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Section 25
The Grieving Process for Children in Trauma

Question 25 | Test | Table of Contents

How Should Adults Talk with Young Children About Death?
References to death and dying may be made relative to the age of the child, but euphemisms are seldom helpful at any age. Adults often use socially acceptable rhetoric such as saying that someone has "gone on," "passed away," or "left us." These abstract terms have little meaning for most children. However, using the words death and dying in such a context that children do not feel that they are taboo or "unspeakable" subjects, provides an opportunity for them to begin accepting the finality of death. Never diminish or belittle children when they ask or comment about death. This sends the message that their questions are insignificant or unimportant.

Very young children, especially those between 3 and 6 years of age, are still in Piaget’s preoperational stage and therefore are egocentric and often given over to magical thinking. For this reason, it is very important that adults use very concrete language when describing the death of someone to a child of this age. Using terms such as "gone to sleep," "gone on a trip," or "left us" only confuse the child because he still believes that when someone goes to sleep they always wake up.

There is no right time to tell a child that someone has died. A child copes much better both physically and emotionally when they hear the news from a family member rather than from a stranger. One of the most damaging things that can be done is to send the child away to visit someone until the funeral and initial grieving process is over. This not only makes the child feel disenfranchised from the family unit, but also does not allow for a sense of understanding of death, even if that understanding is rudimentary (Camp & Willis, 1999).

Some children will be more curious than others about what happens to the body. Again, their understanding of this is a result of their age and maturity. Be factual and explain clearly and concisely what caused the death: "Grandma’s heart stopped beating," or "Papaw got sick and the doctor could not make him well."

Explain that this is not common or necessarily going to happen to the child, who might think that when he gets sick he will die like his grandfather did. Figure 1 is a list of guidelines to aid parents in discussing death with their children.

Fig. 1.
The following guidelines are helpful when talking to a child about death:
1. If at all possible have someone who is close to the child or knows the child well to tell the child.
2. Tell the child in an environment where there is minimal noise and no interruptions.
3. Be specific, honest, and concrete in your descriptions.
4. Answer the child’s questions as clearly as possible. If you do not know the answer, say so!
5. Allow the child time to respond. Often children take longer to react to things than adults.
6. Avoid euphemisms; they are confusing and misleading.
7. If you are not familiar with the family’s belief systems, avoid discussing what happens after death.
8. Assure the child that he did not cause the death.
9. Honor whatever response the child exhibits, even if it not the one you expected.
10. Do not put words in the child’s mouth or force a reaction just because you think it is appropriate to do so.

What are some suggestions for caregivers?
It is important that caregivers and teachers know the common signs of mourning in children, which may include the following: anxiety, sleep difficulty (especially nightmares), sadness, longing, anger, acting out, and physical complaints (Wilken & Powell, 1991). These signs are especially important to recognize in young children who cannot express their emotions and do not necessarily know why they are angry or sad.

Encourage a child to play; it is an important tool for healing whether it occurs alone or with others. It is a natural method for both self-expression and communication. Play encourages the development of emotional and motor skills and provides a safe, non-threatening environment for a child to act on his innermost feelings One way for the teacher to help the child through the grieving process is to introduce objects that encourage interaction. Such objects include balls, blocks, or puzzles. Other children might respond better to activities such as talking on a play phone, writing a pretend letter, or talking to and playing with a puppet or doll. Whatever the child seems to prefer, honor that preference.

Art is another form of expression that often helps children cope with feelings of grief or sadness. Offering a variety of materials to work with provides children with a medium to create something of meaning to them. Such materials can include such items as colorful cloth, box lids, or bottle tops. As with all forms of self-expression, some children will be more willing than others to share what they have created. It is never a good idea to force a child to share or tell you about his artwork. It is important that art be fun for the child and not something that she is doing to "please" a well-meaning adult.

Music, either in a group or individually, is also an effective way to help children deal with their grief. Some benefit from being able to spend some time alone listening to self-selected songs, while others enjoy the togetherness that comes from group music activities (Wolfelt, 1991).

Finally, providing ways for children to become involved in the natural world can be very therapeutic. Most children enjoy being given a chance to go to observe and experience all that nature has to offer. Bright  sunshine, trees, flowers, or even a misty rain can have a restorative effect on a child. Take the class on a nature walk or short hike to a park. So often outdoor time is spent on a playground or in a play area, which may not offer such natural surroundings. Help a grieving child plant a flower or a plant, make and maintain a bird feeder, or start a rock or leaf collection.

Remember that grieving is a process. Children of any age require extra attention and understanding when they are grieving. It is wrong to assume that just because a child is young he or she will "get over" the loss. Most importantly, adults need to remember to model healthy emotional behavior for children. Allow them to laugh, cry, and talk about the deceased person. Just like adults, children of all ages need time and understanding in order to process the concept of death and dying.
- Willis, Clarissa; The grieving process in children: strategies for understanding, educating, and reconciling children's perceptions of death; Early Childhood Education Journal; Jun 2002, Vol. 29; Issue 4.

Personal Reflection Exercise #11
The preceding section contained information about the grieving process in children.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Assessing DSM-5-TR and ICD-11
Prolonged Grief Disorder
in Children and Adolescents:
Development of the Traumatic Grief
Inventory - Kids - Clinician-Administered

- Van Dijk, I., Boelen, P. A., de Keijser, J., & Lenferink, L. I. M. (2023). Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents: development of the Traumatic Grief Inventory - Kids - Clinician-Administered. European journal of psychotraumatology, 14(2), 2197697.

Peer-Reviewed Journal Article References:
Bellet, B. W., LeBlanc, N. J., Nizzi, M.-C., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020). Identity confusion in complicated grief: A closer look. Journal of Abnormal Psychology, 129(4), 397–407.

Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229.

Schonfeld, D. J., & Demaria, T. P. (2018). The role of school psychologists in the support of grieving children. School Psychology Quarterly, 33(3), 361–362.

QUESTION 25
What is one of the most damaging things that can be done with a grieving child? To select and enter your answer go to Test.

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