What to Look for and What to Do
As a parent, there may be no more difficult experience than watching our children grieve. Although we typically think of grief as mourning the death of a loved one, grief can become a part of many life experiences such as divorce, moving, or a big change in the family.
In my work as a pediatric palliative care psychologist, I worked with siblings of children who were dying or had died, witnessing firsthand the commonalities and differences among children when they grieve. In my therapy practice, I see grief in all different forms as children and families weather big life changes, such as medical diagnoses and changes in physical functioning because of medical problems, either for themselves or for a parent.
People often assume this part of my work is “depressing,” but I find it profound and life-affirming. It is truly awe-inspiring to have walked besides so many children and families during the most significant time in their lives. Although the pain is deep and intricate, the wisdom, strength, and resilience uncovered by grief overwhelms me more than the sadness.
If we open our eyes to it, grief is everywhere. That is why grief in childhood can actually be a gift as it allows children the opportunity to develop ways to manage grief that will help them throughout their lives. And the best news is that you are there to help them do it.
Before I jump into developmental differences in the grieving process, including understanding of death, there are several key considerations to keep in mind:
These developmental phases are mapped out based on typically developing children. For kids with developmental differences, like those with Autism, it’s important to consider the age at which they are considered to be functioning rather than their chronological age.
In the case of death, the TYPE of death makes a difference in the grieving process. Traumatic deaths such as suicide or sudden accidents often lead to more complicated grief.
If the grieving is for a parent’s death, this is the most impactful of any loss, and a child will need the most intensive support possible, and will likely have the most complicated response compared to other losses.
EVERY CHILD IS DIFFERENT. Although generalizations help give us guidelines, they are just that: generalizations. Each child carries their own unique personality and history that will play out differently in their grief.
If you, the parent, are going through your own intense grief at the same time as your child, prioritize getting your own support and resources. This gives you a better chance at offering your child the emotional availability they will need from you. But you have to come first, like the oxygen mask on an airplane.
DEVELOPMENTAL GUIDE TO GRIEF
We often assume that babies and toddlers are not affected by death or significant loss. It can be hard to fathom that they know what’s going on, especially before language development. But if the loss changes their daily routine, or they are attached to a caregiver going through his or her own grief, they are absolutely affected. These youngest humans absorb the emotions of those around them, and are most sensitive to their caregivers’ emotional states because of their level of dependence.
What to Look for:
Increased fussiness and irritability.
Changes in sleep (I know – especially hard to know what’s what in the first couple years, but look at the whole picture).
Even more emotional meltdowns than usual.
Changes in appetite or eating behaviors.
Shows of distress if a caregiver appears upset in front of them.
What to Do:
Keep the daily routine the same as much as possible so they know what to expect. This consistency and structure helps them feel safe. If possible, the same caregivers should be available as regularly as possible.
Respond to meltdowns with lots of affection, staying close to them so they know they can count on you to be there.
If sleep and eating problems persist for more than a couple weeks, consult with a pediatrician to make sure physical health is stable.
Manage your emotions in front of them, and focus as much as possible on staying emotionally responsive to their needs in the moment.
If you are the primary caregiver and managing your own grief, prioritize your own support and take the breaks you need.
Preschoolers do not yet understand the permanence of death, or even other significant changes. It’s perfectly normal if they ask the same questions repeatedly, even if you have given them the answers. It doesn’t mean you are doing it wrong, they just need the repetition as they are grasping at the idea of a permanent loss. Their cognitive and emotional development is accelerating, which is already overwhelming, so their emotions will likely be even bigger than normal. Also, it is very typical for this age group to quickly swing from grief reactions to normal life, acting as if nothing has happened.
What to Look for:
Asking the same questions repeatedly – this shows they are aware of the change and trying to understand it.
Magical thinking may mean they connect the death or loss with something they did or said, feeling guilty and responsible.
Sudden behavior changes, like being more clingy, more reserved, or even more hyperactive.
Changes in appetite or sleep, including nightmares.
Repetitive play reminiscent of the loss; play is how they process their experience.
New separation anxiety and difficulty with transitions; they may feel more anxious about not being with you, the parent or primary caregiver, and worried something bad will happen to you or others they love.
Possible regression, such as with potty training, or loss of recently mastered skills.
What to Do:
Answer those repetitive questions as concretely as possible, and explain the death or loss in specific, age-appropriate ways to address magical thinking; see Talking to Kids About Death for more specific guidance.
Maintain the daily routine as much as possible, with increased availability and support for transition times, like school drop-off.
Communicate with teachers about the loss, your observations of what your child needs, and come up with a plan together for dealing with meltdowns or new behaviors in the classroom in supportive rather than disciplinary ways.
