Feelings of grief may be caused by a traumatic event such as death, illness, or divorce. Experiences of discrimination due to racism, ableism, classism, and other stereotypes or biases can also create grief and loss responses in children.  These types of experiences can be direct or indirect. As an adult, it is our role to provide a supportive and empathetic response to help children cope with grief.

Signs of grief and loss in children

It is important to recognize the signs and potential causes of grief and loss experienced by a child and take steps to help them cope.

Children may:

• experience grief and loss differently than adults
• experience fluctuating grief; it may seem to come and go
• understand and cope with grief in different ways as they develop
• experience the loss multiple times as they mature

Children use a variety of ways to communicate how they feel as they try to understand and cope.  Children’s understanding of an experience that creates a sense of grief will also vary depending on the child’s age, developmental level, and the support they receive.

It is not uncommon for children to express their grief through: 

• Using language and making comments that seem out of context
• Lack of an emotional response or display of extreme emotions
• Sensitivity, irritability or being easily frustrated
• Changes in well-established skills and routines (e.g., eating, toileting)
• Nightmares or sleep problems
• Recurrent physical symptoms such as headaches or stomach aches for reasons other than medical
• Sudden and marked decrease in appetite
• Difficulty calming when upset
• Over-dependence on parent/main caregiver, unusual separation anxiety, or seeking additional attention and/or comfort
• Inability to concentrate or finish common tasks
• Lack of interest in activities that were previously considered enjoyable
• Withdrawing or showing little interest in social interactions with others
• Unexpected or unfounded fears

Working through feelings of grief and loss together

You may also be experiencing grief and loss at the same time. Recognizing your feelings and taking steps to manage your own wellness is equally important as helping your child. 

Your child may ask the same questions repeatedly to make sense of difficult information.  This is because children cannot reflect on their own thoughts and emotions like adults and may need information repeated to them several times.  When supporting your child:

• Give them the attention they need in the moment
• Offer affection and reassurance that they are loved and cared for
• Use simple, concrete words and descriptions (i.e., “dead” or “died” instead of “loss” or “passed away”) to talk about what you and your child are experiencing
• Help then recognize, label and talk about emotions.  Let them know that grief typically involves a range of emotions, including anger, guilt, and frustration, and that all their feelings are valid and accepted
• Make sure they have access to play materials such as puppets, dolls or action figures to express their feelings or engage in role-playing games
• Read books about grief and loss or make a personal story to support coping with the experience
• Help them to write in a journal or draw a picture about their experience
• Use natural opportunities to discuss experiences. For example, when you see a dead bug or plant, give factual and brief information such as “The ladybug is not alive anymore, it died.  When a living thing dies, they do not feel anything anymore.”
• Respond using a soothing voice and gestures to comfort them 
• Include your child in your family and cultural practices during the grieving process
• Offer a favourite toy or activity to help comfort your child. Spend some time with them in that activity
• Allow flexibility in your routine. If your child is upset, give them extra time to regulate their feelings 

Answering your child’s questions

Your child may make up their own narrative about what is happening if they are not provided with simple and clear information.  For example, the term “sick” when used to describe terminal cancer might cause confusion, and a child may be worried that all sicknesses result in death.  Use concrete words and avoid confusing phrases when talking about the situation or event that has triggered the grief. For example, statements like “he passed away” or “we lost the dog” are unclear and could be misinterpreted by the child.

Consider the following:

• Ask for clarification if you are unsure of what your child is saying or asking
• Ensure you have your child’s attention before you speak directly to them
• Consider their level of understanding and their temperament
• Only give as much information as is necessary
• Children may ask the same questions often to make sense of difficult information and may need information about the situation repeated several times.
• It’s okay to say you do not know and will try to find the answer

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Definitions

Grief is the response to loss that includes thoughts, behaviours, emotions and physiological changes.  If the loss is permanent, the grief will also be permanent; but it changes as a person adapts to the loss.

