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Caring for grieving children and youth

(An explanatory note: Adults caring for children are not always their parents. They may be grandparents, aunts and uncles, siblings or foster parents - particularly when the person in a family who is dying, or who has died, is a parent. For this reason, “caregiver” is used throughout this article to describe the person caring for children and youth. Educators and others involved in the care of children and youth may also find this information of value.)

Depending on the relationship with the person who has died, children and youth may have a range of experiences from minimal impact to feeling their world has been shattered. Caregivers may wonder how to help children through their grief. Is it okay to talk about the “negative” emotions? Can I take my 10-year-old daughter to hospital to say goodbye to her dying grandfather? And what about shiva or the funeral? Should I arrange counselling for my teenage foster son? And how do I help my three-year-old make sense of his mother’s death? This article looks at some of the common concerns of grief and makes suggestions for parents and other caregivers wondering how best to support their children.

The four “C’s”: Common concerns of grieving children and youth

Children worry about four things when someone they know is dying or has died:

Can I catch it?
Did I cause it?
Could I have cured it?
Who will care for me?

Conversations with children and youth around these worries can provide an opportunity to reinforce that their questions, confusion and range of emotions are natural reactions.

Can I catch it?

When someone dies because of illness, younger children may need help understanding the difference between a terminal illness and the kinds of sickness they have experienced, such as a cold, flu or tummy ache. It’s important to use the proper names of illnesses, such as cancer, ALS, HIV and heart disease, to avoid this confusion.

When the illness is non-communicable, children need reassurance that they can’t catch it, and that they can safely touch this person both while they are alive and after they have died.

When the illness is contagious, explain the steps taken by the the family and healthcare staff to prevent its spread and describe how our bodies’ immune systems fight illness.

Some children and youth wonder if a physical or mental illness is hereditary. Professionals in the field recommend truthful conversations about this possibility when the child or young person is concerned about this possibility or when early screening is available and medically recommended. Paediatric healthcare practitioners can meet with your family to talk about genetic testing where this is appropriate.

Did I cause it?

It’s natural for people at any age to feel a sense of responsibility toward those they care about. Younger children are naturally focussed on themselves, and the magical thinking that is normal at their age can lead them to believe they can affect their world and might have caused the death:

“Daddy got my tummy ache and it caused his stomach cancer.”
“The baby died because I said I didn’t want a sister.”

Older children may suspect subtler factors brought about the illness or death:

“If mom wasn’t so stressed about the cost of my university tuition, her cancer wouldn’t have been so aggressive.”
“If I had gone to dinner with my brother that night, he wouldn’t have gone to the party where he was shot.”

Children and youth need reassurance that they aren’t responsible, even if they aren’t outwardly expressing worry or guilt. As you help them understand the cause of a death, you’re also supporting them to grapple with a loss that may seem senseless and unfair.

Could I have cured it?

Children and youth may also worry that there’s something they could and should have done to prevent the death:

“If I behaved better and wasn’t so hard to take care of, daddy would have come home from the hospital.”
"If I prayed harder, my sister would have woken up from her coma.”
“If I had kept my promise that I wouldn’t fight with her anymore, God would have cured mom’s heart condition.”
“I didn’t call 911 fast enough and the paramedics couldn’t save him.”

Again, it’s critical to reassure children and youth that the illness and death is beyond their control and they aren’t responsible.

This issue of cure can also come up in questioning whether caregivers or health care staff provided adequate care:

“Why didn’t they diagnose him earlier? Then the surgery would have worked.”
“How long did they do CPR? Why didn’t they do it until it worked?”

It may help to talk about the various people, procedures and efforts invested in trying to save the person’s life, or keep them as comfortable as possible in dying.

Who will care for me?

After the death of a parent, children often worry about who will take care of them. They may:
Recognize that parenting is a big job and challenging for one parent to manage alone.
See that their caregivers are grieving and struggling to look after their children while mourning their own loss.
Become anxious about the safety of important people in their lives – fearing that if one person in their life can be taken away, someone else they depend on may also die.
Reassure your children that you will continue to care for them.
Help them identify other adults, such as family, friends, teachers and other community members, who you can both turn to for support during this difficult time.
If you have written a will and assigned a guardian in the event of your death, tell your child. Knowing who this person is can be comforting.
Talk about the secondary losses and changes that often follow the death of a family member as soon as they become known. For example, changes in their financial situation, moving to a new home or town, changing schools, shifting routines and responsibility for chores.
Acknowledge that the changes may be difficult.
Emphasize that every member is important to finding a new rhythm.

Are these emotions normal?

Grief can include many intense emotions. It’s natural for young people to feel not only pain, sadness and emptiness, but a variety of emotions including anger, guilt, fear, worry, confusion or numbness. Even feelings of relief are common at the end of a long illness, or following the death of someone with whom there was a difficult relationship. Sometimes grief wraps us in many feelings at once. Although they can be painful and exhausting, it’s important for children and youth to know that these emotions are normal and to be expected.

