Clinical Reference Systems: Pediatric Advisor 10.0

When a family member dies, children react differently than adults. Preschool children usually see death as temporary and reversible, a belief reinforced by cartoon characters who "die" and then "come to life" again. Children between 5 and 9 begin to think more like adults about death, yet they still believe it will never happen to them or anyone they know.

Adding to a child's shock and confusion at the death of a brother, sister, or parent may be the unavailability of other family members. They may be so shaken by grief that they are not able to cope with the normal responsibility of child care.

Parents should be aware of normal childhood responses to a death in the family and alert to danger signals. It is normal during the weeks following the death of a family member for some children to feel immediate grief or persist in the belief that the family member is still alive. But long-term denial of the death or avoidance of grief is unhealthy and can surface later in more severe problems.

A child who is frightened of attending a funeral should not be forced to go. However, some service or observance, such as lighting a candle, saying a prayer, or visiting a grave site, is recommended.

Once children accept the death, they are likely to display their feelings of sadness on and off over a long period of time, and often at unexpected moments. The surviving relatives should spend as much time as possible with the child, making it clear that the child has permission to show his or her feelings openly or freely.

The person who has died was essential to the stability of the child's world, and anger is a natural reaction. The anger may be revealed in boisterous play, nightmares, irritability, or a variety of other behaviors. Often the child will show anger toward the surviving family members.

After a parent dies, many children will act younger than they are. A child may temporarily become more infantile, demanding food, attention, and cuddling, and talking "baby talk."

Younger children believe they are the cause of what happens around them. A young child may believe a parent, grandparent, brother, or sister died because he or she had once wished the person dead. The child may feel guilty because the wish came true.

Some danger signals to watch for include:

• an extended period of depression in which the child loses interest in daily activities and events
• the inability to sleep, loss of appetite, or a prolonged fear of being alone
• acting much younger for an extended period
• excessively imitating the dead person
• making repeated statements of wanting to join the dead person
• withdrawal from friends
• a sharp drop in school performance or refusal to attend school.

These warning signs indicate that professional help may be needed to enable the child to accept the death and to assist the survivors in helping the child through the mourning process.