Bereavement How to approach the concept of death with a child

Childhood bereavement has different characteristics to bereavement experienced by adults. Children tend to experience it with great intensity, since they have fewer emotional resources to deal with it. That is why the way we communicate the death of a loved one will be especially important.

It is essential that we communicate the death with lots of love and gentleness. It is preferable not to delay the news and to tell them as soon as possible, but taking the time needed, not rushing it. It would be ideal that a parent gives them the news and, if this is not possible, that it is someone very close and familiar to the child.

So that we can calmly talk about what happened, we need to pay attention to where we will have the conversation. We need to look for a quiet place, without distractions, where the child can receive the support they need.

We also need to choose carefully the words that we use. We need to speak honestly and in a simple way so that the child can understand, prioritising short, clear explanations appropriate to their age and level of understanding.

Something fundamental to keep in mind is that children tend to take what adults tell them literally. Therefore, the recommendation is not to use metaphors or euphemisms, such as "fell asleep" or "left". Since children's thinking is concrete, it is necessary to use clear, simple language, as literal as possible, and above all, always speak the TRUTH. It is not good to lie, hide, sugar-coat the issue, respond with evasion or give contradictory messages. We need to talk with gentleness, but always with the truth. With support, children can learn to deal with the truth, no matter how difficult it is; but lies or falsehoods are more difficult to process in the long run.

It is essential that we open up a dialogue with, and listen to the child, to their doubts and concerns, uncertainties, anxieties and fears, without being afraid of their questions or distress. Try to give them space to be able to express themselves as much as possible. That will help us to be attentive to their emotional world, to what they tell us and what they are feeling. If they ask questions, it means that they need to know more. Be prepared to provide them with the information that they need. As they express their doubts and fears through the conversation, we can gradually give them more information, always according to what they need and are ready to receive. It is not necessary to say everything in one go and overload them.

We can give them more details on the death of their loved one little by little. This will depend on what they are ready to take and the pace they need to go at, according to their age, emotional development and respecting their emotional world. This will allow the child to gradually digest the information at their own pace.

If we are faced with a difficult question, it can be helpful to ask the child what they think about it. This will give us an indication of how much they know and understand. We can be honest and acknowledge that we don't have all the answers, and tell the child that, when we know more, we will let them know.

It is not necessary to make efforts not to cry or avoid showing our sadness in front of the child. We sometimes make the mistake of trying to hide our own grief. We may try not to cry in front of them to avoid further suffering, however, this can make bereavement even more difficult for them. If they see us cry, we show them that crying is normal when we feel sad; that it is okay to do so and that it can actually help us to express the grief we feel inside. It will enable them to feel free to do it themselves too.

There are certain aspects that we must focus on and be clear about when communicating the death of a loved one to a child. These are concepts that the child will have to assimilate bit by bit to be able to comprehend the situation in the best possible way. As we explained before, these aspects will not be assimilated immediately, but will be part of the grieving process that each person will go through and that involves a long and difficult journey.

When we speak to the child, our intention should not only be that they understand the concept of death (without focussing exclusively on it), but also that we can attend to their emotional world (the fantasies, feelings and fears that may appear). Hence the need to be attentive, to accompany and respond empathically. We need to clarify their doubts as they raise them, and to do so in a language that is appropriate to their age.

Some of the things the child will need to know are:

• Death is universal. All living things experience it at some stage: people, animals, plants (examples from nature help children to understand a lot of things). As the little ones learn this, it may happen that they begin to fear the fact of dying themselves or of losing other close people who love them and care for them. We can reassure them by explaining that death usually happens when one is very old. Sometimes it can happen at am earlier stage because of an illness, but the person has to be very very sick for that to happen. It is important to provide them with security so that they can overcome that fear.

• Death is irreversible. Children often believe that death is temporary, that their loved one will return. The child needs to know that once the person dies, they cannot live again. That means that they won't be able to see that person again. We can’t turn back time or freeze it either: the loss is definite. The person will no longer return. Children can take time to understand this. We will most likely need to explain this many times.

• When someone dies, their body stops working. They no longer move, they cannot breathe, they do not feel anything. The body does not work anymore and cannot function again. Regardless of any religious explanations that we may give to the child, it is important to physically explain what happens to the body as well.

• There is a physical cause for the death. It is necessary to explain to them that there is a physical cause for the death of their loved one. It could happen that children believe that the person has died because of them (due to thoughts, wishes, jealousy or anger). We have to clarify that these things are not what causes death and that the child is in no way responsible for the death of their loved one.

Finding a way to explain to a child the death of a loved one is very difficult; sometimes the right words are hard to find. What can we tell them?

• We have to tell them that the person has died. As painful as this is, it is necessary to be clear on this point. We can also tell them that the person no longer suffers and does not feel pain. Their body does not feel any pain because it does not continue to function, to work anymore. They are no longer breathing; their lungs are not working and their heart has stopped beating. We can explain to them that since they no longer feel, the body will be put in to a coffin. Then a ceremony and/or a funeral will take place, according to each person’s culture, and that this is a special moment to say goodbye to them.

