1. family and parenting
2. children

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CHAPTER
27
Grief and Bereavement in Children
Robin Fiorelli
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■
Introduction
Children’s Concepts of Death and Responses to Grief
■
Sadness/Depression
Anger
Guilt and Regrets
Fears
Physical Complaints
Bereavement Support Groups for Grieving
Children
Support from Schools for Grieving Children
Play Therapy for Grieving Children
Infancy (to Age 2)
Preschool (Age 2–4)
Early Childhood (4–7)
Middle Years (Ages 7–10)
Preadolescent (Ages 10–12)
Adolescent (Ages 13–15)
Adolescent (Ages 15–18)
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Normal Grief Reactions in Children
Physical Symptoms
Cognitive Symptoms
Emotional Shock and Denial
Sadness, Despair, and Depression
Anger and Acting-Out Behavior
Regressive Behaviors
Fear, Anxiety, and Panic
Guilt, Shame, and Self-Blame
Jealousy
Acceptance
■
■
■
Guidelines for Helping Bereaved Children Express
Their Grief
■
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Guidelines for Helping Grieving Teens
Grieving Parents Need to Take Care of Themselves
Guidelines for Children Attending Funerals and
Memorial Services
Explaining Burial and Cremation to a Child
Ways to Commemorate the Loss with a
Grieving Child
Holidays and Special Anniversaries
Death of a Parent or Significant Adult
Normal Grief Experience for a Teenager
Complicated Grief Reactions in Children and
Teenagers
Preparing a Child for the Death of a Loved One
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Predeath Support
How to Talk to a Child When the Death Occurs
Typical Questions That Children Have About
Death
635
Death of a Sibling
Conclusion
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INTRODUCTION
Both mental health practitioners and parents
alike have been misguided about how children
and teens experience the loss of someone significant to them and about the most effective ways to
assist a grieving child. In a systematic review of
the prevailing misperceptions, Charles A. Corr
listed most centrally the belief that children do
not really grieve because they are too young to
understand death. The reality is that children’s
grief may look different than that of adults, but
it shares fundamental similarities as a physical
and emotional reaction to the loss of a significant
loved one.
The most compelling myth is that it is best to
protect a child from death and also from grief. It
is natural for adults to want to protect children
from painful experiences. However fanciful this
wish may be, children will grieve in their own
unique ways and it is imperative that caring adults
do not dictate or impede that process, instead,
allow and even facilitate children’s expression of
grief.
Another myth is that funerals and memorial
services are not age appropriate and children may
be traumatized by the acute emotional experience
at such an event. As will be discussed, current
research suggests that a child should receive information about what the event will be like and
then should be allowed to make up his or her
own mind about participating, a decision adults
should honor.
Another common myth is that children are
“naturally resilient” and should just “bounce
back” after a loss. This is not always the case and
depends on contingencies such as concurrent
stressful events, the child’s understanding of the
death, the child’s developmental age, and the
support received by adults in their life. On
the other hand, John Bolby in his work on attachment and loss concluded that children are more
■
Specific Populations
susceptible to profound emotional scarring after
experiencing a significant loss. Supposing this potential exists, its realization still depends on the
factors already listed, most importantly the attitudes and behaviors of adults important in their
lives.
Children tend to attribute physical symptoms
to emotional experiences more than do adults.
Many parents are familiar with the headache that
appears when a child is overwhelmed with emotion or with the stomach ache that appears the
morning before a school test. There is much debate about whether children really experience
emotions more as a physical sensation than do
adults or whether they know that adults in their
lives are more apt to heed physical rather than
emotional symptoms.
This chapter begins by outlining children’s
concepts of death and grief responses, differentiated by developmental level and chronologic age,
through adolescence. The most common physical, emotional, social, and spiritual grief reactions of children and teens will be explored in
depth, following which, complicated grief reactions in children and teens will be outlined. The
chapter then shifts to a discussion on how to
prepare a child for the impending death of a
loved one, what to tell them when the death actually occurs, and the questions one might expect children to ask during this difficult time.
The chapter then turns to the topic of how to assist bereaved children and teens in expressing and
coping with their grief as well as where to find additional sources of support for the grieving child
and teen. Suggestions for grieving parents in caring for their own grief needs are also included.
How children may attend and participate in funerals and memorial services, including guidance
for how to discuss burial and cremation with children, and how to help grieving children participate in memorial activities, including those on
anniversaries or birthdays, are shared. Finally,
two of the most significant losses for a child will
be examined closely, that of a parent and that of a
sibling.
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Babies do not have the cognitive capability to understand an abstract concept like death. They
function very much in the present, so when someone significant dies, babies become more acutely
aware of loss and separation. They also react to
the emotions and behaviors of significant adults
in their environment and also to any disruptions
in their nurturing routine and schedule. If there is
a sudden change, they feel tremendous discomfort.
Therefore, in response to a loss, babies may
search for the deceased and become anxious as
a result of the separation. Common reactions include: irritability and protest, constant crying, a
change in sleeping and eating habits, decreased
activity, and weight loss.
back, for example, she or he may ask the same
question again an hour later. These children often have difficulty visualizing death as separate
from life, and not as something that can happen
to them. Preschool children love to play “peeka-boo” games where adults in their life disappear and then reappear again. It is through these
games that they slowly begin to understand the
concept of “gone for good.”
Because preschoolers tend to be presentoriented, their grief reactions are brief although
often very intense. As these children are going
through the developmental stage where they are
learning to trust and form basic attachments,
when a significant adult in their life dies, they
become very concerned about separation and altered patterns of care. Children this age typically
have a heightened sense of anxiety concerning
separations and rejections because they do not
have the capacity yet to use fantasy to gain control over what is happening.
They also respond to the emotional reactions
of adults in their life. If they sense their parents are
worried or sad, they may cry or throw tantrums
either because they are concerned or as a way to
distract their parents from difficult emotions.
Typical grief responses of the preschool child include confusion, frightening dreams and night
agitation, and regressive behaviors such as clinging, bedwetting, thumb sucking, inconsolable
crying, temper tantrums, and even withdrawal
from others. They may search intensely for the
deceased despite assurance they will not return.
They also may exhibit anxiety toward strangers.
PRESCHOOL (AGE 2–4)
EARLY CHILDHOOD (4–7)
CHILDREN’S CONCEPTS OF DEATH
AND RESPONSES TO GRIEF
Each child is unique in his or her understanding
of death and response to grief. This understanding is largely influenced by the child’s developmental level and chronologic age. There can be
tremendous overlap, however, between the age
groups because children and adolescents move
from one developmental level to another at very
different rates.
INFANCY (TO AGE 2)
When will my mommy be home?
How does (the deceased) eat or breathe?
Preschool children do not comprehend the
concept of “forever.” For this age group, death
is seen as temporary and reversible. Even when
a preschooler is told that mommy is not coming
It’s my fault. I was mad at my mother once and I
told her I wish she would die and then she died.
The roadrunner in the cartoon always comes back
to life, so I know Daddy will too
As with preschoolers, children in the 4 to
7 age group tend to view death as temporary and
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reversible. They sometimes feel responsible for
the death because they believe that negative
thoughts or feelings they have had about the deceased caused their demise. This “magical thinking” stems from the belief that everything in their
environment revolves around them and that they
can control what happens. Even when children at
this age are exposed to death through the media
or at school, they still may believe that if you are
careful enough you can avoid death.
Children at this age may also connect occurrences that do not have anything to do with each
other. For example, if a child bought a certain toy
the day that her sister died, she may attribute the
toy to causing the sister’s death, especially if the
real cause of the death is not fully explained to
her.
Not surprisingly, therefore, children of this
age group, much like their younger counterparts,
may repeatedly search for the deceased or ask
where they are. Repetitive questioning about the
death process, such as “What happens when you
die?” “How do dead people eat?” is often common. They will often express their grief feelings
through play instead of verbally. Themes of family
loss and death may surface as they play with dolls
or action figures. They may play act the death
itself or the funeral.
Sometimes, children at this age appear unaffected by the death and act as if nothing
happened, but this doesn’t mean that they are
oblivious or that they have accepted the death.
It may just signify their inability in the moment
to acknowledge very painful reality. They also
may model their grief reaction after the adults in
their lives, feeling uncertain how to express grief
feelings. Other typical responses include anger,
sadness, confusion, and difficulty eating and
sleeping.
As with preschoolers, this age group may
regress as a way to receive more nurturance and
attention during this difficult time. Children who
have experienced a loss at this age tend to be fearful that other loved ones will leave them as well.
Sometimes they form attachments to people who
resemble the deceased in some way.
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Section Five
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Specific Populations
MIDDLE YEARS (AGES 7–10)
Do your fingernails and hair keep growing when you
die?
If I smoked cigarettes, would I die?
Although children between the ages of 7 and
10 often still want to see death as reversible, they
begin to see it as both final and universal. Children in this age group sometimes visualize death
in the form of a tangible being such as a ghost
or boogeyman. They are very curious about the
details of death, cremation, and burial and may
ask candid questions
Even though they know death can happen
to anyone and that there are many things that
cause death, they still do not typically think of
death as something that can happen to them
or their family members, instead, to only old
or very sick people. They may believe that they
can escape from death through their own efforts. They also might view death as a punishment, particularly before age 9. Sometimes they
are unable to comprehend how the death will affect their lives, which can become a source of
anxiety.
Children in the middle years often become
concerned with how others are responding to the
death as they become less focused on themselves
and more on others. They may fear that other
loved ones will die as well. Sometimes they may
become overly concerned about their own health
and may fear bodily harm and death.
Some children in this age group may act out
their anger and sadness and experience difficulties in school due to a lack of concentration. On
the other hand, they may have a jocular attitude
about the death, appearing indifferent, or they
may withdraw and hide their feelings. Other typical responses include shock, denial, depression,
changes in eating and sleeping patterns, and regression to an earlier developmental stage.
This age group tends to have more coping
strategies available than younger children and
may fantasize how they would prevent the death
from happening again as a way to gain control
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over the situation. Death is also play-acted in children at this age, for example, through war games,
especially for those children who have difficulty
expressing feelings verbally.
Children in this age group may assume the role
of the deceased in the family or the mannerisms
of the deceased. They may also take on tasks or
chores normally performed by the deceased, such
as care for their siblings. They may idealize the
deceased as a way of maintaining a bond with
them.
PREADOLESCENT (AGES 10–12)
None of my friends could ever relate to what it’s like
losing their Dad.