Modelling healthy ways to grieve

Children learn how to grieve and care for their feelings by watching those around them, so they need to watch adults grieve and care for themselves in a healthy way. Allowing your children to see you cry, share your thoughts and express your feelings, gives them permission to cry, feel and share.

It’s important, however, not to frighten them with intense feelings, causing worry that you won’t be okay or able to care for them. This can be a difficult balance to find as you struggle with your own grief. Consider enlisting the help of other adults with household tasks, emotional support and caring for the children.

Expressing emotions

Knowing that their thoughts, emotions and experiences are normal and okay, makes it easier for children and youth to explore and express their feelings in ways that are healthy, healing and connect them with others. There is no one right way to express and care for grief. They may:

Express their feelings through play.
Talk about how they are feeling.
Use creative outlets such as art and craft, poetry, movement or music.
“Move” the energy of their grief through physical activity and sport.

When young people feel seen, heard and understood, they feel less alone and gain strength to go through the difficult passage of grieving.

Behaviour and managing difficult emotions

When a young child or youth’s world feels transformed or chaotic following the death of someone important, they may act out in various ways. In an effort to stay safe, they may revert to younger behaviour such as not wanting to sleep alone in their own bed, or finding it difficult to separate from caregivers, stay on top of homework or make good choices in risky situations. If this happens:

Try to understand the feelings behind the behaviour. This will guide you in how to help your child.
Keep to regular routines as much as possible and maintain consistent and predictable limits and expectations of good behaviour. This predictability and consistency can help children of all ages to feel safe.
Help your child understand the difference between feelings and behaviours. Explain that all their feelings are important and need care, but certain behaviours are not acceptable.
Together, brainstorm how to care for and safely express difficult feelings like anger, fear or sadness without hurting anyone or anything.
Let your child know when you yourself feel these emotions.
Cry together.
Recognize their distress.
Remember good times with the person who has died.
Help them safely release angry feelings through sports, movement or creative outlets. For example, dance, jumping jacks, art and play.

Attending ceremonies, rituals and memorials

Children of any age can attend rituals of remembrance such as celebrations of life, funerals, shiva, viewings or memorial services. Participating in some way can be meaningful and help them to feel included. Playing a part in such an important ritual of passage can be a cherished and healing experience for children and youth, just as it is for an adult.

Prepare children and youth for what they will see, hear, smell and experience.
Explain any “rules”; what the ceremony will look like; who might be there; and the possibility of seeing crying adults. Children may be confused when well-meaning adults seem to keep apologizing to them: “I’m so sorry for your loss.”
Agree on a special signal your child will give if he or she needs to take a break with an adult to support them.
Children may want to put something they’ve created, such as a card or special token, into the casket or displayed with an urn.
If a young person wasn’t able to say a final goodbye to the person who died, they may wish to take this opportunity.
In the event of an open casket, it is fine for children to view the body – again, with preparation. Some children might say the person merely looks asleep, while for others the person may appear very different than when they were alive. Let them know it’s safe to touch the person’s body. Remind them that the body doesn’t work anymore and can’t see, hear, think, feel touch or feel emotions.

If your child doesn’t want to attend a ceremony or ritual, be sure they understand what they are refusing. Try to identify fears or misunderstandings that are driving the decision. If your child feels strongly, respecting their wish may be best.

Adults and children grieve differently

Children grieve in chunks. Young children naturally move in and out of strong emotion. They use play to manage their feelings and discharge energy. One moment they may be upset and feeling their grief strongly, and the next they’re playing as though they don’t have a care in the world. This is healthy and normal. It’s also natural for children to explore death through play. You may find your child playing “hospital” or “funeral," or exploring other new experiences that dying and death has introduced to their lives and imagination.

Older children and youth tend to manage their strong emotions by taking breaks and distracting themselves. It’s important to respect their pacing. Forcing them to talk can have the opposite effect and shut them down. Instead, let them know you’re there for them and happy to talk when and if they would like.

Youth may prefer to speak with someone outside the home, such as a teacher or counsellor, and typically turn to their peers for support. Some youth describe warm and compassionate support from friends and classmates, while others feel isolated, stigmatized and alone in their grief. Ask if he or she has enough support or if they’d like you to help them find additional supports outside the home, such as a professional counsellor, an extended family member, a trusted neighbour, a respected teacher, a family doctor, priest or pastor.

Support from your children’s community

Following a death, it can be helpful to notify your child’s school/daycare/camp, and to share the news with friends and their families, extended family, church or activity group. The people in their extended community are then also able to offer support. Some children and youth prefer to keep the death private, not wanting to stand out as different from their peers. Some need time before they feel ready to be vulnerable with people outside their immediate family. When caregivers explore these feelings, they can better understand the help that children and youth need and their ability to open themselves up to others.

Returning to school

Collaborating with the school is vital to a successful return to the classroom. Sharing information on children’s grief, such as this resource, can help school staff better understand what your child or youth is experiencing.

When to return to school is a decision that should be made with your child or youth. If he or she is reluctant to go back, explore why and use creative problem solving to ease the transition.