• If the family is religious, the explanation will vary according to beliefs and religion. If they are Christian, we can explain to them that, with death, the body separates from the soul, from the spirit. That the body remains here but the spirit unites with God and with people who have died before. We can explain that, even though we don't see them anymore, we can communicate with that person through prayer. We can tell them that when a soul is with God, it is at peace and in full happiness. We are sad because we miss them, but they are at peace.

• We can tell them how we feel and what that person means to us. We can tell them that they are not alone, that we will support each other and move forward, although it will be difficult at first. We can tell them that it's okay to be sad if that is how they feel and that they can talk to us about whatever they want, when they have doubts, or just need a hug.

In the book, we also include other messages that can help the children in their grieving process:

• We can tell them that when someone dies, that person is not physically present anymore, but their love remains with us, marked in our hearts. Their love does not go away, it is still alive inside of us. Love is stronger than death. It does not end. It is not lost. It cannot be broken.

• The love that we receive from other people transform us and gives us strength. When someone dies, the love they have given us continues to transform us and give us strength. It does not extinguish, even if the person is no longer physically with us.

• Knowing that this mark of love has also been left in other people, helps us to know that we are not alone in grief; there are others that also suffer from the loss, and we can accompany each other.

• We can keep their memory alive by remembering them. In a way, when we go back in our memories, we also return to the love that the person gave us and that our hearts have absorbed. It is good for us to think of them, to speak about them and to remember them all of our lives.

The emotional process of assimilation of what has happened is not linear, but dynamic. It is a process that requires a lot of personal work from each child: assimilating the loss, expressing their emotions, adapting to their “new” life and finding themselves again. In this process, the little ones can express their grief in various ways and behaviours. There are those who will behave in all of the ways we describe below and there are those for whom only some may apply, or none. There may also be children who take days or weeks before they show any particular reaction to the loss they have suffered.

• Show grief for what has happened and at times show themselves to be happy and calm:

In their everyday activities, young children often move quickly from the sadness and grief of what has happened, to showing themselves to be happy and cheerful. This does not mean that the child is not affected by the death but, because they cannot sustain powerful and intense emotions for a long period of time, they tend to protect themselves in this way.

• Searching behaviour:

Young children have a hard time assimilating the fact that death is irreversible and permanent. That is why it is common that they search for the deceased person, that they expect for the person to return. When they realise that the deceased will not return, it is possible that the child will express their grief through their behaviour.

• Stop asking or talking about the loved one who has passed away:

We may think that the child has assimilated and understood the death of their relative if they stop asking about them or speaking about them. This, however, does not necessarily mean that they have assimilated the situation or that this has ceased to be of interest to them. On the contrary, they may continue to be calm, smiling, playing without difficulties, because they still hope that the deceased person will return. Sometimes, after a few days, they may ask again when the deceased will return, or even look for them around the house.

• Changes of mood and alterations in behaviour:

Although children react in different ways to the loss of a loved one, it is common that they experience ups and downs and mood swings throughout the grieving process.

When children are very young, they do not have the ability to express what they feel in words, so they tend to manifest what is happening to them through their bodies and their behaviour (their fear of being left alone, their grief, their discontent, etc.) Therefore, they may find themselves more irritable, have outbursts of rage or cry more easily, have tantrums, show anger, or be unable to do anything on their own. These are usually some of the ways that children find to express what is happening to them inside. Generally, these changes in their behaviour emerge when they are with their supporting adult figures.

It is important to know that this behaviour is what the child needs to do, rather than what they want to do. There will be times when they will be completely overwhelmed by powerful emotions and they may need to express those emotions in a very physical way. We need to allow them to express themselves, but imposing limits to ensure that they do not hurt themselves or others.

• Withdrawal:

Children may become more introverted and tend to remain alone and quiet. They may show loss of interest in their toys and in the people whose company they used to enjoy. It is important to allow the child to "just be" rather than to try and convince them to participate in activities that they do not want to take part in. They will probably resume those activities again when they are ready.

• Increased separation anxiety:

Being aware that someone important is missing in their lives often creates a lot of fear in children. We see this in daily life with babies who may need to be in constant physical contact with a trusted caregiver and will cry as soon as they are separated from them. Some older children will need to be physically close to an adult they know and may become “clingy” or “clingier” than before. Providing them with physical reassurance, such as hugs, will help them to feel less anxious.

Sometimes it may be helpful to use an object as a “transitional object”. For example, a blanket or a handkerchief that has a familiar scent, a photo or something that is ours. When we have to leave the child somewhere, we can give them the object for them to "take care of " until we return. It is also helpful to explain to them where we are going, when we will come back, and who will be looking after them in the meantime.

• Regressions, behaving like a younger child:

The need to be pampered and to behave as if they were younger is an attempt to return to a time when they felt safer and protected. It may happen, for example, that the child appears to be more dependent, and loses the autonomy that they had already achieved in certain areas. For example, they may want to use the soother/pacifier again, they may wet the bed at night, refuse to eat by themselves, request to be spoon-fed, ask to be taken in someone’s arms, etc. These behaviours will require us to be tolerant and avoid becoming angry with them. We cannot expect them to behave as adults after all that they have been through. We can try and comfort them as we would do with a younger child, as this may be what they need. If we give them the space they need, respecting the time they need, help them and comfort them, they will feel protected and safe, which in turn will help them grow in independence once again.