While I know that Grandma is not coming back and
I will miss her, I don’t understand why my Mom is
so upset about it
Preadolescents conceive of death in much the
same way as children in the middle years with
a few additions. Preadolescents are in the process of establishing their own identity, increasing
their independence from their parents and other
adults and increasing their dependence on their
peer group. In understanding death, preadolescents attempt to understand both the biologic and
emotional process of death. They are, however,
more able to understand the facts surrounding
the death of someone than they are the feelings
surrounding the death.
It is common for preadolescents to want to
cover up their feelings about their loss so as not
to appear “different” from their peer group. They
fear that expressing sad feelings may be seen as a
sign of weakness (particularly for boys). For this
reason, they may appear removed and indifferent. Preadolescents may also express their grief
feelings in uncharacteristic ways such as through
anger outbursts, irritability, and bullying behavior. Feelings may also be exhibited through physical complaints, moodiness, changes in sleeping
and eating patterns, indifference toward schoolwork, or isolation from their peers. They may
639
show concern for practical issues after the death
such as how the household will survive without the deceased or how they personally will be
taken care of. They also might have questions regarding religious and cultural beliefs related to
death.
ADOLESCENT (AGES 13–15)
These years are often marked by stressful physical changes. Boys are usually a little slower to
mature than girls in this age range, but the stress
of change is ever-present—from radical growth
spurts to facial skin problems. Teens in this age
range are seeking to establish their unique identity, often separate from parents and family. They
are beginning to think about spiritual and philosophical ideas for the first time in truly abstract
ways. And, they generally experience powerful
and deep emotions that they may feel no one can
understand.
One of the difficult tasks a grieving teenager
faces is integrating loss into his or her current
emotional life. This integration can be compounded by physical and hormonal changes.
Grief may be expressed by frequent headaches
or stomach aches, or through feeling sad and depressed. Another common reaction is for middle
teens to manifest their grief in mood swings and
outbursts of anger. Some teens withdraw to a safe
place, such as a bedroom, where the anger may
be acted out by pounding on a wall or beating a
pillow. Some may act out the anger through inappropriate social behavior, pouting, or aggression
toward others. Grades may decline in part due
to sleep disturbances, which are often combined
with depression and a general feeling of meaninglessness.
It is not unusual for middle teens, both girls
and boys, to want a special “friend,” such as
a teddy bear to hug and sleep with during this
time. It may be important for a caregiver to protect this information from other family members
and friends, especially in the case of a boy. The
teenager also may want to wear a special article
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of clothing that belonged to the deceased. He or
she may adopt certain mannerisms or behaviors
associated with the deceased loved one, or idealize his or her relationship with the deceased.
Being tolerant of what may be seen as “childish”
or immature behavior allows middle teenagers to
process the loss in their own, personal and important ways.
ADOLESCENT (AGES 15–18)
Adolescents in the 15 to 18-year-old age group
are in the process of becoming young adults.
They want to be treated with respect and collegiality. Providing assistance to grieving adolescents, therefore, can be complicated by the
fact that although they may be young adults,
they do not have the full experience of adulthood. They are also in the process of differentiating and distancing themselves from the parental
figures in their lives. The peer group is their
major authority—and how they are seen and
judged by their peers is of primary importance to
them.
These older teens often become sullen and
noncommunicative. Their anger may be expressed through exaggerated conflict with parental figures, pushing hard to overturn formerly
understood limits. They may become insecure
about the future, question the meaning of life,
and question or abandon the family’s belief system. They may have sleep problems, such as
recurrent or disturbing dreams and insomnia.
Sometimes they regress and become immature
and childish, or they mask their fears with jokes
and sarcastic remarks.
Sometimes, older adolescents who suffer a loss
may idealize the deceased loved one. They may
adopt mannerisms, habits, and preferences of the
deceased. They may want to wear certain items
of clothing, especially a hat, shirt, or jacket that
belonged to their special loved one. Or they may
react by feeling abandoned and angry at unfulfilled expectations in their relationship with the
deceased.
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Specific Populations
NORMAL GRIEF REACTIONS
IN CHILDREN
We now examine more in detail the typical and
normal grief reactions that children and adolescents experience during the grief process. Some
grief reactions with children occur immediately
and others may occur at a later point. In general,
children’s grief tends to manifest in physical and
behavioral expression rather than verbal expression.
In addition to developmental level and chronologic age, the main factors that influence how a
child grieves are the relationship with the person that has died, the nature of the death (when,
how, and where the person died), the child’s own
personality, previous experiences with death, religious, and cultural beliefs, input from the media, and above all, what they are taught about
death and grief from adults and the availability
of family, social, and community support. The
more common physical, cognitive, and behavioral
reactions that may occur to children during the
normal grief process are listed in Table 27–1 and
are discussed below.
PHYSICAL SYMPTOMS
I don’t feel good. I feel sick to my stomach.
Last night I dreamed that Johnny came back to visit
me. He was all grown up, though, and he had a
mean look and wanted to hurt me.
Chief somatic complaints of a grieving child
include headaches, stomach aches, fatigue, lack
of energy, muscle aches, tightness in the throat,
difficulty breathing (especially when they first
learn about the death), skin rashes, change
in eating patterns (lack of appetite or excessive appetite), change in sleeping patterns (both
falling asleep, staying asleep, and sometimes prolonged sleeping), odd and frightening dreams,
hyperactivity and hypersensitivity (especially if
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TABLE 27–1. Normal Grief Reactions in Children
REACTION
EXAMPLES
Muscle aches
Throat tightness
Skin rashes
Hyperactivity
Hypersensitivity
Changes in eating habits
Difficulty breathing
Changes in sleep habits
Odd and frightening dreams
Physical symptoms
Headache
Stomach ache
Fatigue
Lack of energy
Cognitive symptoms
Inability to concentrate
Obsessed with or preoccupied with deceased
Preoccupation with the death, or the meaning of death
Carrying objects owned by the deceased
Repetitively looking at photos of the deceased
Visual hallucinations of the deceased
Adopting deceased’s roles or physical mannerisms
Emotional shock
Anger and acting out
Denial
Regressive behavior
Sadness, despair
Fear, anxiety, panic
Depression
Jealousy
Guilt, shame, self-blame
Acceptance
Behavioral changes
the loss was traumatic). Most of these physical
symptoms are temporary and go away with time
when the child begins to receive adequate grief
support. Some children develop physical symptoms that resemble the symptoms of the illness
that they observed in the deceased. This may be
a child’s attempt to stay connected in some way
with the deceased or a way to express his or her
own fear about getting sick. When children receive a great deal of attention for their physical
symptoms, they may exaggerate the “sick role”
as a means to obtain socially acceptable attention
for their grief feelings.
COGNITIVE SYMPTOMS
I couldn’t focus on my school work today. I don’t
remember one thing that I learned.
My Dad was the best father in the world. He never
even once got mad at me
When I went to sleep last night, my Mom came and
sat in the chair by my bed.
Many bereaved children describe an inability
to concentrate for any length of time after a significant loss. Their thoughts seem to be taken up
with the death and loss of their loved one. Rabbi
Earl A. Grollman discusses how children idealize
the deceased as a way of coping with their loss.
In an attempt to counter unhappy thoughts, the
child may become obsessed with only the positive qualities of the deceased. Some older children become preoccupied with “why” the death
happened, may want to know all the facts surrounding the death, and may search for the
“meaning” of the death. Some children search
for their lost loved ones with the hope of finding them. They may seek out places they used to
go together. Other children become temporarily
preoccupied with memories of the deceased, asking other adults to tell stories about the deceased
over and over again, carrying objects of the deceased around with them, and looking at photos
repetitively.
Visual hallucinations of the deceased are also
common and are experienced as very real to the
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child. Sometimes they can be comforting and
other times terrifying. Identification with the deceased by incorporating mannerisms or taking on
the deceased’s roles such as disciplining the other
children are also common. All these behaviors
are an attempt by the bereaved child to reconnect and relate to his or her deceased loved one.
They should all be viewed as a normal part of the
grief process unless they persist unnaturally long
or cause a great deal of distress for the child.
EMOTIONAL SHOCK AND DENIAL
I don’t believe you. My mother will come back. You
are wrong.
Even though it’s a year later, I still can’t believe that
Grandma is gone.
Usually, when the realization of the death is too
overwhelming, the child temporarily denies that it
happened. Denial of the death is not unusual, but
it can be difficult for adults to endure. It should
be viewed as a protective mechanism; a way for
the child to comprehend painful information at
the speed with which they are ready. Denial is
most common in the first few months following
the death, but may reappear at different times
throughout the grief process.
SADNESS, DESPAIR, AND DEPRESSION
I don’t want to live without my Dad.
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Specific Populations
ANGER AND ACTING-OUT BEHAVIOR
I hate you and wish you had died instead of Dad.
I hate school. I hate my friends. I hate my family. I
hate my life. I hate everything.
It is often easier for children to feel mad, then
to feel sad and children typically strike out with
anger at the people with whom they feel closest
and most safe. There are many reasons why grieving children feel angry. They may feel angry at the
person who died for leaving them, angry at God,
at others in their family, and at the doctor for not
doing more to save their loved one. They may
be angry at themselves because they believe they
caused the death (magical thinking) or that they
did not do enough to prevent the death. Anger
often originates from feelings of helplessness and
lack of control.
There are some bereaved children that channel
their anger by defying authority, rebelling against
everything and by displaying somewhat antisocial tendencies. Antisocial behavior in a bereaved
child is often an attempt to keep themselves away
from any close relationships and the possibility
of being “abandoned” again. It is important to
note that anger expression generally is more socially acceptable among boys than girls. Younger
children are often more physically expressive and
direct when they are angry. They throw things, hit
and kick, and have tantrums. Anger outbursts are
often set off by seemingly unimportant triggers in
bereaved children.
I miss my Mommy and I want her back.
There are many different ways that children
exhibit feelings of sadness and despair following
a loss. They may express it verbally, nonverbally
through a depressed demeanor, through tears,
or by becoming withdrawn, isolated, and quiet.
Children sometimes react in total despair and are
inconsolable when they first learn the news of the
death. The full realization of the loss does not
happen all at once, but as it does, sadness, loneliness, and depression can follow.
REGRESSIVE BEHAVIORS
It is very common for bereaved children to
regress in some way to an earlier developmental or chronologic age. Death of a loved one can
cause complete disruption in their routine and in
their sense of safety, and regression to a time in
their life where they felt more secure and familiar should be seen as a healthy adaptation to a
traumatic situation. Usually, regressive behaviors
are temporary and subside with time as the child
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receives appropriate grief support. It is important
that adults in a grieving child’s life find a balance
between allowing the regression and gently expecting the child to return to his or her former
level of functioning.
