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January 30, 2008

Pediatric Points: Death touches us all

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.

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