Understanding Adolescents’ and Children’s Responses to the Loss

By Renée Bradford Garcia, LCSW, Elizabeth C. Pomeroy, Ph.D., LCSW & Danielle E. Parrish, MSW

Introduction

Birth to Two Years

Ages Two to Five

Ages Six to Nine

Ages Nine to Twelve

Adolescents (Ages Thirteen to Nineteen)

Potential Fears

Tips for Caregivers

How Social Workers Can Help

INTRODUCTION

A grieving young person might ask:

“When is Daddy coming back?”

"Can I go to heaven to see Grandma?”

“Why did Mommy have to go?”

“Are you going to die, too?”

“How did he die? Was it something I did?”

A strong response to the death of a loved one is a universal phenomenon that exists for people of all ages. Children and adolescents, however, may experience grief differently from adults. Knowledge of how children of different ages have experienced a loss is essential to helping children and adolescents who are grieving.

BIRTH TO TWO YEARS

The loss of an important caregiver or adult can impact the infant’s sense of security and well-being in the world. Children of this age are sensitive to changes in routine and stress in their environment. The child may display excessive crying, writhing, rocking, biting and other anxiety related behaviors.

AGES TWO TO FIVE
Children at this age may have feelings of sadness, anxiety, insecurity, irritability and anger. They believe that death is a temporary state that can be reversed. They may equate death with sleeping or being away on a trip, or believe their thoughts or behaviors caused the death of their loved one. Some children may act as if nothing happened, while others may exhibit regressive behaviors, such as bedwetting or excessive clinging.

AGES SIX TO NINE

At this age, children are able to consider the biology of death and grasp its finality. They may develop fears associated with their own death or the death of a surviving parent. Feelings of insecurity may be expressed in a reluctance to separate from caregivers. Some children may be hyperactive, aggressive and disruptive, while others are withdrawn, sad and. Children may have nightmares, difficulty sleeping through the night, or display regressive behaviors.

AGES NINE TO TWELVE
Children this age understand that death is final and that it happens to everyone. Fears and worries associated with the loss may be heightened by the physical occurring within their own bodies. Ironically, they may have a strong need to control their feelings while at the same time they have great difficulty doing so. Because friends are so important to this age group, preteens may feel socially isolated, lonely, confused, scared, guilty and self-conscious.

ADOLESCENTS (AGES THIRTEEN TO NINETEEN)
Teens may have a need to feel “strong”, in control of their emotions and “indistinguishable” from their friends. They may hide (or numb?) their emotions of grief by engaging in risk-taking behaviors, such as reckless driving, alcohol and drug use, sexual promiscuity and defiance of authority. They may be reluctant (or unable?) to Express their feelings with others…The death can cause strong feelings of sadness, loneliness, confusion, fear, guilt and anxiety for the grieving adolescent. They may become more easily distracted, experience sleeping and eating disturbances, perform better or worse in school, and display strong emotional mood changes. Like adults, adolescents may have difficulty coping the loss for months or years following the death.

POTENTIALFEARS
Children of all ages may develop fears associated with a death. These fears can lead to other problems if neglected. Common childhood fears that result from the death of a loved one include: 

Fear for their own death or the death of a caregiver
     “When will I die?” 
     “Is mommy going to die, too?”

Fears about being alone at night or in an empty house, the house being robbed, being in a car accident, or having nightmares 
     “The monster/stranger might come.” 
     “I’m scared to go upstairs.” 
     “I need you to stay with me.” 

Concerns about the intensity of their grief related emotions and those of their caregivers 
     “If I cry, I won’t stop.” 
     “I can’t stand to see my mother crying.”

Fears that their friends and family members will treat them differently or that they will be isolated due to the death 
     “No one will talk to me at school.” 
     “They act like I’m weird.”

Safety related fears that revolve around who will attend to their needs 
     “Who will take care of me?"

Depression is a common outcome of extended grief among children and adolescents. Caregivers should be alert for any changes in the child’s physical well-being and behavior. Typical signs of childhood depression include the general appearance of discontent, low frustration tolerance, needs for comfort but is unsatisfied when comfort is given, acting out behavior, bedwetting, decline in school performance, moodiness.

If a youth’s grief reactions put them at risk of hurting themselves or others, caregivers should promptly seek the support of a mental health professional. For example, if a child or adolescent makes self-destructive behaviors or expresses feelings of hopelessness, it may indicate that there are more serious problems that should be promptly addressed by either a physician or a professional counselor.

While these signs are important indicators of how the child is faring with their grief, caregivers should be aware that most children do not sustain intense emotions for long periods of time (Landreth et al., 2005). A child may be crying about his/her deceased parent one minute and abruptly switch to joyful playing and laughing the next minute. It is OK for children to have “time off” from their grief experience, though this does not mean that the child has resolved all of his/her feelings about the death. Caregivers should also know that children often re-experience grief at different developmental stages.

TIPS FOR CAREGIVERS
Grief has different meanings depending on the family’s background, spiritual orientation and culture. Rituals surrounding the death are often family specific as well as culturally grounded. In some families, for example, it is believed that children should be protected from the negative experiences associated with death and grief and therefore, children are excluded from rituals and discussions concerning the deceased. In other families, children are encouraged to be involved in all aspects of the death and memorialization of the deceased. Balancing these two extremes are the families that involve children in age appropriate ways. These families expose their children to some aspects of the grieving process while protecting them from other aspects that may overwhelm the child’s coping abilities.

Parents and children may need to mourn a family loss individually as well as together as a family. Parents often feel uncomfortable expressing their grief in front of their children, fearing that too much emotion will scare them. Grieving parents should try to strike a balance between modeling the healthy expression of emotions while maintaining a sense of security in the home. 

Children and adolescents tend to weather the pain of grief more easily when family members: 

• Communicate their emotions and their needs concerning the death      

• Understand and respect the individuality of each member’s grieving experience

• Recognize and cope with their own grief while assisting their children 

• Reassure their children that despite the sadness of losing a family member, they will continue to be cared for and they will remain a family unit.

In addition, research has found that adolescents may benefit from: 

• Good health habits such as good diet, nutrition, rest and exercise to combat emotional stress related to grief.

• A return to their normal routine including activities outside of school.

• Participating in activities of interest, such as sports teams and student clubs

• Obtaining professional counseling if necessary (Rask, Kaunonen, Paunonen-Illmonen, 2002).

Collaboration among family, school and professional services is essential to identify grieving adolescents who might not otherwise ask for help. Caregivers should notify school personnel when a death occurs. Teachers and school counselors can be watching for changes in the adolescent’s mood and behavior. Significant changes in the adolescent may suggest that additional help is needed.

HOW SOCIAL WORKERS CAN HELP
Social workers knowledgeable about grief and children can help caregivers: 

• Learn how to explain death to children

• Provide information on how children understand and express grief

• Learn to tolerate and moderate emotions and behaviors exhibited by children

• Communicate to children that they are not at fault or responsible for the death

• Provide assistance for coping with a grieving child or multiple grieving children when the caregiver is also grieving.