Examples of regressive behaviors include
bedwetting and thumb sucking, difficulty separating from significant others, demanding attention, regressing from prior advances toward
independence, difficulty with developmentally
appropriate tasks, needing to sleep in parent’s
bed, needing to be held or rocked, reverting to
fantasies of an earlier age, talking in baby language, giggling inappropriately, and inability to
function with peers.
FEAR, ANXIETY, AND PANIC
Are you going to die when you go to sleep tonight
like Grandma did?
Who is going to take me to school now that Daddy
died?
643
GUILT, SHAME, AND SELF-BLAME
It’s all my fault that Janey died. I told her I wished
she was dead when she broke my doll and now she
is dead.
I never liked my brother. He always teased me. Now
I feel so guilty because he died.
Bereaved children sometimes believe they are
responsible for the death, especially if they had
ever wished the deceased dead. Some children
feel guilty if they experience relief that the person
has died, even though this is very normal reaction,
especially if their loved one had been suffering.
Other children feel guilty because they had a difficult relationship with the deceased. Frequently
interrelated to self-blame is a sense of helplessness and worthlessness. If grieving children feel
helpless, they may try to gain some control by
thinking what they would have done differently
to change the situation.
JEALOUSY
I think I’m going to get cancer too.
Children often react with fear and panic when
they lose someone significant to them and may
be afraid of the intensity of their own feelings.
They become concerned about how other grieving adults will fare. They worry as well about
the changes in care-giving and nurturance that
come with the loss. Some grieving children become concerned that someone else close to them
will die and that they will have to feel that pain
again. In some cases, these children withdraw
from other important adults so as not to repeat
the hurt.
Bereaved children often feel afraid of becoming sick or of dying themselves. They may become
afraid of the dark, of sleeping alone and of being
separated from or abandoned by other significant
adults. Unfortunately, this is especially true if a
parent has died and the other parent is somewhat
detached from the child because of the parent’s
own grief reaction.
I can’t go to the Father/Daughter dance because I
don’t have a father.
I hate when all the kids at school talk badly about
their parents. They should feel lucky they HAVE
parents.
It is very common for bereaved children to feel
like they have been short-changed in some way,
especially if the loss is that of a parent. It becomes particularly difficult for them during holidays such as Mother’s or Father’s Day, at their
birthdays or graduations, and when they receive
awards, because all these events serve as continual
reminders to them of their loss. Feeling jealous
that other children have parents is very common.
ACCEPTANCE
When Dad first died I thought my life was over.
Now I feel like I’m starting to look forward to things
again.
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J. William Worden, a leading expert in grief
and loss, describes the process by which a child
begins to accept a significant loss. Acceptance of
the loss comes gradually as does the understanding that the death is final. Most children describe
a kind of “new normal” as they begin to adjust
to the loss. They still think about their loved one
that died and understand that their life has been
changed, but they begin to reconstruct a life without their loved one in it. In the case of the death of
a parent, they begin to feel secure that they will be
taken care of and will have their needs met. They
realize there are other significant adults available
for support. Older children sometime state that
going through a grief experience allowed then to
learn to feel more compassion toward others and
more tolerance for other problems and challenges
in their own lives.
Alan Wolfelt, another leading expert on children’s grief, calls the healing process that grieving children go through “reconciliation.” He says
that reconciliation happens when a whole and
healthy person emerges from grief. The person
recognizes that life will be different without the
presence of the significant person who has died.
Reconciliation is a process not an event, and it
does not occur all at once—it is a slow, painful
process. The most notable changes during the
child’s “reconciliation” process include a return
to stable eating and sleeping patterns, a renewed
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Specific Populations
sense of energy and well-being, a subjective sense
of release from the person who has died, increased thinking and judgment capabilities, the
capacity to enjoy life experiences, a recognition
of the reality and finality of the death, and the
establishment of new and healthy relationships.
NORMAL GRIEF EXPERIENCE
FOR A TEENAGER
By the end of high school, 20% of today’s students will have lost one of their parents; 90% will
have experienced the death of a close relative or
loved one. Add to this that 1 in every 1,500 secondary school students dies each year, and we can
see that death and the resulting grief following
death is a part of everyday life for many teenagers.
Recognizing and providing constructive ways for
teenagers to express their grief will help prevent
prolonged or unresolved grief and depression.
Grief is as unique as the people who experience
it, but there are some reactions to grief that we all
feel and that are considered normal or typical grief
reactions. For teens who experience the death of
a loved one, these typical grief reactions, listed
in Table 27–2, often resemble those described
TABLE 27–2. Normal Grief Experiences for Teenagers
Assuming mannerisms, traits, or wearing clothes of the deceased.
Emotional regression and even bed-wetting, which can be most upsetting for teenagers.
Needing to repeat again and again stories of their loved one
Saying nothing at all
Becoming overly responsible (the “new” man or woman of the house), which distracts
them from their own feelings by taking care of everyone else.
The need to integrate the loss into their budding identity
Anger and lashing out at others that can happen at any time for no real reason
Intense anger at the deceased for dying, and later feelings of guilt for being angry.
Mood changes over the slightest things; unexpected outbursts or crying.
A feeling that the loss is not real and did not happen at all
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earlier for children, albeit in a somewhat older
age context.
Teenagers experience their loss at different
times in their development and the first and second year may be the most difficult. Part of normal development for a teenager is to reintegrate
what they have learned about their loss into their
current developmental stage. Special days and
important times may serve as reminders of their
absent loved one. The process of integrating the
loss may resurface on these special days. For
example, a high school senior wore his deceased
father’s shirt to his graduation exercises. A 19year-old bride proposed her first toast to her deceased grandmother, a most significant figure in
her life.
COMPLICATED GRIEF REACTIONS
IN CHILDREN AND TEENAGERS
Prior to her mother’s death from liver cancer, Sarah
had been doing well in school, was captain of the
gymnastic team and had several close friends. As
Sarah and her Mom were very close, it was expected
that Sarah would have a difficult time adjusting to
her Mom’s death, although everyone remarked how
“well” Sarah was coping as her mother was dying.
Her father explained, “She seemed to hold it all
together so well.” Even after the death, Sarah returned to school and to her normal routine fairly
quickly. “Then all at once everything started to
fall apart. It was as if she finally understood that
her mother was really gone.” Sarah started missing
school and her grades began to slip. She lost interest in gymnastics and quit the gymnastic team. She
had trouble getting out of bed and began saying that
she wished she were dead. She rejected her peers’
attempts at helping her and stopped answering the
phone. Her Dad noticed that she stopped caring
about her appearance and that she even looked disheveled. At first, her Dad was patient and thought
it would pass. He was so involved in his own mourning that he didn’t seem to notice just how serious her
depression had become. He finally called the school
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counselor who referred him to a grief specialist who
worked with children. Sarah was reluctant at first,
not believing that anything would help. Finally, she
agreed to go, began to express her anger and sadness, and over the course of several months began
to resume her normal activities and functioning.
Thus far, the emotional, physical, and behavioral grief responses that have been described are
normal expressions of grief in children and adolescents. A child may experience some or all of
these reactions or may show no overt reaction
at all. However, if any of these typical responses
to grief are prolonged, extreme, pervasive,
affecting the child’s ability to function normally in school or with their peers, or in providing self-care, like in the case with Sarah, the grief
would now be considered “complicated.” Examples of complicated grief reactions are listed in
Table 27–3. When a bereaved child exhibits any
of these behaviors, immediate professional advice and assistance should be sought. There are
many community sources that provide support
for grieving children including school guidance
counselors, pediatricians, clergy, mental health
practitioners, and hospice bereavement personnel. Further discussion of how to manage complicated grief reactions in children and teenagers
can be found below.
PREPARING A CHILD FOR THE
DEATH OF A LOVED ONE
PREDEATH SUPPORT
If an adult can prepare a child or teen for the death
of a loved one, it is important to do so as soon as
possible before the death occurs. First, asking a
child what he or she knows about a loved one’s
illness allows the adult to discover any misperceptions that the child may have, and assists the
adult in knowing where to start from in educating
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TABLE 27–3. Complicated Grief Reactions in Children and Teenagers
BEHAVIOR
Suicidal thoughts and behaviors
Prolonged sleep disturbances
Persistent personality changes
Aggressive behavior
Excessive or inappropriate guilt
Extreme fatigue or loss of energy
on a prolonged daily basis
Extreme withdrawal or isolation
Pervasive fantasies that
interfere with normal
functioning
Phobias that interfere with
functioning
Hypervigilance
Persistent assumption of
mannerisms of the deceased
EXAMPLES
“I just want to kill myself”
Giving away valued possessions
Preoccupation with suicidal themes in media
Desire to be with deceased loved one
Self-punishment ideation or behaviors
Insomnia
Nightmares
Neat, well-groomed child abandons bathing,
grooming, and dressing habits
Eating habits change: too much or too little
Extrovert turns into introvert
Optimist becomes pessimist
Pleasant child becomes a bully
Secure child becomes anxious and afraid
Dangerous risk-taking behaviors
Behavior dangerous to others
Child ruminates how she or he caused death of
loved one
Inability to get out of bed that lasts more than
10 d
Inability to socialize with others
Despair
Depressed affect
Belief that loved one will return, especially if she or
he is good
Fear of getting sick
Fear of dying
Avoiding anything having to do with death
Checking on other parent constantly
Checking themselves and others for symptoms
that mirror those experienced by the deceased
Hyperalertness in a car if loved one died in a car
accident
Assumption of chores and responsibilities of
deceased that are not developmentally
appropriate
Preoccupation with the deceased to the point that it interferes with normal function
Drug and/or alcohol use
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the child about the illness and prognosis. It is imperative that the adult presents the information
in a gentle and calm manner, allowing the child
to voice questions and concerns. Children can
usually absorb only a little information at a time.
It is important to look for “teachable
moments”—moments when the child seems
open to learning. It should be explained that all
living things must die. The adult could show the
child plants and insects that have died and tell
them that because people are living things, they
die too. Explain that the changing seasons are another example of the cycle of life and death. The
child should be told that the images they see of
death in television cartoons are not always authentic and that death is irreversible. The adult
can explain to the child that people usually live a
long life, but that sometimes when someone develops a very serious illness, he or she dies before
becoming old. The adult can also explain that
doctors usually help people live long healthy lives,
but that sometimes even doctors cannot stop
some people’s bodies from malfunctioning. Using
several adjectives like “very, very sick” or “very,
very old” helps the child distinguish between
someone with a common cold versus someone
with a terminal illness and between their parents,
who may seem old to them, and elderly people.