Some children struggle to feel safe in separating from a caregiver after a death in the family. They may need:

To carry a special object such as a stone or a note that helps them to feel connected.
A lunchtime phone call with a caregiver.
A daily ritual for safety and connection (such as those described in The Kissing Hand or The Invisible String).

Some young people may feel shy or anxious about facing their peers after such a momentous change in their life. It’s important to remember that delaying return won’t take away this moment. It may in fact increase their nervousness and feeling of disconnection from the school community as well as the burden of missed school work. Recognize, too, that some children and youth may not want to appear different or be the center of attention.

If children or youth are unsure of how to share the news of this death with peers, school staff can consult with the student about their wishes and take the lead in sharing information with their class and teachers.

In general, and at school, grieving children may have difficulty concentrating or managing their grief feelings. Together with the school administration and teachers, identify strategies and people and places where children can find support during the day. Children benefit from knowing these are in place whether they need to use them or not. Useful strategies include:

Keeping a journal in their desk to write down thoughts and feelings when they’re preoccupied with the person who died or with grief feelings.
Permission to put down their head, take a break or take a walk in the hallway.
Permission to visit a trusted adult in the school such as a teacher, guidance counsellor, principal or vice principal (to talk or just have quiet space).
Extensions on assignments, extra time on tests, or buddies to help with notes or studying.

A balance of consistency, routine and familiarity that allows for flexibility and sensitivity to the child’s unique needs is key.

Feeling alone

Many children and youth say that “feeling alone” is their most difficult experience. They feel that no one understands what they’re going through. As a result, they struggle to express their feelings and receive support. Trusted adults, whether family members, friends, school staff or other members of the community, may be vital sources of assistance. Children and youth often benefit from grief programs and services, such as groups and camps where young people can meet and share their experience with others like themselves.

Staying connected with the person who died

A few decades ago, when someone died, grievers were expected to “get over it” and “return to normal.” Now we recognize that the relationship with someone important in our life doesn’t end with their death. A key piece of moving through grief is finding new ways to continue that relationship. Children and youth can be helped to express their feelings and maintain their relationship in various ways, including:

Family practices such as:
- Lighting a candle.
- Setting a place at the dinner table.
- Reserving a special place for pictures and special tokens.
- Remembering this person at birthdays and other special holidays.
- Continuing to celebrate their birthday.
Arts and crafts such as:
- Decorating a frame for a special photo of the person who died.
- Sewing a pillow from the deceased person’s clothing.
- Drawing pictures of favourite memories.
- Creating a playlist of music that reminds them of their person.
- Making a memory necklace with different beads representing different special memories.
- Decorating a memory box for photos, letters or other mementos of the person who died.
Individual practices such as:
- Talking to or journaling to the person who died each night.
- Thinking about their person during an activity they enjoyed together such as jogging or dancing.
- Thinking about them while enjoying an activity their person taught them.
- Wearing or carrying an object with special significance to the relationship, for example, a watch, scarf or jewellery.
- Taking on a behaviour of the person who died such as reading the newspaper on
- Saturday mornings or birdwatching.
Reflecting on what this person taught them and hoped for them.
Remembering how they liked to spend time together.

When adults help children and youth to continue their relationship with the person who has died, they contribute to healthy grieving and a meaningful connection that can support them throughout their lives.

When death is sudden, unexpected or violent

A death that occurs suddenly and unexpectedly presents additional challenges for the bereaved.

There is no time to prepare, say goodbye or try to resolve conflicts.
Without this preparation, children may struggle to understand what has happened.
There may be numerous and complicated secondary losses for both child and family.
The family may have greater difficulty adapting to life without this person, emotionally and practically.

A violent death can be traumatic for all family members, and can badly shake a child’s sense of safety in the world.

People who have had a family member die of suicide often struggle with anger, self-blame and question why this person took their own life.
People who have had a family member die of homicide may struggle with anger, a sense of responsibility and sometimes a wish for revenge or justice. As well, they may have an increased sense of vulnerability and insecurity. The involvement of the law and courts can take a long time and delay the process of healing for individuals or families.
When death is accidental, such as in a car accident or a drug overdose, if the person who has died bears some responsibility, children and youth frequently experience stigma and a lack of support from community, family and schools. The same is true of homicide and suicide.

These factors can complicate children’s grief. They may have more difficulty finding the support they need and the opportunities to express their feelings about what has happened. In these circumstances, it may be particularly important to turn to professionals who can offer safe spaces for children and youth to express and work with their grief.

Caring for yourself

In order to have the emotional and physical energy to care for children, it’s important to first look after yourself. Research shows that when grieving adults are well cared for, their grieving children do better. In other words, when we take care of our own grieving process, we are able to help others with their grief and suffering.

* * * * *

Much as we might wish it were possible, we cannot “fix” grief, prevent dying and death, or protect our children from the broken heartedness that comes with living and loving. But we can draw close and mourn together so our children are not alone in their grief. By providing loving support, information and tools so they can work with their own natural responses to the unavoidable storms of life, we help children and youth to grow into confident, healthy, wise and resilient, compassionate and connected adults.

For more information on conversations about death with children and youth, see the following resources: