Wednesday, November 25, 2015

Helping kids understand death

Here's a guide on how to talk to children about death depending on their age and developmental stage.

Helping kids understand death


Earlier this month, I spent a good deal of time with my three young grandchildren (a 3-year-old girl, and 15 and 18 month boys). My mother-in-law died at the age of 90 after a very prolonged decline and then a very short acute illness. The three children all dressed up and doing their best to sit still and not make too much noise, brought a smile to everyone’s face at the funeral services, the internment and during shiva, the Jewish custom of home visitation the week after the burial.

Hundreds of people, mostly new for the children, paying their respects, and I were extremely proud of my grandchildren who were, in turn, shy and mischievous, but mainly took all the hubbub in stride.

During the experience, I was also a little saddened thinking about how some of my patients go through added stress and turmoil when a loved one dies by either leaving the children out of it or expecting too much of them with their behavior when they are included in the process.

Death used to be part of the normal social experience. People died at home. Homes had “coffin corners” cut on narrow twisting steps to get the coffins down from the bedrooms upstairs to the front door. Now people die in hospital (many of which do not even allow children in) with the patient hardly recognizable with tubes and masks and machines trying to keep them alive. Their bodies are brought to funeral parlors and to burial without the child ever seeing them. The child can get very confused because their granny or uncle is suddenly gone.  They feel deserted and sad without ever having been involved with the rituals that let us deal with our sadness, and help us comprehend intellectually and emotionally what has happened.  Fred Rogers once said: “Young children don’t know that sadness isn’t forever.”

When we do let them attend, we do not let them behave as children. Children do not sit still. They do not stay quiet. If they get uncomfortable or are disruptive make sure someone is designated to take them to a comfortable place for a few minutes. But children can add so much. My granddaughter did not really understand what was going on at first, but then she went up to my wife and said with great empathy and sadness, “my mommy says that your mommy died, Grammy.”  She did not understand death or its finality, but she sure understood how awful it was to lose your mother.

Explaining death to a child is dependent on their age and developmental stage. I will briefly go over these, and here are some excellent resources online:

No matter what age a child is, or what the subject, be honest. You do not have all the answers, but do not make up stories. If you do believe in life after death, then telling a child that grandpa went to heaven is fine, but if you believe that death is final, then say:“He will always live in our hearts.”

Children under 7 are very literal (as are some older children). If you say, “Granddad will always be looking down at you from heaven,” a 5 year-old may absolutely believe you and get scared every time he or she makes a mistake.

Young children do not understand that death in final, so do not get annoyed as they repeatedly ask when the dead family member will be coming back. If they ask why grandmom had to die, say her body got old and the doctors could not fix it anymore, so her body stopped working. Avoid euphemisms since they take you literally. I have seen many children have horrible behavior problems at bedtime after someone told them that auntie ‘went to sleep’ and now they are afraid to go to sleep. The young child’s questions are equally literal.  If a 5-year-old asks where the dead person is, say the cemetery, and do not go into a detailed description of the afterlife.

School age children (from ages 6 to 12) may understand that death is final, but may think in terms of agent such as a “bogeyman” or ghost, and can get very frightened.  All the horror shows on TV and movies do not help.  These children also think magically and may feel guilty because they said to the deceased, after the child did not get his or her way, “I wish you were dead.”  And then that person dies, and this school age child thinks that they somehow caused it.

Finally a teenager, who does understand that death is final, may think it cannot happen to me or my friends. When it does, as in a car accident, then can get depressed or even moody as they are truly trying to figure out hard questions such as “Why do bad things happen to good people.”  If you can get the teen to ventilate their feelings without obsessing that is the best you can do.

Death is part of living. Have children visit the ill, go to funerals (if they want to do so) and ask that they tell stories about the deceased.  The more comfortable that they feel, the better they will do.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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