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Grief, Loss & Bereavement Assignment requirement: you will need to submit a 2page summary of the 3 readings for this week, each reading for 3-4 sentences and
make the three readings’ summary into 2 page. The lists of the reading is below and I will
send the readings later.
1. Chapter 16 in Living with Dying. Will send the pdf later on Monday.
2. Himebauch, A.l Arnold, R., May, C.(2008) Fast Facts and Concepts #138- Grief
in Children and Developmental concepts of death.” Journal of Palliative Medicine
11(2): 242-244. doi:10.1089/jpm.2008.9973. https://www.mypcnow.org/blankmtaem
3. Silverman, P.R.. (2012). “Taking Children to The Funeral” Raising Grieving
Children Blog on Psychology Today. Posted 11/23/2010.
https://www.psychologytoday.com/blog/raising-grieving-children/201011/takingchildren-the-funeral last accessed 4/30/17
FAST FACTS AND CONCEPTS #138
GRIEF IN CHILDREN AND DEVELOPMENTAL CONCEPTS OF DEATH
Adam Himebauch, Robert Arnold MD, and Carol May
Background An understanding of age-appropriate grief reactions and conceptions of death are
important when assessing a child’s response to terminal illness and a loved one’s death. This Fast Fact
reviews key developmental concepts and describes strategies for addressing children’s grief.
Children grieve differently than adults. They often grieve in spurts and can re-grieve at new
developmental stages as their understanding of death and perceptions of the world change. Childhood
grief may be expressed as behavioral changes and/or emotional expression. The two most important
predictive factors of a child’s successful outcome after suffering a loss are the availability of one
significant adult and the provision of a safe physical and emotional environment.
0-2 years (Infant) Children at this age have no cognitive understanding of death. However, grief
reactions are possible and separation anxiety is a concern. Behavioral and developmental regression can
occur as children have difficulty identifying and dealing with their loss; they may react in concert with the
distress experienced by their caregiver. There is a need to maintain routines and to avoid separation from
significant others.
2-6 years (Preschool) Preschool age children see death as temporary and reversible. They interpret
their world in a concrete and literal manner and may ask questions reflecting this perspective. They may
believe that death can be caused by thoughts and provide magical explanations, often blaming
themselves for the death. Providing simple and straightforward explanations, avoiding euphemisms,
correcting misperceptions, and reminding them that the loved one will not return are important strategies.
6-8 years (School Age) Children understand that death is final and irreversible but do not believe that
it is universal or could happen to them. Death is often personalized and/or personified. Expressions of
anger towards the deceased or towards those perceived to have been unable to save the deceased can
occur. Anxiety, depressive symptoms, and somatic complaints may be present. The child often has fears
about death and concerns about their other loved ones’ safety. In addition to giving clear, realistic
information, offer to include the child in funeral ceremonies. Notifying the school will help teachers
understand the child’s reaction and provide additional adult support.
8-12 years (Pre-adolescent) : Children at this age have an adult understanding of death – that it is final,
irreversible, and universal. They are able to understand the biological aspects of death as well as causeand-effect relationships. They tend to intellectualize death as many have not yet learned to identify and
deal with feelings. They may develop a morbid curiosity and are often interested in the physical details of
the dying process as well as the religious and cultural traditions surrounding death. The ability to identify
causal relationships can lead to feelings of guilt; such feelings should be explored and addressed. To
facilitate identification with emotions, it may prove useful to talk about your own emotions surrounding
death and to offer opportunities for the child to discuss death. The child should also be allowed to
participate, as much as they feel comfortable, in seeing the dying patient and participating in activities
surrounding the death.
12-18 years (Adolescent) Adolescents also have an adult understanding of death. They are
developing the ability to think abstractly and are often curious of the existential implications of death.
They often reject adult rituals and support and feel that no one understands them. They may engage in
high-risk activities in order to more fully challenge their own mortality. They often have strong emotional
reactions and may have difficulty identifying and expressing feelings. It is important that adults support
independence and access to peers, but to also provide emotional support when needed.
Summary The generalizations and strategies provided above only serve as a framework when dealing
with the death of a loved one. When in doubt, seek help from pediatricians, child-life specialists, mental
health professionals, and others specializing in bereavement.
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References
1. Gudas LS, Koocher GP. Grief and Bereavement. In: Behrman RE, Kliegman RM, Jenson HB,
eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, PA: Saunders; 2004.
2. Himelstein BP, Hilden JM, Boldt AM, Weissman D. Pediatric palliative care. N Engl J Med.
2004; 350:1752-1762.
3. Trozzi M, Dixon S. Stressful Events: Separation, Loss, Violence, and Death. In: Dixon SD, Stein
MT, eds. Encounters with Children: Pediatric Behavior & Development. 3rd ed. St Louis, MO:
Mosby; 2000.
4. Fine P, ed. Processes to Optimize Care During the Last Phase of Life. Scottsdale, AZ: Vista
Care Hospice, Inc.; 1998.
