Helping children cope with death

Dennis Lisk, of Redmond, Washington, died of glioblastoma at age 44. His wife, Jenny, and their two kids were shocked. One day he was perfectly fine, and eight months later he was dead.

In the aftermath, Jenny not only had to deal with her own grief but also somehow help her children through the process. She found herself trying to answer questions from her kids, like “Why did Dad have to die?”

And unfortunately, Jenny isn’t the only parent who has had to steer her children through grief. It’s been estimated that over 280,000 children in the United States lost one or both parents to a COVID-19-associated death as of March 2023.

Grief looks different for every child and is unlikely to follow an orderly timeline through stages like denial, anger and bargaining. Helping a child navigate grief may feel overwhelming, but understanding how a child may process and express grief can help parents and family members better support them.

Talking to children about death

Children are naturally curious and seek information. Death and the corresponding emotions may be new to them, and they need information to start processing these feelings.

“Give honest and developmentally appropriate information to children,” advises Sarah R. McCarthy, Ph.D., M.P.H., L.P., a pediatric psychologist and assistant professor at Mayo Clinic.

This means that how you talk about death to a 2-year-old is very different from how you would discuss death with a 10-year-old or a teenager, because children’s brains develop and grow throughout childhood. You should always consider the age of the child and tailor the information from there.

For children of all ages, Dr. McCarthy advises using specific language, like, “Grandpa’s heart stopped working and he died.” The goal is to establish that the person is no longer alive.

If possible, prepare for the conversation ahead of time.

“I really encourage parents, teachers and anybody who might be in this situation to just take five or 10 minutes beforehand and plan out what they’re going to say. And sometimes, even write it down, because these are very difficult conversations to have,” says Dr. McCarthy.

Use precise words. Sometimes people will describe death as “going to sleep” to avoid the words “death” and “died.” This may be an effort to lessen the pain of the moment.

But these euphemisms can be really confusing for kids, and this can cause problems later on. For example, telling a child that “Grandpa went to sleep” can create a fear of sleeping — since Grandpa went to sleep and didn’t wake up.

In the case of terminal illness, there may be time to prepare a child for the impending death. For Jenny Lisk and her two children, daily illness became their reality, so there was no hiding it.

“I got some advice to be honest with them. The kids needed to hear what was going on from me rather than from the other kids on the playground. It was completely awful telling them that their dad’s tumor was cancer and that the doctor couldn’t fix it,” says Jenny.

She believed that the only thing that would have been worse than that conversation would have been her children learning that information from someone else when Jenny wasn’t around to support them.

Parents will sometimes ask if preparing a child for a loved one’s death is the best approach. Dr. McCarthy thinks that this can be helpful, but the timing of providing this information and how much detail to include depends on the individual child.

“With an 8-year-old who is anxious, or a worrier … does she seem to benefit from some preparation? Many kids do, but some kids do not. It just makes them worry more. This is where the adults who know the child best will need to use their judgment,” advises Dr. McCarthy.

Remember, the goal is to be honest and clear, while giving information that is developmentally appropriate. This information will likely need to be given more than once, and repeated questions should be answered in the same way — with information that is honest and clear.

Answering the tough questions

Talking to a child about death should not be a one-time conversation. Try to answer children’s questions as they come up — which may happen at what seems like random, “inappropriate” or awkward times. Children don’t always understand societal expectations about the “right time” to talk about death, but you should try not to shut down the conversation in these instances. Giving children opportunities to process information and leaving conversations open is very important.

It is OK to not have all the answers. Jenny says that she wishes she’d known this at the time. In retrospect, she believes that some questions would have been good opportunities for her and the children to look up something together, such as how cancer works in the body, or what different medicines do. Other questions, like “Why did Dad have to die?” were unanswerable for Jenny.

Dr. McCarthy can relate to this. She lost a child and then supported her surviving, grieving child.

“There were times that I just could not answer her because, at that moment, as a mother, I just couldn’t get those words out. And so I would say, ‘You know, that’s a really good question. I don’t know the answer to that. But I will find it and come back to you.’ Or ‘I can’t talk about that right now. But I promise I will talk about that with you.’ I always made sure I came back to those conversations,” says Dr. McCarthy.

Jenny shares that after her husband died, it was helpful to bring up the topic of the children’s father in everyday conversation.

“I think I was afraid at first that if I mentioned him at a time when no one appeared to be sad, that it would cause everyone to start crying — as if it might remind them he was dead or something. Of course, no one could forget he was dead,” says Jenny.

What grief looks like: Changes in a grieving child

After the child gets the information, it is helpful for people tasked with the child’s care, like family and teachers, to understand what grief can look like.

“As it plays out in my own family, myself, my husband, my daughter, our extended family, our friends — you realize that grief looks different for everybody,” says Dr. McCarthy.

The way a child responds will likely vary based on the age of the child. It is important to remember that not all kids grieve visibly, and this is OK. Different people display grief in different ways, and all expressions are valid. The most important thing is to tell children that no matter what feelings they have, there are no “wrong” feelings.

Infants and toddlers are sensitive to the emotions of their caregivers; they feel the stress and anxiety. They may respond with changes in their sleep patterns, eating habits and moods. This can result in their becoming clingier, eating less, and acting grumpier and crankier.