The child should be reassured that this is not a
punishment, or God’s fault or anyone’s fault, but
that sometimes it just happens. She or he can also
be reassured that death is usually not painful and
that it is almost always quiet.
When a loved one is dying, if a child is old
enough to understand what is happening and
both the child and the dying person would like
to see each other, the child should be allowed
to visit the loved one. The child should be prepared beforehand about what she or he might
see or hear and what feelings might be experienced. The child should be told what the loved
one might look like, and the setting, including
medical equipment if applicable, should be described. Depending on the age of the child, it may
be advisable to keep the visit short. Visiting with
a dying loved one might be a way for a child to
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understand the reality of the death, and a way for
important communication to take place between
the child and the loved one. The key is that the
visit must be the child’s choice. If the child does
not want to visit, a supportive adult should attempt to elicit why the child is resistant, but the
child’s wishes should be honored.
Throughout the illness, a child should be told
about changes in a loved one’s condition as they
arise. A child should be allowed to care for a loved
one in a way that he or she chooses, be it through
writing cards or bringing a glass of water or tissues. Sometimes, caring for a dying loved one allows a child to feel less helpless.
HOW TO TALK TO A CHILD WHEN THE
DEATH OCCURS
Ideally, a child or teen should be told in a gentle
and caring way about the death as soon as it occurs, by someone they trust and feel close to. It
might be helpful to prepare the child for the news
by saying, “I’m afraid I have some bad news.”
The explanation should be kept simple, avoiding euphemisms such as, “passed away,” “expired,” “went away,” or “went to sleep.” These
euphemisms may cause the child to believe the
person will come back or wake up, or conversely,
may cause the child to be afraid to go to sleep at
night. A suggested approach might be, “Daddy
has died. He was very, very sick. Daddy had a disease that made him very weak and he was not able
to get better. Daddy is now unable to move, feel,
talk, eat, or hurt anymore.” By being direct, the
child’s confusion and fantasies about what happened are usually diminished.
When a child is told about the death of a loved
one, she or he needs to be allowed a lot of time
for expressing reactions and feelings, as well as
for raising questions and concerns. By sharing
their own feelings with a child, adults can help
normalize what the child might be feeling. The
child should also be made aware of what others
in their environment may be feeling and thinking
and should be reminded that sadness, anger, and
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fear are all normal feelings when someone dies.
It is also important that the child is told what funeral arrangements or rituals will happen next, so
they know what to expect. They should be reassured by being told specifically what will happen
to them and how they will be taken care of.
TYPICAL QUESTIONS THAT CHILDREN
HAVE ABOUT DEATH
It is important that the questions posed by children and adolescents are answered in a specific,
straightforward, and brief fashion, and reflect the
developmental level of the child. Children can
usually absorb only bits of information at a time
so it is important to pay attention to their cues.
Checking to see if a child has understood what
has been said is also critical. Adults unsure of the
meaning behind a child’s question should probe
further by asking what the child meant or knows
about the topic. Children often repeat the same
questions merely as a way to assimilate the answers. It is also okay for adults to tell the child
they do not know the answer to a specific question.
Some of the most common questions children
ask are the following:
Why did daddy die?: It is important to probe
further to assess whether they are asking
this question because they feel sad, angry, or
guilty about the death. If so, it is imperative
to allow the child to express those thoughts
and feelings. The child should be reassured
that death does not seem fair. It may also
be that they are asking about the physical
process of death.
When is mommy coming back?: It is okay to tell a
child in a gentle loving way that people who
die do not come back; that as much as she
or he may want mommy to come back, she
can’t because she is dead. Sometimes, it is
reassuring for a child to know that she or he
can always hold onto feelings and memories
about a loved one and that in that way, the
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Specific Populations
loved one will always be with him or her. It
may also be reassuring for a child to know
that the feelings of sadness that he or she is
experiencing about a loved one being gone
will go away over time.
Where is daddy now?: Before answering this
question, it is helpful to know where the
child thinks daddy is. The adult’s response
would then be based on that belief. If
the child believes daddy is in heaven, because that is the family’s spiritual belief,
than that belief should be validated. Also,
to minimize confusion, it might be helpful
to remind the child about the burial, for example, that the loved one was placed in a
casket underground.
Will you die too?: It is important when answering this question to give reassurance and
support and also to answer honestly. An example would be: “I will die sometime but I
hope to be here a long time yet. I do not have
any serious illnesses.” Sometimes when a
child asks this question, she or he is afraid of
losing another loved one. A clarifying question might be,” Are you worried that I won’t
be here to care for you?”
How long will I live?: A response might be that
no one knows how long they will live, but
that no one lives forever. The child should
be reassured that most people live until they
are old and that many old people are not
worried about death.
GUIDELINES FOR HELPING
BEREAVED CHILDREN
EXPRESS THEIR GRIEF
A hundred years ago death was much more a natural part of a child’s experience. Grandparents
often lived with families, so children witnessed
them growing older and dying. Modern medicine
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has made strides in reducing infant and child
mortality and has prolonged life expectancy for
the elderly, so children witness fewer deaths.
More and more elderly die in nursing homes and
hospitals, outside the home environment. The exclusion of death from children’s lives requires us
to teach them explicitly about death and grief.
In Mourning and Melancholia, Sigmund Freud
outlined his belief that young children did not
have the capacity to mourn. He believed that only
as a child developed into an adolescent did they
acquire the ego capacity to grieve. More contemporary research has concluded that children do
in fact have the capacity to experience and express grief, but it is often more intermittent and
drawn out over a longer period of time than with
adult grief. General guidelines for helping children express their grief are presented in Table
27–4, whereas guidelines that address some of
the most common specific feelings that children
experience are listed in Table 27–5.
TABLE 27–4. General Guidelines for
Helping Grieving Children
Express Grief
Allow children to express grief in their own ways.
Do not pressure children to resume normal
activities before they are ready.
Allow children to feel that it is OK to talk about
death and grief.
Be available to listen.
Let children know that having and expressing
feelings are normal.
Avoid expressions that suppress grief.
Gently intervene if the child is taking on the role
of a bereaved adult.
Grieving adults should not hide feelings from
children.
Allow children to express religious and spiritual
concerns.
Allow children to remain in familiar
surroundings. Avoid sending children away.
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The grieving process helps people heal from
their pain. Pain is a natural reaction when we lose
someone close and children are capable of accepting pain of loss directly and openly. When adults
try to protect children from such pain, they are
usually, in reality, trying to protect themselves.
The most important thing to remember in helping children cope with the death of a loved one is
to allow them to express their grief in their own
way and in their own time. It is important not to
pressure children to resume their normal activities if they are not ready.
Children tend to have “grief bursts” followed
by play and normal activities. Children may not
be able to succinctly verbalize what they are feeling and instead may demonstrate their feelings
through their behavior and play. They may laugh
or play at a time that feels inappropriate to an
adult.
Children need to feel that it is okay to talk
about death and grief. However, if a child does
not want to talk about grief, adults also need to
respect that desire. Adults should let the grieving child know that they are available to listen
and help and that any feelings they have, such as
anger, sadness, fear or regret, are normal. Hugging and touching helps the grieving child feel
secure in expressing emotions and also reassures
the child that he or she is loved and will be cared
for. Alan Wolfelt feels that if grieving children are
ignored, they may suffer more from the sense of
isolation that from the loss itself.
Messages relayed to a grieving child such as
“Don’t cry. You need to be strong,” “You’re the
man in the family now,” or “Be a good girl. Your
mommy needs your help now more than ever,”
suppress grief expression in children and set up
unfair expectations of them. Adults should gently intervene if they observe a child taking on the
roles and tasks of a bereaved adult. Grieving children should not be allowed to take on the role of
the “confidante” or partner of one parent if the
other has died.
It is important that adults not hide their
own feelings of grief from a bereaved child. If
they do, they teach them that experiencing these
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TABLE 27–5. Guidelines for Managing Specific Expressions of Grief
EXPRESSION
Sadness/depression
Anger
Guilt and regret
Fear
Physical complaints
SUGGESTED ACTIONS
Draw memories of the deceased and show to others
Show photographs and describe keepsakes to others
Develop a memory scrapbook
Engage in physical activity
Allow child to dissipate anger with various activities
Ask children about their anger
Ask the child to suggest ways of responding to anger
Maintain household rules and chores
Write a letter or draw a picture describing “unfinished business”
with the deceased
Write a note about feelings of guilt and tie it to a helium balloon
in order to “let it go”
Create puppets so that child puppet can talk to puppet of the
deceased
Help child identify fears
Provide repetitive reassurance that all will be OK
Spend time alone with child and reassure that s/he is special and
loved
Ask about other possible feelings, symptoms, or emotions
Remind the child why the death occurred
Pediatrician visit to reassure child
feelings are not okay, that they are something to
be ashamed of or to be kept to oneself. It is also
true that grieving adults should not grieve profusely and at length in front of a child as it might
frighten and worry the child.
Religion is an important source of strength for
many adults and children during the grief process. Children takes things literally, so explanations such as “It is God’s will” or “Bonnie is
happy in heaven” could be frightening or confusing rather than comforting, particularly if religion
has not played an important role in the child’s life.
It’s important to inquire how the child perceives
what is explained about the death. It is also important that children be allowed to express their
religious and spiritual concerns.
Parents may be tempted to “send children
away” when there is a loss—either to protect them
from painful feelings or because it is difficult to
care for them while grieving themselves. During
the grieving period, children are often most comforted by familiar surroundings and routines, and
separation may increase their fears about abandonment.
SADNESS/DEPRESSION
Grieving children that are sad or depressed require a lot of support and attention so that they
can express their sad feelings and work them
through. Helen Fitzgerald, a well-known children’s grief therapist, recommends several techniques for helping a depressed grieving child. She
suggests having the child draw good and bad
memories of the deceased and share them with
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others. The child could also could show photographs and describe keepsakes to others and
develop a memory scrapbook. For a child that
feels so despaired about a loss, it might be helpful to ask the child to fantasize how life might be
different if she or he was not so sad. Encouraging
the child to engage in physical activity is another
useful technique with a depressed child.
Johnny was very withdrawn and depressed for several months after the death of his mother. Finally,
his grief counselor suggested he make a “God box”
where he could write down all his sad feelings and
put them in the box and God would help him
feel better. He wrote a new note almost every day
and soon his father noticed that he seemed more
cheerful.