Acute grief may occur in the early period after a loss. Strong feelings of yearning, longing and/or sorrow are typical. 

Integrated grief is a lasting form of grief in which loss-related thoughts, feelings and behaviours are integrated into a person’s ongoing functioning; the grief may have a place in the person’s life without dominating it.

Complicated grief is a persistent form of intense grief in which negative thoughts and behaviours and/or preoccupation are present.

Adapting to loss entails accepting the reality of the loss, including its finality, consequences and changed relationships; adapting means seeing the future as holding possibilities.

Collective grief is felt by a group. For example, this could be experienced by a whole community as with a global pandemic.

Children’s literature

• Brown & Brown. (1996). When Dinosaurs Die:  A Guide to Understanding Death.   New York, NY:  Little, Brown & Company.
• Thomas, J., & Dale, U. J. (2012). What does dead mean? – a book for young children to help explain death and. Jessica Kingsley Publishers.
• Mellonie, Bryan & Robert Ingpen. (1983). Lifetimes:  The beautiful way to explain death to children.  Toronto, ON:  Bantam Books.
• Munsch, Robert. (2003). Lighthouse – A Story of Remembrance.  Vancouver, BC:  North Winds Press.
• DiSalvo, DyAnne. (1999). A Dog Like Jack.  New York, NY:  Holiday House.
• Heegaard, Marge. (1991). When Something Terrible Happens.  Salt Lake City, UT:  Woodland Press.
• Palmer, Pat. (2004). “I wish I could hold your hand…” – A Child’s Guide to Grief and Loss.  Oakland, CA:  Impact Publishers, Inc.
• Thomas, Pat. (2001). I Miss You.  New York, NY:  Barron’s Educational Series.
• Silverman, Janis. (1999). Help Me Say Goodbye:  Activities for Helping Kids When a Special Person Dies.  Toronto, ON:  Fairview Press.

Websites and resource links

• Bereaved Families of Ontario – Toronto: Support for a person, family or group dealing with grief from the death of a loved one.
• Dr. Jay’s Children’s Grief Centre  
  • An article on Supporting Kids & Teenagers through Grief 
• Sesame Street in the Community – Grief Section 
• A short video about grief & memories 
• Kids Grief Website 
  • Online module – Understanding Children’s Grief
• Canadian Virtual Hospice
  • “Parenting a child through a death and grief” Video with Andrea Warnick 
• Children and Youth Grief Network
  • What are the 4 C’s? Four Common Concerns of Grieving Children and Youth
• Dignity Memorial:
  • “Helping Your Child Endure a Loss” by Ken Doka
  • Article, “Coping with Grief:  Helping Others Endure Their Loss” by Ronald H. Sunderland
• The Centre for Complicated Grief, Web information,
  • “When Grief Gets Complicated“
• National Institute of Mental Health, Web information,
  • “Helping Children and Adolescents Cope with Disasters and Other Traumatic Events: What Parents and the Community Can Do“
• Hospital for Sick Kids, Web information,
  • “Post-traumatic stress disorder: Signs and Symptoms”

References

Elizz.com, (2020). Tips of grief and loss. Retrieved June 29, 2020 from: https://elizz.com/caregiver-resources/types-of-grief-and-loss/

KidsGrief.ca. (2020) (5AD).  Talking to kids about death and dying. Retrieved on June 29, 2020 from https://kidsgrief.ca/

Kubler-Ross, E. (2014). On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. Scribner.

Canadian Virtual Hospice. (2020). Featured Content. (n.d.). Retrieved June 4, 2020, https://www.virtualhospice.ca

Librach, S. L., & Obrien, H. (2011). Supporting Children’s Grief within an Adult and Pediatric Palliative Care Program. The Journal of Supportive Oncology, 9(4), 136–140. doi: 10.1016/j.suponc.2011.04.003

The Centre for Complicated Grief. (2020). Key Definitions. Retrieved on June 2020 from: https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

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