Grief can be a challenging topic to discuss, especially when children are involved. Every child reacts differently to the information given to them regarding death. Keep these things in mind as it relates to the child: the child's relationship with the person who has died, how the person died, and any previous knowledge that the child may have about death to help you better communicate loss. 

Use these guidelines when talking with a child about death:

• Give the child an age-appropriate explanation of the cause of death.
• Understand that mourning and sadness are appropriate for people of all ages.
• Listen and be prepared for questions.
• Show you understand and care through words and actions.
• Help your child say goodbye.
• Depending on the age, involve your child in the funeral arrangements, but always offer them a choice. Never force them into any situation.
• Plan special activities alone with the child.
• Introduce common fears and discuss these fears with the child.
• The child may have questions or concerns, but may not be able to express them.

Preparing your child for the death of a loved one can help them understand what is happening and ease their minds on what death is. Click here for age appropriate tips on how to prepare a child for the death of a loved one.

Below are some common questions that children may ask after the loss of a loved one, questions you may be wondering about, as well as helpful tips and ways to answer each question.

Q: Why did they die?

A: Be concrete and concise in your descriptions with younger children. For example, if a preschool or school-aged child's parent died from a heart attack, you can tell the child "Mom or Dad's heart stopped beating. The heart pumps oxygen to the brain and around the body, so without oxygen, the brain isn't able to function, and the body stops working. When your body doesn't work, you are unable to breathe, eat, and move like you once did." It is important to stress that the medical team did everything they could. Older children may need more detail and that is okay to give as much detail as you feel comfortable giving.

Q: Is death contagious?

A: Often children may not know the difference between kinds of illnesses. Preschool and elementary school-aged children may think that death is contagious. It is important to reinforce that they cannot "catch" the death or illness. Let them know that if they played with their dying sibling or hug their dying grandparent, it does not mean that the illness or death will "spread" to them.

Q: Is it my fault? 

A: It is important to stress to children that their loved one did not die because of anything they said or did, that the person that died loved them very much and that this isn't a punishment. Also, guilt is very common for some children/adolescents, such as feeling as though they should have noticed something was wrong sooner than they did. As a caregiver, it is important to validate these feelings and reassure them it is not their fault.

Q: Who will take care of me now?

A: If one parent dies, children often think that it is likely the other parent could die. Of course, a parent shouldn't promise they will live forever, as death is inevitable. However, it is important for a caregiver to reassure the child of their health, that not everyone who is sick dies, and that they intent to care for them.

Q: Where do people go when they die and are they coming back?

A: No matter the belief system, it should be stated concretely that the individual is not coming back. Their body has stopped working, so they can no longer breathe, eat and play like they used to. Be sure not to use the phrase "sleeping," as this can lead to misconceptions and unnecessary anxiety around bedtime.

Q: Do children grieve differently than adults?

A: Some children grieve similarly to adults, modeling coping behaviors from a trusted caregiver. However, many children grieve differently than adults. For example, some children need to play through their emotions, some will have stomachaches and other physical symptoms, and others will yell and cry about seemingly unrelated topics in attempt to sort through their feelings. It really depends on the child as each individual will grieve differently. If there are a lot of behaviors that are concerning to you, contact the child's doctor.

Q: Should children see their parents and/or family grieving?

A: Watching parents and/or family openly grieve is how children learn how to express their own emotions and cope in a healthy manner. Children need to see that it is okay to cry. They are comforted by the fact that they are not alone in feeling these emotions and are more open to talking about feelings rather than internalizing them. For example, allowing time to talk and express emotions regarding th loss of a loved one as a family (or one-on-one) is important for children to learn to cope effectively.

Q: How can caregivers help a grieving child?

A: In order to provide an open, caring and supportive environment, caregivers should actively listen to their children talk about their feelings, let them know it is okay to cry, comfort them with hugs, and assure them that while it is okay to feel sad, it is also okay to feel happy. If the child does not want to talk about it, reassure them that whenever they do want to talk, the caregiver will be present. Talk with a Child Life Specialist or a school counselor to discover additional resources such as cramps, that may be available for children dealing with grief.

Q: Can loss permanently scar a child?

A: Most children will eventually learn to live with their loss when provided with adequate comfort, love, and support. It will be an adjustment, but ultimately, children are resilient and learn to cope with the loss. However, if you notice red flags, such as sleep disturbances, regression of certain skills or seeming withdrawn for a period of time please contact the child's doctor.

Q: Should children be able to see their caregiver, sibling, etc. in the hospital? What if they are on hospice or a ventilator?

A: Some caregivers prefer that this is not the last image of the child's loved one that they are left with - they want them to remember a happier memory. Some caregivers want older, school-aged children to have the opportunity to say goodbye and gain a sense of closure. It truly is up to the caregiver's individual judgment as they know their child best. Children who are old enough to make this decision themselves should be provided with options on how they can say goodbye (i.e. in person, written letter, voice recording). Regardless of age, it is important to prepare the child ahead of time for what they will experience (i.e. see, hear, smell) when they visit their loved one in the hospital.

Q: Should children attend funerals?

A: When children are given the choice to attend a funeral, they are able to feel as though they are part of the grieving process and receive the love and attention that they need. When not given the opportunity to attend the funeral, children may feel left out or may not receive the closure they need. If a child is nervous about the funeral, an adult can find a time when the child can say goodbye in private, either before or after the service, and the child can play (ask your funeral director if there is a playroom available) when everyone else is saying goodbye. The closer a child is to the loved one, the more important it is for them to attend the funeral, but ultimately, it is up to the caregiver to make this decision. 

Q: Do children need an explanation of what to expect at a funeral in advance?

A: Honesty and clarity should be used while explaining what to expect at a funeral to a child. The simpler the language that is used, the better. For example, a caregiver could explain to a child that a funeral is a way to say "goodbye" to a loved one after they have died. A caregiver should also explain what a child will see and hear at a funeral (i.e. "There will be a lot of flowers, and it will be a very quiet atmosphere. There may also be people crying"). It will also be important to explain to the child that the loved one's body may be lying in a special box, called a casket. The child does not have to go up to the box, but he or she can if they would like to. If the loved one is cremated, it means that the loved one was put in a very warm room until their bodies turned into soft, powdery ashes. The ashes were either put into a vase, or they were spread in a place that was special to the loved one.

Q: Can we protect children from the loss?

A: Death is inevitable, and it is better to include children in mourning practices, than to put it off or shield them from these experiences, so that they can learn how to deal with overwhelming emotions.

Q: How long will an individual grieve? Is this normal?

A: Validating one's feelings is essential. Remember that grief is a physical, emotional, cognitive, social and spiritual experience, and that everyone grieves differently and at various paces. There isn't a "grief timeline" that an individual should follow. It may be helpful to refer the individual to an appropriate support group so they realize they are not alone in feeling this way. Finding positive coping strategies, such as listening to music, painting, journaling, exercising and/or talking to a loved one can be very helpful as well. 

If you have any questions or you're concerned about how to discuss this with your child, Child Life at HSHS St. Vincent Children's Hospital is here to help. They are trained to teach children and families the skills it takes to cope with a loss of a loved one. If you are interested in speaking or meeting with a Child Life Specialist, please call (920) 433-8641, or notify your child's doctor.