Children’s understanding of and reactions to death

After parent-child attachment and trust are established, the loss, even if temporary, of the significant person is profound.

Prolonged separation during the first several years is thought to be more significant in terms of future physical, social, and emotional growth than at any subsequent age.

Toddlers are egocentric and can only think about events in terms of their own frame of reference—living.

Their egocentricity and vague separation of fact and fantasy make it impossible for them to comprehend absence of life.

Instead of understanding death, this age group is affected more by any change in lifestyle.

As children grow older, they will be increasingly able and willing to let go of the dead person.

Ritualism is important; a change in lifestyle could be anxiety producing.

This age group reacts more to the pain and discomfort of a serious illness than to the probable fatal prognosis.

This age group also reacts to parental anxiety and sadness.

Encourage parents to remain near child as much as possible yet be sensitive to parents’ needs.

Maintain as normal an environment as possible to retain ritualism.

If a parent has died, encourage having a consistent caregiver for child.

Promote primary nursing.

Their egocentricity implies a tremendous sense of self-power and omnipotence.

They usually have some understanding of the meaning of death.

Death is seen as a departure, a kind of sleep.

They may recognize the fact of physical death but do not separate it from living abilities.

Death is seen as temporary and gradual; life and death can change places with one another.

They have no understanding of the universality and inevitability of death.

They may feel guilty and responsible for the death of a sibling.

Greatest fear concerning death is separation from parents.

They may engage in activities that seem strange or abnormal to adults.

Because they have fewer defense mechanisms to deal with loss, young children may react to a less significant loss with more outward grief than to the loss of a very significant person. The loss is so deep, painful, and threatening that the child must deny it for a time to survive its overwhelming impact.

Behavior reactions such as giggling, joking, attracting attention, or regressing to earlier developmental skills indicate children’s need to distance themselves from tremendous loss.

Help parents understand behavioral reactions of their children.

Encourage parents to remain near child as much as possible to minimize the child’s great fear of separation from parents.

If a parent has died, encourage having a consistent caregiver for child.

Promote primary nursing.

Because of their higher cognitive abilities, they respond well to logical explanations and comprehend the figurative meaning of words.

They have a deeper understanding of death in a concrete sense.

They particularly fear the mutilation and punishment that they associate with death.

They personify death as the devil, a monster, or the bogeyman.

They may have naturalistic or physiologic explanations of death.

By 9 or 10 years of age, children have an adult concept of death, realizing that it is inevitable, universal, and irreversible.

Communicability of the disease to themselves or others

Consequences of the disease

The process of dying and death itself

Their fear of the unknown is greater than their fear of the known.

The realization of impending death is a tremendous threat to their sense of security and ego strength.

They are likely to exhibit fear through verbal uncooperativeness rather than actual physical aggression.

They are interested in post-death services.

They may be inquisitive about what happens to the body.

Encourage parents to remain near child as much as possible yet be sensitive to parents’ needs.

Because of children’s fear of the unknown, anticipatory preparation is important.

Because the developmental task of this age is industry, interventions of helping children maintain control over their bodies and increasing their understanding allow them to achieve independence, self-worth, and

self-esteem and avoid a sense of inferiority.

Encourage children to talk about their feelings and provide aggressive outlets.

Encourage parents to honestly answer questions about dying rather than avoiding the subject or fabricating euphemisms.

Encourage parents to share their moments of sorrow with their children.

Provide preparation for post-death services.

They are still influenced by remnants of magical thinking and are subject to guilt and shame.

They are likely to see deviations from accepted behavior as reasons for their illness.

They have the most difficulty in coping with death.

They are least likely to accept cessation of life, particularly if it is their own.

Concern is for the present much more than for the past or the future.

They may consider themselves alienated from their peers and unable to communicate with their parents for emotional support, feeling alone in their struggle.

Adolescents’ orientation to the present compels them to worry about physical changes even more than the prognosis.

Because of their idealistic view of the world, they may criticize funeral rites as barbaric, money making, and unnecessary.

Avoid alliances with either parent or child.

Structure hospital admission to allow for maximum self-control and independence.

Answer adolescents’ questions honestly, treating them as mature individuals and respecting their needs for privacy, solitude, and personal expressions of emotions.

Help parents understand their child’s reactions to death and dying, especially that concern for present crises (e.g., loss of hair) may be much greater than for future ones, including possible death.