• Sleep disturbance

It is common for young bereaved children to find bedtime particularly difficult. They may cry more than usual when they need to go to sleep or wake up in the middle of the night needing to be comforted. It is also possible that they do not want to be left alone and they may feel anxious about turning off the lights. They may want to sleep next to their caregiver so as to feel close to them. Bad dreams can also be common.

Let us try to maintain the usual routines when it comes to putting the child to bed, but being aware that they may need someone to stay with them until they fall asleep. The need for this extra comfort at bedtime may reduce once the child becomes less anxious and regains their confidence. Sometimes using a “transitional object,” a dream catcher, or something similar, or a music box, can help children manage better their night-time fears.

• They develop their own theories about what happened:

When doubts are not clarified, communicated properly, or simply left unanswered, children tend to work out what happened in the way they can. As they tend to use magical, concrete and literal thinking, they can invent their own theories to give an answer to their concerns. This can generate more anxiety and confusion, since their theories, which can be terrifying theories and very different from reality, are influenced by their own fears, fantasies and interpretations of death.

One of our most difficult tasks really comes after communicating the news and explaining the topics we have discussed before (as many times as it is necessary for the child). This is helping the child so that they can acknowledge what they feel and are able to talk about it. In order to help them be able to put their emotions into words and share what they think, we need to make ourselves approachable, receptive and accessible to them. Yet, as we mentioned before, always respecting the space and time that they may need and showing respect for their personal world.

Some keys to help grieving children:

• Acknowledge what has happened:

We can try to put what happened into words, call things by their name, and give an explanation appropriate to the age of the child and their ability. We should try not to be afraid of speaking with them. No matter how small a child is, they will gradually be able to grasp what we are saying to them.

• Let us not assume that the child understands everything:

We should be prepared to repeat explanations and communicate what happened as many times as necessary. The child may ask about it over and over again. Instead of getting frustrated with having to repeat ourselves, we can view it as an opportunity to speak with them, and to see if we can help them in whatever they may need. Also, their understanding of what has happened will change over time. What they would have assimilated when they were two years old will be different to what they understand or reflect upon when they continue to grow and mature. The questions they previously asked may be repeated, in response to their need for more detailed explanations.

• Encourage them and help them express their feelings

It is through playing that young children grasp and interpret the things that happen around them. They may play at being doctors, being sick in the hospital, or even being dead. Let us not be afraid to play along with them, as we can help them to understand better what has happened. Dolls, teddies, figures, puppets can be helpful to recreate scenes and help the children to express their thoughts and feelings.

We can try to facilitate them with ways to relax, offering spaces and resources for them to express themselves and process what has happened, such as drawings and art, books, games, observing the cycle of nature and activities like the ones you will find on this website.

These activities will aim to open up a line of conversation or “play” so that the children can process what they feel and what has happened to them in the best way possible. Instead of changing the conversation when difficult questions arise, we can use these as opportunities to really know how the children are and to respond to their queries.

• Try to answer questions honestly

Use of clear, simple, and age-appropriate language. We can try to make sure that the people that are in contact with the child know what has been communicated to them, to help avoid differences in approaches and confusion.

• Awareness that adults will be seen as role models

It will be us that will set the example, by expressing our feelings, talking about the person who died and crying if we need to (this will show them that being sad is inevitable, that crying is natural to human beings; that it is not bad), and also showing them how being accompanied can help to relieve the grief. In this way, we show them the necessary tools for them to find their own forms of expression.

• Provide affection and calmness:

When someone close dies, the world can become a very scary place for a young child, and they may start to wonder who else will leave them. It is important that they receive a lot of affection from those around them, especially during this time and from those closest to them. The children should feel safe, protected and accompanied for the longest time possible. This will help them to feel that, although their world has changed, it will continue to be stable, their needs will be met and they will not be on their own.

• Help the child and their family resume their usual routine:

Excessive changes can create anxieties in children, which will affect them at this difficult time. They will need to know that their world will not fall further apart, but that there is continuity. That is why it is beneficial to continue with their routines, with their friends and their activities. It is important that the child returns to their home if they have been away from it. That they get used to being at home with their family, and that they resume their routines and daily life. It is easier to achieve stability without excessive changes in routine, by maintaining schedules, activities, habits at home, that can provide a certain level of security.

• Patience and love:

We know that during the grieving process children may experience changes in behaviour and mood. These can be very difficult for adults to handle and will require a lot of patience so as not to respond to the child with anger. This does not mean that we must ignore disruptive behaviour, or not continue to set limits. We can come back to it later and focus our attention on trying to interpret what is really happening with the child. It will be easier to support the child in their grief if we know that these reactions are ways that they find to express their pain. If we react with patience and love, the child will feel understood, supported and helped.