DEATH AND ITS
IMPLICATIONS
ON CHILDREN & ADOLESCENTS
Plan of session
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Introduction
Death and dying in the 21st century
Encounters with death
Video excerpt
Developmental perspective to understanding death
Factors involved in bereavement
Cascade of Events Model
Resolving grief
The grief of children
Behaviours of grieving children
What children need
To Emily
To Emily at four
death is grandma
a Christmas tea party
and then no more
So I tell her OLD
and I tell her ILL
she’s too young for CANCER
or MURDER or KILL
death is a rabbit
an uninhabited hutch
and a garden rose
growing through its bones
and heaven at best
is somewhere to rest
when we’re tired.
Emily says yes
death is a bird
so many birds die
death is a word
she follows with WHY
she can see heaven
clearly she can
with grandma and rabbit and bird
and the leg from the one-legged man
(Susan Wallbank)
DEATH IN THE 21ST CENTURY
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Death has become the taboo subject which previously
characterised the subject of sexuality.
Death has been medicalised and is now usually
contained to hospitals. Not long ago, death was familiar
and usual, occurring in the same household where
several generations lived together.
Furthermore, the reduction of infant mortality has
nurtured the illusion that death is confined to old age.
The general decline in religious observance, the
disappearance of mourning traditions, the breakdown of
the nuclear family and a deteriorating social environment
which “sanitises” grief complicates the bereavement
process.
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Thinking about death carries a profound threat:
The painful recognition that we are all going to
die.
However hard we try to evade it, death must be
mourned and grief cannot be dismissed as
morbid.
How well we accomplish the fact that we must all
some day embrace death will have much to do
with whether our children shrink from the
knowledge of death or learn from the beginning
to see death as part of the whole life cycle.
As much as we intrinsically feel compelled to
protect children from death, we simply cannot.
Whether we discuss it with them or not, children
are aware of death.
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In fact, death is still very much present in our lives. Daily,
40 children in England and Wales are bereaved by the
death of a parent. In the USA, approximately 4% of
children under the age of 16 years experience the death
of a parent.
Considering that suicide and HIV infection is highest in
men within the 25-44 age group (who might well be
fathers), it is possible to assume that many children,
particularly those in deprived social situations, will
experience bereavement in their young lives.
The process of learning about death in childhood is vital
preparation for the mature tasks of coping with it.
What we tell children about death should be consistent
with what we feel and how we behave.
ENCOUNTERS WITH DEATH
Children may need to adjust to various unpredictable losses
in their lives:
 Death of a pet
 Death of a sibling
 Death of a parent
 Death of a close relative
 Death of a neighbour
 Death of a classmate or class teacher
 Their own death
The above losses can occur through an accident, illness, old
age, chronic conditions, a natural disaster, and suicide.
Children may also view death vicariously. In fact,
Hayworth (1998) stated that through the media children
may see 15,000 deaths before reaching puberty. However,
the awareness of death is often lacking, and its
implications are usually largely ignored.
VIDEO EXCERPT
When viewing this excerpt, what pertinent
issues come to mind?
 What are Molly’s primary emotions during
this excerpt?
 Imagine that Molly were 13. What would
you expect to be different in the scene with
Corinna?
 If you were Corinna, what would you have
done differently?
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TAKING A DEVELOPMENTAL
PERSPECTIVE TO DEATH
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Children’s views about death change depending on the
developmental stage they are in. Death education and
therapeutic intervention must be tailored to their specific
developmental stage.
Applying psychological principles, the developmental
view about death is mainly tied to their cognitive
understanding of the situation. A child in the egocentric
stage of development will be viewing and interpreting the
world primarily through an egocentric lens.
Other factors, such as coping abilities, parental attitudes,
level of intelligence, previous life experiences,
environment and culture will also affect children’s
understanding of death.
Babies and toddlers:
less than 3 years
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Babies do not understand the concept of death. Initially they view their
caregiver as an extension of themselves. Hence, the world and themselves
are one.
Babies are in a symbiotic relationship with their mothers and have the task
of differentiating themselves from the surrounding environment.
Gradually, they develop an understanding of themselves in relation to their
immediate context. They develop an understanding of “being” (e.g. when
awake) and “non-being” (e.g. when asleep).
By the age of 3 months, games such as peek-a-boo provide a safe
opportunity to experiment with “being and non-being”. Babies respond with
both fear and delight.
When the basic understanding of “being and non-being” is consolidated,
toddlers enter into the “disappear and return” phase. They engage in
various games and delight in seeing the object re-appear (e.g dropping toys
from a highchair). However, they soon start to suspect that really not all
things return, and at times they are “all gone” (e.g. lighted match, switch,
and bathtub).
