As much as we would like to protect our children from anything sad or hurtful, death — at some point — touches us all. Whether it is the death of a grandparent, a classmate, a teacher or even a beloved pet, every child will eventually know death. How a parent approaches death with a child depends not only on who has died and what relationship that person had with the child, but also the circumstances under which the death occurred and the age and developmental stage of the child.
When deciding on the best approach to use, it is helpful to have some knowledge of a child's developmental concept of death. Preschool children often see death as temporary or reversible. Cartoons where characters magically pop back to life after falling off a cliff or being hit by a bus serve to reinforce this notion. Magical thinking is also common in this age group. For example, preschoolers may believe that their own negative or angry thoughts caused the death. Death is often personified as a figure such as a skeleton and these images can be a source of bad dreams or nightmares.
School-age children are just beginning to grasp the universality of death. They have some basic understanding that all living things die, but are only gradually coming to terms with the fact that death is permanent and irreversible. While most adolescents fully comprehend their own mortality, they may react to the enormity of this knowledge by taking unnecessary risks with their own health and lives.
There used to be some controversy about whether or not children mourn. Pediatric professionals now agree that they do, though their grief process does not necessarily look like that of adults. Children may express anger or become irritable or aggressive in response to a death. Young children are more likely to have increased activity than to be subdued, which can be disconcerting to a roomful of adult mourners. Also, children may not express their sadness all at once at the time of death, but rather do it intermittently, often at unanticipated moments. Because adults at that point may have already worked through much of their grief, having a child bringing up the loss over and over again can be painful.
Children are aware of death — whether we discuss it with them or not. Not talking about death doesn't mean we are not conveying something to our children. Kids are great at reading our faces and picking up on our moods. When we avoid talking with our kids about things that disturb us, children may get the wrong message. They may learn that they can't bring up certain subjects for fear of upsetting us. Instead of us protecting our children, they are trying to protect us. This can put a terrible burden on a young child.
On the other hand, using euphemisms like "resting in peace" may confuse children, even make them fearful of naps. Trying to dodge the issue with a "grandpa went away" may also needlessly worry a child about brief separations. We must also be careful about associating death with age or illness, giving plenty of reassurance lest our kids think that all illness leads to death or that all older people are about to die.
So what do we say? Young children should be given very brief simple answers to questions. Keeping things familiar in terms of the absence of functions can be helpful. For example, "when fish die they don't swim any more" gives the child a concrete way of understanding death. Answering questions honestly is key, but figuring out exactly what information a child is looking for can be tricky. For example, if a child asks, "Are you going to die?" chances are they are not so much interested in the issue of the universality of death as they are concerned about who is going to take care of them. We should take this opportunity to be very reassuring to them about their future.
Lastly, it is important to remember that we are not alone in our grief. Here in Haverhill, we are very fortunate to have many excellent resources at our disposal. Both Merrimack Valley Hospice and the Center for Grief and Healing offer programs for children who have lost loved ones. Both agencies are also available for outreach to groups, such as schools, as well as individually to children and families. In addition, the librarians at the Children's Room of the Haverhill Public Library have wonderful book recommendations to help children of all ages deal with all kinds of difficult issues. And of course your pediatrician knows your child and family well and should be an excellent resource, too.
For more information, you can call Merrimack Valley Hospice at 978-552-4522, the Center for Grief and Healing at 978-774-5100, or Haverhill Public Library at 978-373-1586.
Dr. Carolyn Roy-Bornstein is a board certified pediatrician with Merrimack Valley Child and Adolescent Health and Merrimack Valley Hospital. Her office is at Merrimack Health Center, 62 Brown St. adjacent to the hospital. She can be reached at 978-521-8108. Parents are invited to e-mail questions for future columns to CRoy.MVCAH@comcast.net.