Version History: This Fast Fact was originally edited by David E Weissman MD and published in June
2005. Version re-copy-edited in April 2009; then again in October 2015 .
Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate
editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a
volunteer peer-review editorial board, and are made available online by the Palliative Care Network of
Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s
content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact
information, and how to reference Fast Facts.
Copyright: All Fast Facts and Concepts are published under a Creative Commons AttributionNonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/). Fast Facts
can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a
Fast Fact, let us know!
Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This
information is not medical advice. Fast Facts are not continually updated, and new safety information may
emerge after a Fast Fact is published. Health care providers should always exercise their own
independent clinical judgment and consult other relevant and up-to-date experts and resources. Some
Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that
recommended in the product labeling. Accordingly, the official prescribing information should be
consulted before any such product is used.
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Taking Children to The
Funeral
Children recognize the importance of being at their
parent’s funeral
This past week a book group I belonged to read a book that led into a
discussion of how death was dealt with in our own families as we
were growing up. We recalled that as children we were usually not
part of any family rituals when a family member died. Most of us grew
up in homes where our parents felt that children had to be sheltered
from this aspect of life. This meant that children did not go to
funerals, and death was rarely talked about in the house.. When my
grandmother died, I was an adult living in another city. My mother
called me and wondered if I needed to come home? She was still
trying to protect me.
My experience with death was such that,in 1966 when I was offered
the opportunity to work with the widowed, I almost refused. What
convinced me to work on this project was the opportunity to get a
secretary who would type my dissertation. This was before
computers were available and any correction might involve retyping
large portions of the work. In spite of my reluctance about work
related to dying, this was enough of a reason to take the job.
In the late 1970’s a friend wrote an article for a local newspaper
arguing that children did not belong at funerals. It was well received
and reflected the practice in many communities in the greater Boston
area. By then I was involved with the Widow-to-Widow program and
had dealt with my own fearthat involved closing my eyes when I went
by cemeteries, and feeling very frightened by the place . I could now
question the certainty that was reflected in the article.
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For me the discussion, in the book group, led me to ask if being more
familiar with the fact that people die and with the rituals that follow a
death, such as a funeral, makes it any easier for a family when a
death occurs. I was particularly interested in what effect being
familiar with burial rituals might have if there were dependent children
at home. At the book group, I was the only one in the room whose
work was related to this topic.
My thinking went back to the MGH/Harvard Child Bereavement study. I
was co-principal investigator and project director. We had interviewed
70 families where a parent had died. There were 125 children
between the ages of 6 and 17 in these families. Ninety-five percent of
these children went to their parent’s funeral. We did not ask what
their prior experience had been with death or with funerals. These
children, reflecting on their participation several months later, felt
than it was important that they were there to honor their parent and to
say good-bye. Their surviving parent respected their wishes.
A colleague from Florida, seeing these statistics said that this would
not be true in Florida. In a similar situation the children, even teenagers, would not go to the funeral. I can only hope that this is not true
there today.
As a wrote this blog I began to think about what we learned from the
Child Bereavement study. Going to the funeral has several parts to it.
Most of the younger children went to the religious service but not to
the cemetery. Robert Fulton said that through out history funerals
have meet the needs of adult mourners to acknowledge the death,
honor the life of the deceased, and provide social support and
comfort.
I found a paper my colleague Bill Worden and I wrote reporting on
these children’s experience over the 2 years that we were
interviewing them .The children’s responses two years after the death
indicated that the funeral met the same needs as those of adults.
Younger children under the age of 8 at the time of the death often did
not know what to call the “box” their parent was lying in. They talked
about nice people who were there to help but did not know what to
call these people who worked at the funeral home. By the time they
were all interviewed, two years later, most ofl the children could
reflect on the ceremony and talk about it with a more mature
understanding. In their own way, they knew by then , that it was
important that they had been there to show respect for their parent, to
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see them one last time and that being there helped them to accept
the death. The older children were able to articulate this more clearly
than the younger ones but the basic message was the same.
One thirteen year old wanted the funeral to be in a place that
reminded her more of her father. He loved to hike in the mountains
and she thought that setting would have been more suited to help
remember him and who he was. Some children wanted the color
black to dominate, reflecting their sadness. Others preferred bright
colors at the funeral to help remember the “good things” about their
parent. They were pleased that there were many people at the
funeral who cared for their parent. They talked about the importance
of remembering , celebrating their parent’s memory and mourning
together. The funeral helped them do that. A 10 year old girl
remembered “when I was crying at the end my little cousin came up
to me and gave me a hug and said it was ok. She was only three.”
One teen age boy said the purpose of a funeral was to get everyone
feeling ok about the death. Anybody who wants to can come. It is for
children too. A way for little kids to understand people have a life on
earth, but they die. Maybe bring religion into it but don’t bring in hell
because it might scare the kids.” A teen age girl whose mother had
died said,” Everyone gave me support. I felt better because all the
people were there.”
In this blog I have come a long way from my book groups discussion
But what we learn from children is that the funeral plays an important
role in their mourning , and helps them see death as a fact of life.
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