ANGER
It is sometimes easier for a child to feel mad rather
than sad or guilty. Anger is not always rational and
it can escalate by feeding upon itself. Anger does
need to be expressed, however, and adults can
be helpful in teaching grieving children how to
express anger in constructive ways. Unexpressed
anger can turn into depression or into anger that
is out of control.
Children generally tend to express their anger
physiologically. Instead of asking an angry child
to “calm down” it may be more useful to allow
them to dissipate their anger in other ways such
as running, exercising, scribbling on paper, ripping paper, singing, and sculpting play dough.
It is important to not try to deal with the cause
of anger until the intensity has decreased. Adults
can ask children questions about their anger at a
time when they are not angry. It might be helpful
to ask questions like, “What usually leads to your
feeling angry?” or “How does your body tell you
that you are becoming angry?” Examining these
precipitating factors usually diminishes the intensity if the anger and gives the child a sense of control by learning what triggers an angry response.
It is helpful to ask the child what he or she
thinks are more appropriate ways to respond to
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angry feelings. It is also appropriate for an adult
to set a limit with an angry bereaved child who is
acting out. “It’s not okay to hit me but you can
hit this pillow.” Maintaining household rules and
chores actually increases the sense of normalcy
and security for a grieving child.
Stephen had been very close to his grandfather
and when he died, his parents noticed he began
bullying his younger siblings and picking fights at
school. They called his football coach who suggested that Stephen might “work out” some of his
aggression by staying after practice and “ramming”
the dummy players. After two weeks of “extra” practices, Stephen was much less aggressive with other
children.
GUILT AND REGRETS
Some children have regrets about negative aspects of the relationship with the deceased or regrets about things that did not happen or were
not said prior to the death. Examples might be:
“I never told my mother I loved her,” “I lied to
my father and never told him the truth,” “I was
mad at my Mom the day she died,” or “I didn’t
have a chance to say goodbye.”
Helen Fitzgerald describes some techniques
that are useful with children in helping them work
through feelings of guilt and regret. One suggestion is to write a letter to or draw a picture for the
deceased describing their “unfinished business.”
Another suggestion is to have the child write a
note about what she or he feels guilty about, tie
the note to a helium balloon, and then release
the balloon into the sky. For younger children,
she suggests making two puppets and drawing
one puppet face as the child and the other as the
deceased person. The child puppet could tell the
puppet of the deceased what they feel guilty about
or what they regret about the relationship.
After her mother’s death, Emily’s father noticed
that she seemed very preoccupied and unable to
focus on her schoolwork. After several months,
he referred her to the school counselor who had
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experience in working with bereaved children.
When she suggested Emily write letters to her
mother, Emily seemed relieved to be able to “communicate” with her mother in this way. Emily then
asked the counselor to read the letters. They were
full of ways that Emily believed she could have prevented her mother’s death. After several of these
letters and the counselor’s educating Emily on the
nature of her mother’s serious illness, Emily began
to relax and was able to focus on her school work
again.
FEARS
It is important to help fearful children identify
what they are afraid of specifically and then to
address each fear individually. Children who are
fearful generally need repetitive reassurance that
they will be OK. It is also important that a parent
or other significant adult spend time alone with
and focused on the grieving child, reassuring the
child that they are special and loved.
Both of Anwar’s siblings had been killed in an automobile accident. Anwar was terrified of riding in a
car for months after their death and was also afraid
that someone else close to him would die. His parents and family provided a great deal of love and
support during this time. His father decided to help
him confront his fear of riding in the car by taking
incremental steps. First they sat in the car for a long
time as Anwar expressed sorrow about his loss and
his anger at the driver that hit the car. Later, his
father backed out of the driveway reassuring Anwar
that he was safe. The next day he drove down the
street assuring Anwar about how accomplished a
driver he was. Soon Anwar was able to ride in a car
again without fear.
PHYSICAL COMPLAINTS
When grieving children routinely have physical
complaints like headaches and stomach aches, it
is sometimes helpful to ask what other feelings
they may be having as well. They may not disclose their emotions right away, but they may begin to make their own connection between their
physical and emotional concerns.
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If the physical complaints mirror those of the
deceased, it is helpful to remind a child why the
death happened. A visit to the pediatrician may
also be advised, so the child can hear reassurance
from the doctor that nothing is wrong with them.
Jose complained of headaches for weeks after his father’s death. He was the oldest son and felt he had to
be “strong” for his other siblings and for his mother,
so he expressed very little emotion. Two months
after his father’s death, his uncle asked Jose if he
wanted to visit the cemetery. When they arrived,
Jose began to cry when they came to the grave. He
and his uncle spent several hours while Jose talked
to his father and reminisced with his uncle. After
that, Jose no longer complained about headaches.
BEREAVEMENT SUPPORT GROUPS FOR
GRIEVING CHILDREN
Child bereavement support groups are among
the most successful ways to provide support to
a grieving child, particularly for older children.
Donna L. Schuurman, Executive Director of the
Doughy Center, an agency that specializes in the
grief and loss issues of children, suggests that children should be grouped by age and developmental level in grief groups. She also suggests that
mixing death types and relationships to the deceased are acceptable but that children experiencing different losses (i.e., divorce, death) should
not be mixed in the same group. Children support
groups are typically less structured than adult
groups and usually incorporate play time.
One of the most important reasons that bereavement groups are helpful is that grieving children discover in the group that there are other
children whose experiences are similar to theirs.
Being in a peer group with other bereaved children helps normalize their experience and reactions, helps then to understand that their feelings
are important, and allows them to feel hopeful by
listening to other children who are coping successfully. In bereavement support groups, children learn that they can express themselves in
healthy ways and also learn tips from one another
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about how to deal with similar emotions and circumstances.
SUPPORT FROM SCHOOLS FOR
GRIEVING CHILDREN
Children spend a great deal of time in school
and both teachers and peers can be an important source of support for a grieving child. Teachers and school counselors should be told about
the progress of the illness while the child’s loved
one is still alive and of the death when it happens. The teacher should be aware of what the
child knows about the illness and could be given
advice on how best to support the child. Teachers can also help by monitoring the child’s emotional state and behaviors in the time following
the death. The school may need to alter assignments or provide extra instructional assistance for
a grieving child.
The teacher should share with the child’s classmates’ information about the death and also provide guidance on what they can do and say and
how they might be helpful when the grieving
child returns to the classroom. Children could be
prompted to say, “I was sorry to hear about your
sister,” or “I felt sad when I heard about your father dying.” Welcome back posters or sympathy
cards are very appropriate.
It is important to remember that some children
spend more time processing their loss with peers
than with other adults. On the other hand, some
children, especially older children, do not want to
feel different than their peers and may be hesitant
to share their loss as it might single them out as
different from others.
PLAY THERAPY FOR GRIEVING CHILDREN
A child’s play is often the main avenue through
which a grieving child expresses his or her grief,
particularly younger children. When young children are trying to comprehend death, one can
often observe rituals where they bury animals
and insects in the ground or use dolls and action
653
figures to play out the both the dying and grief
processes. Through play, children can take apart
traumatic experiences and replay them in a way
that is comforting to them, and they can do this
in relative safety, one step removed from reality.
If parents or teachers find that a child’s play has
taken on a rigid, sad, or repetitive character, they
should talk openly with the child about what is
being experienced.
Many grief therapists who work with young
grieving children use play therapy to assist the
child in coming to terms with their loss. The
advantages of play therapy are that young children tend to have a limited verbal ability for describing their feelings, they tend to have a limited
emotional capacity to tolerate stress and the pain
of loss, they have a shorter attention span, and
finally, young children communicate their feelings, wishes, fears and attempted resolutions to
their problems through play. The goals of therapy for the bereaved child are to help facilitate the
mourning process and to help clarify any cognitive confusion the child may have about the death.
GUIDELINES FOR HELPING
GRIEVING TEENS
Table 27–6 presents the “Bill of Rights for Grieving Teens.” Written by a grieving teenager, this
document, is, in essence, guidelines for how to
assist teens who are bereaved.
The most important thing an adult caregiver
can do for grieving teens is to be available to them.
Availability means being approachable, nonjudgmental, caring, and appropriate. Letting
them know you are there to talk at any time and
letting them know you will hear what they are
saying, no matter what it is, will make all the difference in your ability to be a helpful presence for
teenagers who have suffered a loss.
Do not assume they will come to you to talk.
You will need to ask if they want to talk. And, if
a grieving teen asks, “What do you want to talk
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TABLE 27–6. Bill of Rights for Grieving Teens
A grieving teen has the right . . . .
r To know the truth about the death, the deceased, and the circumstances
r To have questions answered honestly
r To be heard with dignity and respect
r To be silent and not tell you her or his grief emotions and thoughts
r To not agree with your perceptions and conclusions
r To see the person who died and the place of death
r To grieve any way he or she wants without hurting self or others
r To feel all the feelings and to think all the thoughts of his or her own unique grief
r To not have to follow the “Stages of Grief” as outlined in a high school health book
r To grieve in one’s own unique, individual way without censorship
r To be angry at death, at the person who died, at God, at self, and at others
r To have his or her own theologic and philosophic beliefs about life and death
r To be involved in the decisions about rituals related to the death
r To not be taken advantage of in this vulnerable mourning condition
r To have irrational guilt about how he or she could have intervened to stop the death
Written by teenagers at the Dougy Center (http://www.dougy.org/grief-resources/bill-of-rights/); Reprinted with
permission of the Doughy Center, Portland, OR.
about?” tell him or her. Be open and address your
own feelings or difficulties regarding your loved
one’s death. Be honest. Avoid euphemisms such
as, “passed on” or “left us.” Use the deceased
person’s name or family role (like mother, grandmother, etc.). It’s also OK to say, “I don’t know”
if she or he asks you a difficult question. Don’t
pretend to understand something that you don’t;
your teenager likely will learn that you don’t, if he
or she doesn’t pick up on it immediately. Then be
open to just listening. Ask leading questions that
invite your teenager to talk to you. Review the
conversation, asking your teenager to summarize
what you discussed. This provides opportunities
to clarify if there are misconceptions or misunderstandings.
If you are unable to talk about death with your
teenager, find someone else who feels comfortable talking about it, like another relative, another
bereaved teen, or a professional, such as a social
worker, faith practitioner, or school counselor.
Share your own thoughts, concerns, and feelings. Acceptable expressions of grief will be
demonstrated by your example. Give your
teenagers permission to grieve by allowing them
to see you grieve. Telling stories, reading, and
writing poetry and journaling are all useful means
of expressing one’s grief. These things could be
shared with others or not.