Play with your child, but let them lead the way. They are gaining a sense of control over events through their play, so they need to be in charge of it. Follow their lead first and foremost, and do some reflecting (“oh that little girl seems so sad!”) but go along with it if they correct you.
Be patient with regressions rather than punitive, supporting them in regaining their milestones or skills when they are ready.
Abstract thought is developing, so this age group will more logically understand the death or loss and have the cognitive capabilities to discuss it. This means potential for complicated conversations, including hard questions that may not have answers. This age group is also tuned into how their caregivers are managing grief, and may even feel like they are protecting their parents by not expressing their own grief. It is important to give children explicit permission to talk when they need to talk, and tell them you are able to listen.
What to Look for:
New physical complaints like stomachaches or headaches.
Not wanting to go to school.
Withdrawing from friends.
Difficulty having fun.
Changes in sleep or appetite (notice a theme?), although in this age group, this is more likely to look like difficulty falling asleep, or even sleeping more than usual, and there could be overeating.
Difficulty focusing, which may mean changes in grades or academic performance.
Feelings of guilt about the death or loss, or about times they feel happy; increased worries about people they love.
Thoughts about death and dying.
What to Do:
Encourage normalcy as much as possible, including going to school everyday (after the first week or so of a death or loss).
Communicate with teachers about events and specific concerns about your child, as well as what you think will support them best.
Identify other school resources such as a social worker or psychologist who could meet with your child during the school day for extra coping support.
Talk to your child about it. Let them lead the discussion with their questions. Do your best to answer their exact questions and not flood them with information. They will let you know what they are ready to hear. If your child is not bringing it up, you can gently let them know you are ready to talk when they are, so they feel permission AND control.
If you are sharing in the loss with them, model for them appropriate expression of sadness or anger (at a level that’s not scary to them), and show them it’s okay to still laugh and have fun.
As adolescents are bridging that gap between being kids and becoming adults, this can be an especially trying phase for navigating grief, but also one with great potential. Since this is the stage of wanting more independence from parents, they may seek more support from friends than from you. They may also quickly alternate between this heavy reliance on friends and wanting you right next to them, sometimes regressing to how dependent they were at younger ages, even if is fleeting.
What to Look for:
ALL OF THE ABOVE FOR AGES 7-12.
Possibly MORE time away from home as they look to friends for support.
Increase in risky and impulsive behaviors, like drinking or reckless driving (terrifying, I know).
Existential questions as they can more easily generalize their experience of the fragility and uncertainty of life beyond themselves to the world at large.
What to Do:
Encourage staying connected as much as possible, showing your adolescent child you are there for them no matter what.
Set limits and maintain structure, with room for flexibility. Teenagers are famous for testing limits anyways, and going through grief may multiply this, but limits and structure help them feel safe even if they rage against you in the moment. Keep that curfew in place. Enact consequences for negative behaviors, from a place of love and compassion for their well-being.
Communicate to them you want to listen and understand them, and it’s up to them what they share with you.
If they don’t already do it, you could encourage private outlets like starting a journal – make sure they know you will respect their privacy.
If you are also grieving, be open about what it’s like for you as a way to model communication about the loss, while also assuring them you are getting the support you need so they don’t feel like they need to shield you from their own grief.
WHEN TO SEEK PROFESSIONAL HELP
Length of time: Grief symptoms and behaviors are common for up to a few weeks, again depending on the age and individual child, but if the symptoms seem to be lasting into months, the child may benefit from professional support.
Intensity of symptoms: Grief is like the ocean – waves of sadness/anger/crying, etc. ebbing and flowing with more normal day-to-day functioning. If you see your child’s symptoms or behaviors getting worse or more frequent over time, it’s probably time to consult with a professional.
Suicidal ideation: Grieving or not, any time a child makes a statement about wanting to die or wishing they were dead, it’s time for help. Especially in the case of a child who is grieving a death by suicide, a professional should be involved in assessing risk and figuring out a safety plan with you.
IF THEY ASK FOR HELP: If a child or adolescent ever actually requests seeing a therapist, DO IT. Trust me, it’s a rare occurrence, so if it happens they know they need it AND they will get even more out of it because they are so motivated.
Important disclaimer: This blog post is NOT a substitution for consultation with a professional. If you think your child needs more help, set up an intake or evaluation with a mental health professional, preferably someone who has worked with children, adolescents, and grief. Follow your instinct as the ultimate expert on your child!
There are so many to share, that I have a whole page dedicated to grief resources:
Books for different ages
Grief and Children: Help for Parents, An interview with yours truly on Let’s Talk About Grief! with Addie Anderson, Voiceamerica radio show