of depression in the surviving
caregiver(s).
o Discuss concerns with the infant’s pediatrician, or
caregiver’s primary care provider.
Toddlers (12-36 months)
How they understand death:
o Death is primarily experienced as a separation.
o Toddlers have little concept of the permanency of
death.
Key points in the hospital setting :
o Use concrete language, including the words “death,
dead, dying.”
o Offer appropriate play items.
Toddler patients
What to tell the caregivers:
o Maintain their routines as much as possible.
o Provide plenty of play opportunities.
Materials/services:
o Offer a legacy item, books/resources.
o Offer to sit with the toddler while the family takes a
break.
Warning signs of poor coping:
o Poor coping may manifest as tantrums, sleep
disruptions, or regression.
Toddler visitors
What to tell the caregivers:
o Maintain their routines as much as possible.
o Provide plenty of play opportunities.
o Use concrete language, repetition, and patience.
Materials/services:
o Provide safe play materials.
o Offer a legacy item, books/resources.
Warning signs of poor coping:
o Poor coping may manifest as tantrums, sleep
disruptions, or regression.
o Discuss concerns with the toddler’s pediatrician.
Preschoolers (3-5 years old)
How they understand death:
o Preschoolers are sensory learners, with limited
understanding of the permanency of death.
o This is the age of magical thinking.
o It is common for a preschooler to believe that they
caused the death through their thoughts/wishes.
Key points in the hospital setting :
o Explain death as a sensory experience.
o Watch for signs of misconceptions.
Preschooler patients
What to tell the caregivers:
o Provide reassurance and play opportunities.
o Model healthy emotional expression.
o Review that “bad thoughts” do not cause an illness.
Materials/services:
o Provide appropriate play materials.
o Offer a legacy item, and books/resources.
Warning signs of poor coping:
o Watch for misconceptions about the cause of illness.
o Pretend-play about injury/illness/death is normal.
Preschooler visitors
What to tell the caregivers:
o Provide reassurance and play opportunities.
o Model healthy emotional expression.
o Review that “bad thoughts” do not cause an illness.
Materials/services:
o Prepare a preschooler prior to a bed-side visit.
o Offer a legacy item and books/resources.
Warning signs of poor coping:
o Watch for signs of misconceptions about cause of
death.
o Discuss concerns with the teacher or pediatrician.
School Age Children (6-12 years old)
How they understand death:
o Younger children are sensory learners, and may still
think of death as reversible. Older children
understand the finality of death.
o It is normal to ask direct questions, and show
interest in the physical aspects of death.
Key points in the hospital setting :
o Answer questions honestly and directly.
o Provide lots of play opportunities.
o Normalize the full range of emotions, and the desire
to play.
School age patients
What to tell the caregivers:
o Encourage healthy emotional expression.
o Normalize and encourage play.
o Children may attempt to reflect adult grief patterns.
Materials/services:
o Offer a legacy item, and books/resources.
o Offer activities to encourage emotional expression.
Warning signs of poor coping:
o Watch for changes in sleeping/eating patterns,
disruptive behavior, or non-compliance with medical
staff.
School age visitors
What to tell the caregivers:
o Encourage play and emotional expression.
o It is normal for children to fear their own death.
Materials/Services:
o Offer a legacy item, and books/resources.
o Prepare children prior to a bed-side visit.
Warning signs of poor coping:
o Watch for changes in sleeping/eating patterns,
disruptive behavior at school, or excessive testing of
boundaries at home.
o Discuss concerns with the teacher or pediatrician.
Adolescents (13+ years)
How they understand death:
o Death is understood to be permanent and universal.
o They may question their faith/religion & self-identity.
o Behaviors may alternate between adult/child like.
Key points in the hospital setting :
o Provide adolescents with privacy and respect.
o Expect inconsistent and contradictory responses.
o They may look to their peers for support, including
texting and social media.
Adolescent patients
What to tell the caregivers:
o Allow peer support, be patient with contradictory
behavior, and address risk-taking behaviors promptly.
o Model healthy emotional expression.
Materials/services:
o Offer a legacy item, and books/resources.
o Offer therapeutic activities to encourage emotional
expression.
Warning signs of poor coping:
o Watch for social withdrawal, changes in
sleeping/eating patterns, and risk-taking behavior.
Adolescent visitors
What to tell the caregivers:
o Allow peer support, be patient with contradictory
behavior, and address risk-taking behaviors promptly.
o Model healthy emotional expression.
Materials/services:
o Offer a legacy item, and books/resources.
Warning signs of poor coping:
o Watch for social withdrawal, changes in
sleeping/eating patterns, and risk-taking behavior.
o Get support from teachers, peer-support groups, and
pediatricians.
Legacy Items
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Ink prints (hand, foot, fingers, etc.)
Lock of hair
Thumb print medallion
3D hand replicas
Photos, scrapbooking
Video or audio recordings
Artwork
Letters for the future
Memory box
Books
• No Matter What by Debi Gliori
(infant/toddler/preschooler)
• Lifetimes by Bryan Mellonie & Robert Ingpen
(toddler/preschooler/school age)
• When Dinosaurs Die by Laurie Krasny Brown & Marc
Brown (preschooler/school age)
• The Saddest Time by Norma Simon (school age)
• The Next Place by Warren Hanson (adolescent)
• When A Friend Dies by Marilyn Gootman
(adolescent)
Guided Journals & Other Resources
• Sesame Street: When Families Grieve
• Fire in my Heart, Ice in my Veins by Enid Traisman
(adolescent)
• When Someone Very Special Dies by Marge Heegaard
(school age/adolescent)
• When Someone Has a Very Serious Illness by Marge
Heegaard (school age/adolescent)
Child Life Services
(customize this slide with contact information,
availability, and services.)
Contact Child Life Services by (call, page, email, consult)
Child Life Services offers the following end-of-life
support services:
o Consultations with caregivers (by phone or in
person).
o Support for pediatric patients, siblings, and children
of adult patients.
o Support prior to, and during, hospital visits.
o Diagnosis teaching play.
o Legacy items, and books/resources.
o Psychosocial support.