Hence, toddlers worry about separation, mainly from their mothers, and
enter into a phase characterised by separation anxiety. Hence, for them,
dying means separation.
Pre-Schoolers: 3 – 6 years
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Children view the world from the perspectives of their own
experience. Although children may use the words “die” and
“dead”, they cannot truly comprehend the concept, both
verbally and cognitively (e.g. Jane and her grandmother).
Preschoolers cannot imagine what it is like to die. They
believe that even when dead, one still lives. The questions
they ask attest to this (e.g. how can grandpa breath
underground? Where will he eat?)
At this age, children rely on what they learn from adults,
peers, books, and television. Although they do not fully
understand the concept, they recognise death as something
unique which often arouses negative feelings.
Preschoolers take a matter-of-fact approach towards death
because of 2 basic assumptions they make: death is
accidental and people die only under certain conditions; and
they themselves will not die.
Pre-Schoolers: 3 – 6 years
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They still believe that death is mainly a separation. Hence, any
separation may arouse thoughts of death. Parents can alleviate
worries as children cannot differentiate between short and long
absences.
At this age, children still believe that death is reversible. In order to
understand the finality of death, children have to recognise that they
are separate from their parents and that, without them, they could
still exist. Preschoolers cannot do this.
Preschoolers need their parents to protect them, so they perceive
death as being temporary. The media reinforces this concept,
although the parents may highlight the permanence of death.
Magical thinking is characteristic of this age. Hence, when death
occurs, children may believe that their words or wishes caused it to
happen. Death may be perceived as a punishment for their thoughts
(e.g. “you will be the death of me”).
Preschoolers also believe that superficial or irrelevant details may
cause death. Preschoolers often mention that not obeying one’s
parents may cause things to die. They see the act, rather than the
consequences of the act, as causing death (e.g. crossing the road).
They also tend to connect events that do
not belong together and, if they are
missing facts, they will fill in the blanks
from their imaginations.
 Death may also be associated with
darkness, monsters, evil, and sleeping.
Nightmares and fear of the dark are
common at this age.
 This carries implications for working
therapeutically with preschoolers, who
should be helped to verbalise their guiltinducing thoughts.
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Early school age: 6 – 10 years
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Mid-childhood children can neither deny nor accept death in their
own lives. Hence, they reach a compromise, acknowledging that
death is real in an external and distant sense.
6 to 7 year olds suspect that their parents will die some day and
that the same fate might await them. For them, death is not so
imminent. Hence, they fear their parents’ deaths rather than their
own. They may accept the fact that someone died and that death
is final but they do not fully understand the fact that death must
happen to everyone, including themselves.
Young school-age children speak less often about death. They
become secretive and keep their thoughts and feelings about
death to themselves. Possibly, they are still too vulnerable to
accept the emotional implications of their new thoughts about
death. They are also more tuned into reality. Although death is
not much spoken about, death anxiety is greatest in this period of
development. Children may fear “catching death”, being
mutilated, abandoned, or separated from their parents. Hence,
broaching the subject of death with these children is of great
importance.
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Although mid-childhood children are better testers of
reality, they still carry an amount of magical thinking.
They have a strong tendency to personify death, viewing
it as an evil taker that stops life. Whoever can get away
will live (e.g. the fairytales of Hansel and Gretel,
Sleeping Beauty, and Snow White).
Children, particularly boys, use fantasy life to confront
death. Hence they play act war and violence, discussing
gory details. They also seek detailed information about
death and their bodies, trying to gain a sense of control
through their own rational analysis of the situation.
Children begin to develop their own sense of moral
judgement. They may try to reason out the meaning of
life, heaven and life after death. Children may spend
time thinking about who God is and what God will do to
them. Parental and societal pressures will have a great
impact on their thoughts.
Gradually, young school children accept the fact that
death is final, inevitable, universal, and personal.
Early adolescents: 10 – 12 years
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Early adolescents can better distinguish
between animate and inanimate objects. They
also stop believing that everything that moves is
alive.
Hence, death becomes more abstract and
spiritual. It is recognised as personal, universal,
and real.
Death can now be understood in relation to the
laws of nature. Rather than viewing death as an
external power that comes upon them, early
adolescents view it as an internal dysfunction
that causes life to end. Death now assumes a
logical perspective.
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However, early adolescents are better able to
understand the facts surrounding death than
they understand the feelings. In fact, while they
intellectually recognise that death is final and
irreversible, they may continue to view death as
a punishment. Early adolescents are also
concerned with relationships following death
(e.g. who will take care of Grandpa? Where shall
we get the money once Daddy has died?)