Share and discuss religious beliefs with your
teenager. If your teenager has spiritual questions
you can’t answer, admit it and seek the assistance of your faith professional (minister, priest,
rabbi, imam). Try not to react negatively if your
teenager is expressing faith or beliefs that are different from the accepted family practice. Older
teens especially will be developing their own faith
practices to prepare for future losses. This may
require some religious “experimentation” on the
older teen’s part. Refer him or her to your local
faith professional.
Being an adult companion to a bereaved teen,
especially if you are a parental figure, may make
you the focal point of anger and, perhaps, cruel
remarks. This can be especially difficult to tolerate if you are experiencing your own grief. Try
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not to engage the teenager in a way that will
result in building barriers, but shift the focus
to the underlying pain the teenager is trying to
mask with these remarks. The bereaved teen may
not be approachable at the moment that the remarks are made; you may want to establish a
time to talk in the future and describe what you
want to talk about when making your “appointment.”
Times before, during and immediately after a
death are disruptive. Try to re-establish a routine,
with appropriate expectations and limits, as soon
as possible. Teenagers as well as younger children need the reassurance and sense of security
that comes from structure, rules and limits. The
main difference in an older teen is that you should
be open to negotiate the rules and limits appropriate to the teen’s age. Remembering your own
fears and anxieties during this period of your life
may help you be less rigid and more reasonable
in negotiating rules and limits.
Teens need to be allowed to mourn intermittently. Two teenagers who were present for the
home death of their father were seen playing
video games within an hour of his death. Some
family members wondered if this was “appropriate” behavior. It was fortunate that a hospice
professional was present to reassure the family
that this was normal, and that teenagers need
to be given room to mourn in their own ways.
Sometimes the overwhelming nature of the loss
requires teenagers to “take a break” from their
mourning and engage in whatever may distract
them from the loss. Also be ready for mood swings
and emotional expressions at unexpected times.
Be prepared for resurfacing of emotions on special days or anniversaries, such as birthdays, holidays, and the anniversary of the death.
The secure presence of some understanding,
caring and appropriately affectionate adult role
models can make all the difference to a teenager’s
experience of and ability to cope with his or
her grief. Remember that each teenager’s grief
is unique. Let him or her teach you what the loss
means and then help the teenager to his or her
own meaning as he or she grows up with this loss.
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In most cases, teenagers who have experienced
the death of a loved one will not need professional
help. Continuing to live a routine life in a loving
caring environment of friends, family and community will provide the support and refuge they
need to learn to live with their loss and prepare
for future losses life undoubtedly will put in their
way.
However, in some situations, professional help
is needed. After any experience of violent death,
whether that violence is manmade (such as murder, an act of war or mob violence) or natural
(such as flood, tornado, earthquake, or hurricane), the evaluation of a caring family-oriented
healthcare professional may be appropriate. In
these situations, the possibility of long-term complications, such as posttraumatic stress disorders,
should be addressed.
Always seek professional help and evaluation
if the teen has developed symptoms that are of a
concern to you. Grief is often expressed through
behavior. Your teenager needs to hear that you
care about him or her even if the teen is acting
out. If grief is severe or prolonged, don’t hesitate to seek grief counseling for your teenager.
Family and friends can provide a wealth of support, when relationships are established that are
trusting and appropriate. Individual counseling
can help address personal issues. Child and family counselors are a primary source of assistance
to the whole family in grief. Support groups can
help your teenager feel less isolated and different from other teens. Peer groups are usually
more authoritative than parents during the teen
years. A well-facilitated youth group can help immensely with teenagers’ grief.
When seeking grief counseling for a bereaved teen, the first place to go to obtain
appropriate help should be the teenager’s primary healthcare provider. The family healthcare
provider can make appropriate referrals to mental
health providers or recommend other interventions that may be necessary. The provider may
also help access any insurance benefits that may
be available, or make referrals to public health
resources.
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The teenager’s school may be another important resource, as a large part of a teenager’s time
is spent at school. If a teenager is having a difficult
time with his or her grief, the school staff, such
as teachers and the guidance counselor should be
involved. They can be invaluable allies in helping a teenager with his or her grief. In addition,
guidance counselors often know about community resources. Inform the teenager’s school guidance counselor and teachers of the death, and
how close your teenager was to the deceased. Ask
teachers and guidance counselors to provide you
with feedback if they see any changes—good or
bad—in your teenager’s behavior or performance
at school. Watch for academic decline. Grieving teenagers may not be well-rested due to insomnia or interrupted sleep patterns. They may
have trouble concentrating in class or completing
homework. Offer assistance and, if necessary, see
if the school can recommend a tutor.
There are also many resources in the general community. A growing number of communities have bereavement centers with programs
for children and teenagers. Also, many communities have self-help phone numbers or help hotlines that may list bereavement services available
in your community for children and teenagers.
Some communities will have a public mental
health center, and these centers often will help
to evaluate and refer teenagers who are having a difficult time with bereavement, especially
when they are depressed, despondent, or unusually angry. Another source of community
help for bereavement care is your local hospice
provider—even when the deceased was not a
hospice patient. Hospices generally provide resources and referrals for bereavement care at no
cost.
Youth groups that are either recreational, such
as the YMCA or Scouts, or religious youth
groups, may be a useful resource to assist the
grieving teen, as participating teenagers receive
nurture and distraction from their routine in a
wholesome environment. Some of these youth
groups may even provide direct access to coun-
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selors who can address and assist with grief recovery. One’s local temple, church, or mosque, and
the local minister, rabbi, pastor, imam, or other
spiritual counselor is another important resource
to consider if you are looking for help with bereavement. Many local faith groups provide bereavement groups and pastoral counseling that
address issues of bereavement from a spiritual
point of view.
The internet can provide a wealth of information and support for grieving teenagers. Keep
in mind that while there is also a lot of inappropriate information on the internet, there are
reputable sites that provide an opportunity to
read information and write or start your own
blog (a web site with short entries and links to
personal or other websites on a particular subject, i.e., bulletin boards). Libraries and book
stores offer reading in the area of grief and grief
recovery.
GRIEVING PARENTS NEED TO
TAKE CARE OF THEMSELVES
Although this chapter focuses on the care of bereaved children, one would be remiss in not at
least touching on the need for grieving parents
to care for themselves while caring for bereaved
children. Many parents find this particularly challenging, which is why it is imperative that adults
make a special effort to get the support and assistance they need so that in turn they can attend to the grief needs of their children. Some
adults, however, do find it particularly therapeutic to give to a grieving child, because it can be
healing to provide assistance to someone else. To
ensure the best possible interactions can occur
between grieving parents and children, several
suggestions are provided in Table 27–7. A full
discussion of bereavement care for adults can be
found in Chapter 17.
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TABLE 27–7. Suggestions for Grieving Parents
r Take time for themselves to sort out their own concerns, doubts, and fears. It is hard
for an adult to be reassuring to a child when they have their own unresolved fears.
r Take care of their physical health—rest, eat right, exercise moderately, and avoid
alcohol and drugs.
r Keep a grief journal, read books about grief, and join a bereavement support group.
Many grief experts also suggest waiting on making any major life decisions.
r Take people up on their offer to help and support. Relatives and friends can run
errands, take care of the children, or assist with the final arrangements. It is very
important not to become isolated.
r Allow the child to care about them as well as long as the child doesn’t become
consumed with care.
r Have someone they can share the responsibility of providing emotional grief support
to the child.
GUIDELINES FOR CHILDREN
ATTENDING FUNERALS AND
MEMORIAL SERVICES
Therese Rando, a well-known grief and loss expert, explains that rituals allow structure for important events that happen throughout our lives,
including death. A funeral offers a controlled time
where individuals can emotionally and physically
ventilate their feelings. Funeral rituals generate
social support and offer opportunities to find
meaning, by applying spiritual and philosophical
understandings to loss. Funeral rituals are most
effective when they are personal and involve participation from friends and family.
When the death of a loved one occurs, adults
are faced with difficult choices about whether
to include children and teenagers in death rituals such as funerals and memorial services. As
a general guideline, children should be allowed
to attend a wake, funeral, and burial if they want
to. Children can also be involved in the funeral
planning. Joining family members for these ritu-
als gives them a chance to receive grief support
from others and a chance to say goodbye in their
own way to the deceased.
Children should never be forced to attend a
funeral or memorial service. It is important, however, to understand the children’s reasons for not
wanting to attend, so any fears or questions can
be addressed. Questions that might assist adults
in understanding a child’s fears or concerns might
include: “What is the thing you are most afraid
of about the funeral?” or “What do you think
you might feel if you were to go to the memorial
service?”
Always prepare children for what will happen
at any death ritual. Describing the funeral process step by step (what they will see, how other
people might react, how they might feel) can
help allay children’s anxieties about the event.
It is important to reiterate that crying or not
crying are both OK. Extra attention and affection from adults may be necessary so children
do not feel forgotten or neglected, remembering not to embarrass a teenager in front of his
or her peer group. It is helpful to make arrangements with a trusted adult so a child could leave
the funeral or memorial service early if he or she
wishes.
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Children should never be forced to view or
touch the body; they need to be given a choice
that will be respected. If they are going to view
the body, it is helpful to remind them that death
is final and to describe how the body might look.
An explanation could go like this: “Sally will be
lying in a wooden box called a casket. She will
look like she is sleeping, but she is not. She is
dead. Her chest will not rise and fall because she
is not breathing.” For some children, touching
the body may satisfy their curiosity, be a way of
saying goodbye, or be an expression of love. If a
child decides to touch the body, he or she should
be told that the body will feel cold and hard. Some
children, however, do not need to touch or see the
body to know that the death is real. If a child does
not want to see or touch the body, an adult could
relay that the body was seen and that the deceased
was not living or breathing.
Children should be asked if there is anything
they would like buried with their loved one. It
is often comforting for the child to place a small
gift, a drawing, a letter, or a picture of themselves
in the casket.
EXPLAINING BURIAL AND CREMATION
TO A CHILD
If the deceased will be buried, it is helpful to explain to children in detail what that means so they
will not develop fantasies about where their loved
one was put to rest. An explanation may go like
this: “The casket will be sealed shut and then
taken to a cemetery where there are several other
bodies buried under the ground (or placed in a
hole in the wall of a building called a mausoleum).
They have to be placed there because, like with a
dead squirrel, their body will begin to decompose
because it is no longer living.”
It is sometimes difficult for a child to understand cremation. When describing it, it is important to remind the child that the dead person no
longer feels anything, so it is not painful. If the
child wants to view the body before a cremation,
most mortuaries can arrange for this. When de-
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Specific Populations
scribing cremation to a child, it might be helpful to say: “Cremation happens at a place called
a crematory. There they use heat to change the
body into ashes. These ashes are usually placed
in a special box and the family decides what they
want to do with the ashes.”
