Bereavement

The death of a parent, relative, friend or pet is one of the most traumatic experiences a child or young person can have. Children's grief is different to that of adults because of a number of factors:

• Understanding of death is limited by age and cognitive development
• Limited ability to verbalise feelings
• Limited capacity to tolerate emotional pain
• Sensitivity to bereavement makes them different to peers

0-2 Years

• Children are thought to have no concept of death until they are around 2 years of age
• They may experience grief due to separation from people but do not understand the finality of death
• Death is viewed as temporary
• May ask when the dead person is coming back
• May be matter of fact or appear unconcerned when told of the death
• Tend to take explanations literally
• Need simple factual explanations that cannot be misconstrued

3-5 Years

• Children view death as similar to sleep
• They do not understand that it is permanent or that eventually all living things must die
• May believe that they have caused the death by bad behaviour or bad thoughts
• May believe that the deceased will return if they are very, very good
• May show separation anxiety

5-9 Years

• Children realise the finality of death
• Around 9 years children may become upset by the idea of death and in particular about the possibility that people might die
• Knowledge may be a mixture of fact and fantasy
• May visualise death as a ghost or skeleton
• Questions children ask may be upsetting for adults
• They believe they caused the death by magical thinking
• Children may be interested in the biological aspects of death
• Denial is a common reaction
• Focus on their own feelings
• Little awareness of the impact of the death on others
• May grieve in short bursts

9-12 Years

• Children become aware of finality and the inevitability of death
• They often experience some anxiety around thoughts of death and dying
• May understand the permanence and irreversibility of death
• Will have more understanding of the context of the loss
• May realise that they will one day die
• Can understand what the loss may mean to others
• Pseudo-adult behaviour possible
• May assume role of deceased parent
• May postpone grief to support other family members
• Peers may be important for support and consolation
• May repeatedly go over details of the incident
• May become anxious, insecure and fearful

12 Years Into Adolescence

• Greater acceptance of thoughts around death
• Some become defiant of death, daring it to occur by playing games of 'chicken' or other risk-taking behaviour
• As they grow they are vulnerable to re-experiencing their loss as understanding of death and its finality develops

Other Factors to Consider

• Relationship with the deceased
• Child or young person's personality
• Previous experiences of death
• Gender, for example boys may feel that they cannot express their feelings because they need to be tough, girls may feel they need to care for everyone around them and hold in their own feelings
• Social support
• The nature of the relationship that the child had with the person who died will impact upon how they react
• The structure of the family will also be an important factor
• The younger the child, the more acutely they will fell the loss of a mother as they are seperated from their primary caregiver
• The death of a father may be more significant for boys who will have lost a male role model
• Some boys will feel it is their responsibility to take on the role of 'head of the house', this can be overwhelming as it is a role that they cannot cope with
• The loss of a sibling may be particularly difficult for a child or young person, they may fear for their own safety and that of other family members
• It is not unusual for them to experience guilt about things that they did or said, having survived or maybe about feeling glad they have their parents to themselves
• Some children may try to take the place of their sibling by changing the things they do or how they behave
• Parents may feel unable to talk about their own grief or support the grieving of the child in circumstances where the relationship with the person who has died has been difficult or abusive. The child or young person may feel relief or display ambivalence about the death

The Grief Process

There are a number of models of grieving for children. One of the most useful is that put forward by Morgan (1985) who suggests children's grief occurs in three phases.

• Protest: The child refuses to accept that the person is dead. They may become angry and make attempts to get them back.
• Hurt, despair and disorganisation: There is an acceptance that the person has really gone. Feelings of abandonment and hostility towards the dead person are quite usual.
• Hope: They begin to adjust to life without the deceased person.

It is difficult to put a timeframe around the grieving process. Circumstances before and after the bereavement will have a significant influence on how it is experienced. Great uncertainty about the future can accompany the death of someone close; there can be worries about who will care for them or where they will live. It will probably not be in the power of the child or young person to resolve these questions.

Signs That a Child or Young Person is Not Coping with Their Loss

Although most of the following are normal grief reactions, it is when they continue without change that they become concerning and when accessing specialist professional bereavement services should be considered.

• Regression into an earlier stage of development
• Continuing hostile reactions towards the person who has died
• Eating - loss of appetite, overeating, development of eating disorders
• Bed wetting
• Sleep disturbance
• Complaints of illness (may be some of the symptoms of the person who has died)
• Attempting to replace the deceased
• Adopting the mannerisms of the deceased
• Aggressive behaviour
• Learning problems
• Denial
• Withdrawal
• Guilt
• Anxiety
• Panic
• Sadness or even short term depression of less that 3 months are normal following bereavement

Support

• Recognise that reactions to loss are different in individuals
• Deal with death in an open, sensitive manner in order to provide good role modelling
• Discuss death in terms that children can understand
• Provide information about death and grief appropriate to their developmental age
• Encourage children to express feelings verbally, through writing, drama or art work
• Be available to listen or to help
• Ask them what help they would like, if any
• Recognise that you cannot take the grief away, or 'make things better'
• Encourage the child to talk about loss
• Promote constructive attitudes and approaches from peers towards bereaved children
• Create links with the child's home
• Do say you are sorry about what happened and about their pain
• Be sensitive to special occasions e.g. birthdays, anniversaries
• Find someone you can talk to, to support you