Early adolescents view death as terrible,
horrible, evil, sad, and surrounded by gloom.
Furthermore, death is no longer personified.
At this age, fear of suffocation, fear of being
buried alive, fear of pain and suffering, and the
fear of thinking about their own death replace
mutilation and separation anxiety.
Adolescence: 12 – 18 years
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Adolescents share most adult concepts of death
and cope with death in a similar manner.
As death destroys the body, it is particularly
threatening for adolescents who are concerned
with beauty and strength. With puberty,
adolescents discover their changing bodies and
realise that the natural progression of aging is
possible even for them. Death is thus seen as
the natural enemy of their new emerging self.
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Adolescents are future-oriented. Death is perceived as
the instrument through which goals are destroyed.
Hence, they question the meaning of life when they
understand the nature of death.
Adolescents are in the process of fast change, which is
mostly out of their control. They attempt to attain a
degree of autonomy by asserting control over an area
they perceive as being completely beyond their control.
Hence, defiance of death may prompt some adolescents
to challenge death at close proximity (fast driving;
drugs).
Adolescents do not like making a public spectacle of
their sorrow. Hence, they may prefer to mourn in private
or with their close friends. An exception may occur when
their friends are mourning as well.
FACTORS INVOLVED IN
BEREAVEMENT
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In a study conducted by Winston’s Wish, a
summer camp for children who gave gone
through bereavement, children were asked what
questions concern them, in connection with
death and bereavement. The following questions
were put forward:
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Causes of death
The process of living and dying
The inability of doctors to save people
The appearance of the body after death
Spiritual issues
Grieving feelings
The Cascade of Events model (Christ, 2000).
RESOLVING GRIEF
John Bowlby believed that a child can resolve losses
appropriately when:
 The child has had a reasonably secure relationship with
the person who has died.
 The child receives prompt and accurate information
about what has happened. The child is allowed to ask
questions, which adults answer as honestly as possible,
acknowledging that they do not know the answer if that
is the case.
 The child is allowed to participate in the family grieving,
both publicly and privately.
 The child has easy access to a trusted adult who can be
relied upon for comfort and a continuing relationship.
THE GRIEF OF CHILDREN
Grief is not a linear process with well-defined
boundaries. Rather it is an amalgamation of
overlapping phases that vary between
individuals.
 When a child grieves, the same acute range of
emotions experienced in adulthood will be felt.
 However, children may find it hard to identify
their emotions, which are often conflictual, and
hence find it difficult to express their feelings.
 In spite of the many possible factors which have
an impact on the quality of grief, each child’s
bereavement must be recognised as unique.
COMMON BEHAVIOURS OF
GRIEVING CHILDREN
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Children go through various reactions, which may be
immediate and/or delayed. It takes approximately 2
years to resolve grief. The following are the most
common behaviours:
Shock and denial: Children go through life
mechanically, with shock usually lasting from a few hours
and up to a week. Denial can extend longer. If the reality
is too difficult to accept, it is pushed away for some time.
Denial can provide period of reprieve from an
overwhelming sense of loss and abandonment.
Panic: As children tend to be self-oriented, they start to
worry about how their needs will be met, especially if a
parent has died. They need to be reassured that they will
be taken care of.
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Anger: Bereaved children often feel angry at
the person who died and they indirectly
express their anger by acting out, at home
and at school. They may also feel angry at
God, at the surviving parent or at anyone who
may have been involved in the death. It is
important that they express these feelings.
Guilt: Children may at some level feel
responsible for the death, particularly if a
stormy relationship would have pre-existed.
They may start blaming themselves for the
death, even if they are cognitively able to
understand that they are not responsible.
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Regression: Children’s world view is challenged and
hence they regress to earlier behaviours to maintain
some form of control. Normal routines should be followed
to restore a sense of security.
Bodily distress and anxiety: Psycho-somatic symptoms
may be present, and they may be similar to those which
the deceased person experienced before death. Children
may fear that they are dying. Constant reassurance and
clarification is necessary to cope with this stage.
Clinging or replacement: Many children become clingy
and tearful as they fear that other people they love will die
too. The children need to be informed of the whereabouts
of significant people in their lives and of any possible
separations. Children may also try to find a substitute to
fill the void, by seeking the affection of another person.
Tell the children that, although no one can ever take the
place of the deceased and everyone misses him/her so
much, there are many other people who love them.
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Preoccupation with the deceased: Children may find
themselves thinking of the deceased all the time and this
may cause them unrelenting pain. Reassure and share
memories at a family level, emphasising that running
away from the situation will not make it go away.