WAYS TO COMMEMORATE THE LOSS WITH A
GRIEVING CHILD
During the grieving process, there comes a time
to bring emotions into perspective, modify patterns of thinking, develop a new awareness of
the loss and the importance of life, and start to
free oneself from the profound pain of grief. This
change, and it can be a significant one, is facilitated by the act of commemoration. Commemorating a loss can be a public or private event,
elaborate or simple. The important thing with a
grieving child is that the ritual should be planned
with the child’s consent and is not imposed. The
child could be asked to actively participate by
sharing ideas for commemorating the deceased.
A helpful way to commemorate a loss is to
visit the cemetery or final resting place of the deceased. It may be a means for the child to say
goodbye or to satisfy natural curiosity. As with
funerals, it is important to describe to children
beforehand what they will see and how they may
feel at the cemetery, and allow them to ask questions. Often families take flowers, pictures, small
gifts, or notes to place on the grave. It is helpful if adults share their feelings while visiting the
grave to give permission to the children to share
as well. It is also helpful to process afterwards any
thoughts and feelings about the visit.
Phyllis Silverman, William Worden, and others have described how bereaved youngsters often maintain a connection of some type to the
deceased person who they loved, such as a parent. They may believe the parent is somehow with
them when they are awake. There are many rituals and activities that children enjoy doing that
enhance a positive connection to the deceased.
Adults should allow grieving children ample
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opportunity to share their memories of their loved
one and adults should talk about the deceased
person as often as possible. Viewing photo albums, telling stories, visiting special places where
they went with their deceased loved one, having
memorable possessions of their loved one are all
important commemorative activities.
There are many creative ways to commemorate the loss as well. One is to write letters to the
deceased. The letters could be kept in a special
place, could be shared, or could be burned in
a ceremony. The burning of letters is especially
significant if there was unfinished business in the
relationship, particularly with older children. Artwork can be very therapeutic for grieving children
as it allows them a nonverbal channel to express
themselves. It is important to allow children the
choice about whether or not to share their artwork
with others. Some children may choose to write
about their emotions and memories in a poem,
story, or journal. Other creative ideas include
making a scrapbook or photo album, making
a treasure box where mementos of the deceased
can be stored, planting memorial trees or plants,
and donating money to charity in their loved one’s
name.
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Mother’s and Father’s Day can be particularly
difficult for children that have lost a parent. They
may choose to commemorate their loss by visiting
the cemetery or visiting a special place where they
have positive memories of their parent. If they
are supposed to participate in an activity with the
parent, for example, a Mother’s Day celebration,
they may choose to take a “substitute mother” to
the event.
As the first anniversary of the death approaches, children often find themselves reliving
very intensely the last days of their loved one’s life.
Children often need extra reassurance and support during this anniversary. It is also important
that the adults in their life share their own feelings about the anniversary and memories about
the deceased.
Children often choose to celebrate the birthday of their deceased loved one. They might make
a birthday gift for their deceased loved one, or
bake a cake and light birthday candles. The celebration could include sharing memories about
past birthdays with their loved one. A visit to the
cemetery might be a special way to allow a child
to say “happy birthday” to their deceased loved
one. Other holidays may be commemorated in a
similar fashion, by giving gifts, sharing memories
of the deceased, and developing special rituals.
HOLIDAYS AND SPECIAL ANNIVERSARIES
Holidays and special anniversaries can be very
difficult for grieving children and adolescents, especially during the first year. Holidays and anniversaries serve both as a reminder of the loss
and of pleasant memories of the deceased. It is
sometimes difficult for children to watch others
enjoy the holiday, when for them it just brings up
the void they feel. Often, the anticipation of the
holiday can be worse than the holiday itself.
It is important to let bereaved children know in
advance that they might experience some painful
feelings during the holiday or anniversary. It is
also helpful to plan with them in advance ways to
make these events more tolerable. Holiday rituals
that included their loved ones could be altered
and new rituals developed.
DEATH OF A PARENT OR SIGNIFICANT ADULT
Parents naturally love their children and children
depend upon parents for survival and stability.
Silverman believes that what a child experiences
as lost along with the death, how they talk about
their deceased parent or significant adult, and
how they understand his or her place in their
lives, can be even more critical than age-specific
understanding of death. The death of a parent
or significant adult seems to be more difficult if
the death was sudden or if the child lacks a solid
replacement figure.
Some children fantasize that their parent will
return, and others have the wish to die so they can
be reunited with their deceased parent. Usually,
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this is a fleeting desire rather than true suicidal
ideation. Children expressing these wishes, however, should be questioned more deeply, and an
investigation made as to whether they do have
a specific plan and means available to carry out
their wishes.
Silverman describes the accommodation and
adaptation to the loss of a parent or significant
adult that a bereaved child experiences throughout his or her life. These children tend to revisit
the meaning of their parent’s death over and over
again at different developmental stages. They also
re-experience the loss at events such as graduation, marriage, and the birth of a child.
Some bereaved children idealize their parent
or significant adult as a way to keep their pleasant, comforting memories of them alive. This can
be adaptive unless it gets in the way of a child
expressing angry feelings toward the parent for
“leaving” or for any “unfinished business” in the
relationship. It is important that surviving parents
allow the idealization of the deceased parent, but
also stress with children how much they love them
and reassure them of their care and support.
DEATH OF A SIBLING
When a sibling dies, the surviving child reacts to
both the loss of the sibling and to the change in
behavior and grief process of his or her parents.
The grief response of siblings may be longer or
shorter than parents and they may have a different understanding of the death. Siblings are often
asked numerous questions about their brother’s
or sister’s death from their peers and from other
adults. This can feel overwhelming to a child.
An ill child often receives more attention from
parents than their siblings who are well. The surviving children often believe they will get more attention from their parents after the death of their
sibling and then are disappointed when those expectations are not met. Surviving children may
also grapple with identity and role issues after the
■
Specific Populations
loss. “Am I still a little brother?” or “Who’s going
to take out the garbage now?”
Sometimes, grieving parents are overprotective of the remaining siblings, concerned that they
may die or become ill as well. Other parents place
unreasonable expectations or demands on the remaining siblings, for example, asking them to take
on the responsibilities and roles of or to have the
same attributes as the deceased sibling. It is important that parents avoid being either overprotective or overpermissive with grieving siblings,
despite the temptation. Care should be taken
to not make comparisons between the deceased
child and any siblings, as it may lead the surviving children to feel inadequate. Care should also
be taken not to assign inappropriate responsibilities to a child that the deceased sibling used to
have, especially responsibilities that are not developmentally appropriate.
For all these reasons, grieving siblings need a
lot of reassurance from their parents that they are
loved for who they are and that they will be cared
for and supported. They need to be reminded
that they did not cause their brother’s or sister’s
death. They also should be encouraged to share
memories and hold keepsakes of their deceased
sibling and to participate in family rituals related
to the deceased child.
CONCLUSION
Bereaved children and adolescents are unique in
that they experience the pain of loss earlier than
other people, earlier than they are expected to.
Bereaved children are also unique in that they
may not completely comprehend the meaning of
“gone for good,” instead, may hold onto an inner
representation of the deceased. Children who are
grieving the loss of a parent or significant adult
differ from other children in that they lose the innocent belief that their parents will be there to
care for them forever. Surviving siblings or children whose young friends have died are forced
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Grief and Bereavement in Children
to face the fact that young people sometimes die
earlier than they are supposed to.
This chapter outlines the typical emotional,
physical and behavioral manifestations of children and adolescent grief and offers guidelines
for interventions that adults can provide to grieving children. When adults really listen to grieving children and take their cues for action from
them, adults learn that what grieving children
most need is unconditional love, reassurance that
they will be cared for, inclusion in the mourning
process, and availability to work through their
grief. Adults also can be comfortable that the
community at large can play a significant role in
the positive outcome of a grieving child.
When adults talk openly and honestly with
children about death, especially before the child
ever faces a loss and if children are given the
straight facts about death, they begin to understand death as a natural part of life, instead of
something to be feared or something that happens to others and never to them or their families. This affords children the time necessary to
be able to face the reality of death and to properly
mourn, and as a result, attain a positive outcome
to their grief process.
BIBLIOGRAPHY
Bolby J: Attachment and Loss: Loss, Sadness and
Depression-Volume III. New York, Basic Books,
1980.
Cline, KD: A Family Guide to Helping Children Cope.
California, American Cancer Society, 1988.
Corr CA: Eight myths about children, adolescents and
loss. In: Doka KJ, ed. Living With Grief, Washington, DC, Hospice Foundation of America, 2000,
p. 33.
Corr CA: What do we know about grieving children
and adolescents?. In: Doka KJ, ed. Children, Adolescents and Loss: Living With Grief. Washington, DC,
Hospice Foundation of America, 2000, p. 28.
Doka KJ, ed: Children, Adolescents and Loss: Living
with Grief. Washington, DC, Hospice Foundation
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Doka KJ: Using ritual with children and adolescents.
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ing with Grief. Washington, DC, Hospice Foundation of America, 2000, p. 154.
Doka KJ, ed: Children Mourning, Mourning Children.
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1995.
Dyregrov Atle: Grief in Children: A Handbook for Adults.
London, Jessica Kingsley Publishers, 1990.
Fitzgerald H: The Grieving Child. New York, Simon &
Schuster, 1992.
Grollman Earl: Bereaved Children and Teens: A Support
Guide for Parents and Professionals. Boston, Beacon
Press, 1985.
Grollman EA: Grieving children: Can we answer
their questions?. In: Doka KJ, ed. Children Mourning, Mourning Children. Washington, DC, Hospice
Foundation of America, 1995, p. 21.
Huntley T: Helping Children Grieve. Augsburg, Augsburg Fortress, 1991.
Kroen WC: Helping Children Cope with the Loss of a
Loved One. Minneapolis, MN Free Spirit Publishing, Inc, 1996.
Osterweis M, Solomon F, Green M, eds: Bereavement:
Reactions, Consequences and Cure. Washington, DC,
National Academy Press, 1984.
Pennells Sr., M, Smith, SC: The Forgotten Mourners:
Guidelines for Working with Bereaved Children. London, Jessica Kingsley Publishers, 1995.
Seibert D, Drolet JK, Fedro JV: Helping Children Live
with Death and Loss. Carbondale, IL, Southern Illinois University Press, 2003.