Preschoolers may react to grief by reverting to a previous stage of development. This can look like bedwetting, using baby talk and expressing fear of the dark. They also may try to escape through play and have physical symptoms like headaches and stomachaches. This age group also will ask the same questions over and over again. Try to be patient and answer with love and understanding.

Older, school-aged children also can experience changes in behavior. Look for those changes at school, as the behavior may be aggressive. Preteens and teens can have a wide range of emotions including shock, denial, anger, fear, depression, sadness and withdrawal. Withdrawal can manifest as immersion in television and video games, or a preference to grieve with peers. They may even appear to not be grieving at all. Be on the lookout for outlandish behavior like acting out, or in the case of teens, engaging in risk-taking behaviors like driving fast or experimenting with alcohol and drugs.

“Almost all children will go back and forth between different types of reactions. They are able to go in and out of grief,” Dr. McCarthy emphasizes.

Supporting children of different ages as they grieve

Helping to guide a child through grief is mostly being able to identify what grief may look like based on the age of the child — and being able to respond in a supportive way.

For infants and toddlers:

• Provide nurturing as often as needed in the form of food, diaper changes, hugs and cuddling.

For preschoolers:

• Identify fears and assumptions and correct any confusion. For example, if a grandparent died in sleep, address head-on the possible fear that a child may have of going to sleep.
• Provide outlets for grief through art, music and play.
• Be clear about who will fill roles like school pickup, bath time and other activities if a child has lost a parent.

For preteens and teenagers:

• Respect their privacy but be available to talk when they need to. Do not assume, regardless of how they act, that they are able to process grief on their own without support.
• Encourage them to process their grief constructively, whether it’s through journaling, poetry, music or other activities.
• Give them the option to participate in end-of-life rituals. Do not force them.

For some children, routines are very important, so it may be best to have these children return to school more promptly.

As you and the child adjust to a new normal, you may find yourself inclined to let the child do or act however the child wants to because the child is grieving. While children who are grieving certainly should be given some latitude, remember that structure and rules often help children feel safe. Dr. McCarthy encourages helping them to separate feelings from behavior.

“We talk a lot about the fact that it is absolutely OK to have big feelings. It’s not OK to take those big feelings out on someone. So it is OK to be angry. But it is not OK to hit your sister,” says Dr. McCarthy.

Navigating grief from the funeral onward

A common major grieving ritual is a funeral or memorial service. Whether it’s the death of a parent, sibling or close family member, give the child possible options of participating. It is not recommended that children be forced to attend a viewing or funeral. Instead, give them choices within the experience.

Ask if they want to help with planning the service program, such as choosing a color scheme or a song. If a young child is attending, it may be helpful to assign a trusted family member or friend as a buddy for the day. Handing that responsibility over to someone else eases a burden for the parent.

In the immediate aftermath of death, there’s usually a lot of support, but eventually everyone moves on with life. Acute grievers, like immediate family members, don’t just move on. Focus on supporting children where they spend most of their time, whether it’s at home or at school.

It’s important to let a child’s teacher know about the death while keeping the lines of communication open between school and home. Encourage people outside the home, like teachers and coaches, to share information with you. You want to know if the child is acting differently at school than at home.

Holidays and special occasions, like a school graduation, can be hard and can warrant specific conversations.

Validating children’s feelings while allowing them to grieve

When we think about grief, we think about crying and sadness. But oftentimes, grief can show up as anxiety, anger, irritability, temper tantrums or avoidance. Physical symptoms can include difficulty sleeping, resulting in fatigue, difficulty concentrating, low appetite or bigger appetite. These can all be feelings of grief.

Dr. McCarthy suggests using conversation starters like, “It looks like you’re feeling really sad. Can you tell me what you’re feeling sad about?” Or “Let’s talk about it.”

It also is helpful for children when they see adults express emotion. Allow your child to see you sad or crying. This gives them permission to grieve. The same goes when you’re angry or irritable. If you’re able to make the connection at the time, share with your child that you’re feeling angry and it’s not because of anything that your child has done but because you are really missing the person who died. This shows the child that you’re acknowledging your feelings and modeling the ability to talk about them.

Don’t try to hide your feelings; kids are smart and are often able to read their parents’ emotions.

“I work specifically with kids, and if nobody is talking about it, what they’re going to do is form a story in their heads. Because they’re trying to make sense of the world,” says Dr. McCarthy.

The stories that they’re telling themselves are often even worse than what is going on. If a parent is upset and crying and sneaking out of the room, kids may think that if the parents aren’t talking, this is so bad that nobody can even talk about it.

How do I know if my child needs professional help?

It is hard to quantify how long it will take a child to grieve.

“I think the idea of closure is a total myth, honestly. There’s no closure in grief. And there’s no one thing that you can do to prevent future distress,” says Dr. McCarthy.

There are now many resources available to help a grieving child, particularly because so many children lost parents and family members in the pandemic. Having big feelings does not necessarily mean that your child requires professional help. Dr. McCarthy recommends the following as indicators that it may be helpful to talk with your child’s pediatrician or seek advice from a mental health professional:

• Persistent behaviors that are impacting functioning — for example, the child is unwilling to be separated from a parent and has been missing school.
• Any talk about self-harm.
• Very significant mood changes.

Also remember that therapy can take the form of support groups. Learning to live without a loved one is hard, especially for a child.

Relevant reading

Mayo Clinic Guide to Raising a Healthy Child

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