Hyperactivity and shortened attention span: Some
children may become hyper aroused, jumping from one
activity to another. They may also find it challenging to
concentrate for a length of time. Children need to be
provided with structured activities. Teachers should be
informed of the death so that they will be able to
understand behavioural changes.
Withdrawal: Grieving children may withdraw from
people they love, as they are afraid that these people will
die too. They may also avoid getting to know new people
as they fear hurting again. Explore these fears with the
children. Acknowledge the fact that a person can die
unpredictably, but that loving a person is worth the risk.
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Assumptions of mannerisms of the deceased: Bereaved
children may start to act or talk like the deceased person.
Remind the children that although the dead person was special
and they may share some characteristics, you love them just as
they are, for their own uniqueness.
Idealisation of the deceased: Children often remember only
the good things about the person who would have died. It is not
healthy for children to fantasise that the dead person was
perfect. This may encourage unrealistic expectations of other
people. Emphasise that no one is perfect but we can love them
anyway.
Repressed feeling expressed later: When children do not
express their sorrow (due to their age or lack of support), they
may need to revisit their grief at a later stage in their lives.
Something in the future may trigger the feelings which would
have been denied or repressed.
Other symptoms: Children may also develop phobias (of the
dark; of hospitals; of doctors; of school). They may suffer from
depression, nightmares, experience sleeping or feeding
difficulties, bite their nails, play with their hair or pick
themselves.
WHAT CHILDREN NEED
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Information: They need to have information prior, during and
following the death. This is particularly true when the death is
a public event covered by the media.
Explanations: Information given to children should be
truthful, sensitive and honest, even if this is hard for the adults
concerned. Children’s fantasies might be actually worse than
the reality of the death. Explanations should be concrete,
clear and understandable. The “drip feed” system can help
children in that they have time to evaluate and assimilate the
explanations given.
Help in expressing feelings: When adults express their
feelings, children will learn what is acceptable and healthy.
Children’s reactions to the death should be viewed as part of
a healing process, however stressful they might be to the
surviving adults. Furthermore, the bereavement process may
be complicated when children receive contradictory messages
about the way they should behave (e.g. “you have to take
care of mummy now”).
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The funeral: Till some time ago, children were not included in rites of
passage. It is now argued that grief is a family and community event, which
is resolved better if shared and understood.
 Inclusion: Not including children at the funeral may cause confusion,
anger and a gap in their understanding of the situation. Children should
be allowed to ask questions prior and following the funeral, hence
dispelling any myths they might have.
 Viewing the body: This is a daunting prospect, even for adults. For
children, viewing the body might dispel myths that the person is still
alive. However, children need to be informed beforehand about what to
expect, even at a sensory level (i.e. sights, sounds, touch and smell).
They need to be aware that this is the last opportunity to say goodbye.
When the adults are sure that the child understands the significance
and the importance of the rite, the child should be allowed to decide,
and never coerced.
 Attendance at the funeral: As with viewing the body, the child needs to
be given information about the process of a funeral service. They should
be asked whether they want to say something to the deceased. The
child should also be invited to take part in post-funeral gatherings,
where the life of the deceased is celebrated.
Reassurance: Following the disruption caused by death, children need
reassurance to understand that the world as they know it has not completely
disintegrated. They need boundaries and structure to feel safe, with a return
to the normal daily routine providing security and reliability. They also need
time to explore the new environment in their family caused by the death.
Maternity
One wept whose only child was dead,
New born, ten years ago.
“Weep not; he is in bliss,” they said.
She answered, “Even so,
Ten years ago was born in pain
A child, not now forlorn.
But oh, ten years ago, in vain,
A Mother, a mother was born.”
Alice Meynell (1847 – 1923).
BIBLIOGRAPHY
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Hagan Arnold, J., & Buschman Gemma, P. (1983). A child dies: A portrait of family
grief. Maryland: Aspen Systems Corporation.
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Jewett, C. (1994). Helping children cope with separation and loss. London: Free
Association Books.
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Kubler Ross, E. (1985). On children and death. New York: Macmillan Publishing
Company.
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National Council for Hospice and Specialist Palliative Care (2002). Early
bereavement: What factors influence children’s responses to death? London: King’s
College.
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Smith, S. C. (1999). The forgotten mourners: Guidelines for working with bereaved
children. London: Jessica Kingsley Publishers Ltd.
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Smith, S. C., & Pennells, M. (1995). Interventions with bereaved children. London:
Jessica Kingsley Publishers.
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Wolf, A. W. M. (1975). Helping your child to understand death. New York: Child Study
Press.
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