Schuurman DL: The use of groups with grieving children. In: Doka KJ, ed. Children, Adolescents and
Loss: Living with Grief. Washington, DC, Hospice
Foundation of America, 2000, p. 175.
Silverman P: When parents die. In: Doka KJ, ed.
Children, Adolescents and Loss: Living with Grief.
Washington, DC, Hospice Foundation of America,
2000, p. 221.
Silverman P, Nickman S, Worden W: Detachment revisited: The child’s reconstruction of a dead parent.
In: Doka KJ, ed. Children, Adolescents and Loss: Living with Grief. Washington, DC, Hospice Foundation of America, 2000, p. 131.
Walsh, F, McGoldrick, M: Living Beyond Loss: Death
in the Family, 2nd ed. New York, W.W. Norton,
2004.
Webb NB: Play therapy to help bereaved children. In:
Doka KJ, ed. Children, Adolescents and Loss: Living
with Grief. Washington, DC, Hospice Foundation
of America, 2000, p. 78.
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Wolfelt A: Helping Children Cope with Grief. Bristol,
Accelerated Development, 1983.
Wolfelt A: A Child’s View of Grief: A Guide for Caring
Adults. Houston, TX, Service Corporation International, 1990.
Worden, JW: Children and Grief: When a Parent Dies.
New York, Guilford Publications, 2001.
RESOURCES FOR GRIEVING CHILDREN
Books for Children
Aliki: The Two of The. New York, Harper Publisihers,
1987.
Blackburn LB: The Class In Room 44-When A Classmate
Dies. Omaha, NE, Centering Corporation, 1991.
Boulden JJ: Saying Goodbye. Weaverville, CA, Boulden
Publishing, 1992.
Brown, LK, Brown MT: When Dinosaurs Die: A
Guide to Understanding Death. Boston, Little, Brown
Books, 1996.
Brown MW: Dead Bird. New York, Harper Collins,
1995.
Buchanan-Smith D: A Taste of Blackberries. New York,
Harper Collins, 1992.
Buscaliglia L: The Fall of Freddie the Leaf. Austin, TX,
Holt, Rinehart and Winston, 1982.
Clifton L: Everett Anderson’s Goodbye. Austin, TX,
Henry Holt & Company, Inc., 1988.
DePaola T: Nana Upstairs, and Nana Downstairs. New
York, Penguin Young Readers, 2000.
Douglas R: Rachel and the Upside Down Heart. New
York, Penguin Group, 2006.
Fassler J: My Grandpa Died Today. New York, Behavioral Publications Co., 1971.
Harris RH: Goodbye Mousie. New York, Margaret K.
McElderry Books, 2001.
Hazen, Barbara Shook: Why Did Grandpa Die? New
York, Random House Children’s Books, 1985.
Heegaard M: When Someone Very Special Dies.
Minneapolis, Woodland Press, 1998.
Johnson J, Johnson M: Tell Me, Papa. Brooklyn, Center
for Thanatology, 1980.
Krementz J: How it Feels when a Parent Dies. New York,
Knopf, 1991.
Levine Jennifer: Forever in My Heart. Burnsville, NC,
Compassion Books, 1992.
McNamara Jill: My Mom is Dying. Minneapolis, Augsburg Fortress, 1994.
Parker MB: Jasper’s Day. Tonawanda, NY, Kids Can
Press, 2002.
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Romain T: What on Earth Do You Do When Someone
Dies?. Minneapolis, Free Spirit Publishing, 1999.
Schwiebert P, DeKlyen C: Tear Soup. Portland, OR,
Grief Watch, 1999.
Shavatt D, Shavatt E: My Grieving Journey Book.
Mahwah, NJ, Paulist Press, 2001.
Simon N: The Saddest Time. Park Ridge, IL, Albert
Whitman, 1986.
Van-Si L, Powers L: Helping Children Heal From Loss.
Portland, OR, Portland State University, 1994.
Viorst J: The Tenth Good Thing About Barney. New York,
Atheneum, 1972.
Wilhelm H. I’ll Always Love You. New York, Dragonfly
Books, 1988.
Winsch JL: After the Funeral. Mahwah, NJ, Paulist
Press, 1995.
Wolfelt A: Healing Your Grieving Heart: 100 Practical
Ideas for Kids. Ft. Collins, CO, Companion Press,
2000.
Yolen Jane: Granddad Bill’s Song. New York, Penguin
Young Readers, 1998.
Zalben Jane: Pearl’s Marigolds for Grandpa. New York,
Simon & Schuster, 1997.
Books for Teens:
Blume J: Tiger Eyes. New York, Random House, 1982.
Fitzgerald H: The Grieving Teen: A Guide for Teenagers
and Their Friends. Wichita, KS, Fireside (also available in downloadable digital edition), 2000.
Fry VL: Part of Me Died, Too: Stories of Creative Survival
among Bereaved Children and Teenagers. New York,
NY, Dutton Books, 1995.
Gootman M: When a Friend Dies: A Book for Teens
About Grieving and Healing. Minneapolis, Free
Spirit Publishing, 2005.
Gravelle K: Teenagers Face to Face with Bereavement.
Englewood Cliffs, NJ, Silver Burdett Press, 1989.
Grollman EA: Straight Talk about Death for Teenagers:
How to Cope with Losing Someone You Love. Boston,
MA, Beacon Press, 1993.
Grosshandler-Smith J: Coping when a Parent Dies. New
York, Rosen Publishing Group, Inc, 1995.
Hughes L: You Are Not Alone: Teens Talk About Life
After The Loss of a Parent. New York, Scholastic,
Inc., 2005.
Kolf JC: Teenagers Talk about Grief. Grand Rapids, MI,
Baker. Publishing Group, 1990.
Krementz J: How it Feels When a Parent Dies. New York,
Knopf, 1988.
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Myers E, Adams K: When Will I Stop Hurting? Teens,
Loss, and Grief. Lanham, MD, Rowman & Littlefield Publishers, Inc., 2004.
Meyers K: Truth about Death and Dying. New York,
Facts on File, Inc., 2005.
Samuel-Traisman E: Fire in My Heart, Ice in My Veins:
A Journal for Teenagers Experiencing a Loss. Omaha,
NE, Centering Corporation, 1992.
Wolfeldt A: Healing Your Grieving Heart for Teens: 100
Practical Ideas. Fort Collins, CO, Companion Press,
2001.
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Internet Resources:
http://www.centerforloss.com/.
http://kidsaid.com/.
http://www.newhope-grief.org/teengrief/.
http://www.wnyafn.com/teengrief/.
http://www.dougy.org/.
http://www.centeringcorp.com/catalog/index.php.
http://www.compassionbooks.com/store/.
http://santaclaracountylib.org/kids/lists/death dying
grieving.html.
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SELF-ASSESSMENT QUESTIONS
1. All of the following are myths associated with
children and grief in this culture EXCEPT?
A. It is best to protect a child from experiencing grief
B. Children should only be allowed to attend
funerals and memorials if they choose to
C. Children do not have the capacity to really
understand death and grief
D. Children are more resilient than adults
and quickly “bounce back” after a loss
2. All of the following are considered typical
grief reactions for infants and toddlers (until
about age 4) EXCEPT:
A. Anxiety related to the separation from a
major attachment figure
B. Understanding that death is final and irreversible.
C. Irritability, protest, and crying
D. Changes in eating and sleeping patterns
E. Do not envision that death is something
that can happen to them
3. All of the following are considered the important factors that influence how a child and
teenager respond to grief and loss EXCEPT:
A. Developmental level and chronologic age
B. Nature of the relationship with the person
that has died
C. Child’s own personality
D. What they are taught about death and
grief from adults
E. Whether they know how to read or not
4. Which of the following behaviors exhibited
by a child to the loss of a significant loved one
is most likely to require trained, professional
help to resolve?
A. Memory difficulties
B. Searching behavior
C. Difficulty concentrating
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D. Preoccupation with memories of the deceased
E. Idealization of the deceased
5. According to Alan Wolfelt, all of the following
characteristics indicate that a child is beginning to adjust to the loss of a significant loved
one EXCEPT:
A. Return to stable eating and sleeping patterns
B. Decision to forget their loved one and
move on
C. Increased thinking and judgment capabilities
D. Establishment of new and healthy relationships.
6. Which of the following is considered a complicated grief reaction in a teenager?
A. Assuming mannerisms, traits or wearing
clothes of the deceased.
B. Emotional regression and even bed-wetting, which can be most upsetting for teenagers.
C. Becoming overly responsible (the “new”
man or woman of the house)
D. Prolonged sleep disturbances, including
insomnia and nightmares
E. Needing to repeat again and again stories
of their loved one
7. All of the following are considered behaviors
associated with complicated grief in a child
or teenager EXCEPT:
A. Excessive rumination about having
caused the death
B. Extreme withdrawal, isolation, and inability to socialize with others
C. Pervasive fantasies that get in the way of
normal functioning
D. Anger and lashing out seemingly for no
reason
E. Persistent assumption of the mannerisms
of the deceased, including those not developmentally appropriate
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8. All of the following are considered appropriate interventions in preparing a child for the
death of a loved one EXCEPT:
A. It is important to wait to tell the child until
just before the loved one dies so the child
does not carry unnecessary anxiety prior
to the death.
B. The child should be told that the images
they see of death in television cartoons are
not always authentic and that death is irreversible
C. The adult should use adjectives like “very
very old” or “very very sick” to help the
child distinguish between getting a cold
and someone with a terminal illness
D. If the child is old enough to understand
what is happening and both the child and
the dying person would like the visit, the
child should be allowed to visit.
E. If the child does not want to visit, a supportive adult should attempt to elicit why
the child is resistant, but the child’s wishes
should be honored.
9. All of the following are helpful interventions
by an adult who is trying to help a grieving
child EXCEPT:
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A. Assure the child with specifics about how
his or her care giving needs will be met.
B. Keep the child in their environment and
continue their routine as much as possible
C. Tell the child that God wanted their loved
one and that is why he or she died can be
comforting to a child.
D. Adults should not use children as their
sole support during their grief.
E. Respect a child’s desire to not talk about
their grief
10. All of the following are helpful interventions
that an adult can use with a grieving child
who is angry EXCEPT:
A. Be direct and ask the child to “calm
down.”
B. Help the child dissipate the anger by running or exercising
C. Involve the child in art work such as scribbling, ripping paper, sculpting dough, etc.
D. Ask questions like, “What usually leads to
your feeling angry?” “How does your body
tell you that you are becoming angry?”
E. Ask the child what he or she thinks are
more appropriate ways of responding to
angry feelings.
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