The topic of death remains a taboo in society, especially when discussing it with a child (Francisco, 2018). In many cases, when a loved one or a friend becomes ill or passes away, children are often kept in the dark without a clear explanation of what is happening. This practice extends even to cases where the child themselves is ill or in a terminal phase, with some families choosing not to provide them with information about their situation. Therefore, in accordance with Francisco (2018), it is common for children to feel confused about the concept of death.
It is important to note that boys and girls do not understand death in the same way as adults (Carrera et al., 2020). Their understanding of the concept evolves throughout their development, shaped by their experiences, the questions they ask, the responses they receive, and the interests and concerns that emerge during their life cycle (Carrera et al., 2020). Consequently, effective communication and honest information tailored to the child's needs are essential for them to face their fears appropriately (Francisco, 2018). But how do you talk to a child about death? At what age does a child have similar ideas about death as an adult?
How Does a Child Acquire the Concept of Death?
It is understood that boys and girls face death differently, depending on their cognitive maturity (Francisco, 2018). This implies that children's understanding of the concept of death is based on their developmental level rather than their chronological age. Therefore, in accordance with Reguera (2019), understanding the grieving process in children will enable us to provide better support during these difficult times.
Barbara Kane describes three stages in the development of the concept of death in children (Francisco, 2018). The first stage is characterized by the acquisition of separation concepts, meaning the understanding that the deceased no longer live among us, and the lack of movement, meaning that the deceased remain motionless. In the second stage, the concepts of universality, i.e., that death will reach us all, and the cessation of bodily activity are distinguished, along with irreversibility, i.e., that death is final, and causality, initially related to external causes such as accidents or illness. In the final phase, the child can think about death in an abstract way, almost like an adult. As can be observed, the concept of death is defined multidimensionally by integrating the understanding of three basic concepts: universality, irreversibility, and cessation of bodily processes. But, according to Francisco (2018), at what approximate age are each of these concepts acquired?
When Does a Child Acquire the Concept of Death?
Prelinguistic Stage (0 - 18 Months)
At this moment, there is a relative lack of understanding of the meaning of death, so it is not considered as something final (Figueroa, Cáceres & Torres, n.d.). Even though death may not be fully comprehended at these ages, infants can perceive the emotions of the person caring for them. Therefore, it is crucial that primary caregivers recognize their own emotional needs. It is also essential for the primary caregiver to strive to maintain as many routines as possible (Figueroa, Cáceres & Torres, n.d.). In the absence of the loved one, the routine provides the infant with a sense of security (Carrera et al., 2020). Otherwise, the child may experience a certain degree of confusion, restlessness, and uncertainty when these routines are disrupted or canceled (Carrera et al., 2020). In short, according to Figueroa, Cáceres & Torres (n.d.), routine serves as a protective force for infants amid significant disruptions.
On the other hand, death is equated with separation in a concrete sense, from the perception that something or someone is missing (Sánchez, 2013). In this way, separation is experienced as abandonment and represents a threat to security (Sánchez, 2013). Therefore, it is important to avoid physical separation, provide additional physical care to comfort the child, and enhance their sense of security (Figueroa, Cáceres & Torres, n.d.). This way, the little ones will feel loved and protected by someone else (Reguera, 2019). However, in line with Reguera (2019), it is important to note that this will not make them stop expecting the deceased to return, but it will help them overcome the pain and gradually return to normalcy.
Preschool Stage (18 Months - 5 Years)
From the age of two, when language development significantly expands, preschoolers tend to perceive death as a reversible, transient, and impersonal phenomenon (Paris, 2011). As a result, it is common for them to insist on the possibility of seeing the deceased person again, even after being told that this will not happen (Reguera, 2019). At this stage of life, there is a belief that illness is caused by external factors or accidents (Francisco, 2018). Additionally, according to Francisco (2018), death is interpreted as a dream characterized by the loss of mobility, separation, or temporary malfunction.
This stage is also characterized by magical thinking, meaning that children believe the dead breathe, eat, and move from one place to another (Francisco, 2018). This kind of thinking can lead them to experience illness as a punishment for their misbehavior or bad thoughts (Francisco, 2018). Since children at this stage are concrete thinkers, interpreting things as they appear, it is crucial that information about death is provided to them in understandable and simple language (Figueroa, Cáceres & Torres, n.d.). Therefore, euphemisms like "went to sleep" or "traveled to the beyond" should be avoided, as these phrases may not be understood and, in some cases, may induce fear of sleeping or during long journeys (Salek & Grinsburg, 2016). Instead, according to Figueroa, Cáceres & Torres (n.d.), they should hear that their loved one has died and that means they won't be able to see them again.
During this stage, questions about the whereabouts of the deceased or when they will return may persist (Salek & Ginsburg, 2016). However, it is necessary to provide clear messages, which can be softened with the idea that memories will endure forever (Figueroa, Cáceres & Torres, n.d.). The decision to use religious explanations rests with the parents, but relying solely on religious explanations at this stage may be ineffective, as children require more concrete explanations about the physical reality of death (Salek & Ginsburg, 2016). Considering that, at this age, children cannot always express their thoughts and fears, these often emerge at unexpected moments, such as during their playtime (Figueroa, Cáceres & Torres, n.d.). According to Salek & Ginsburg (2016), it is important to emphasize that play is the language of childhood; therefore, caregivers should pay attention to what children are trying to communicate through it.
Moreover, some children may revert to immature behaviors, such as baby talk, thumb-sucking, becoming clingy, or irritable (Figueroa, Cáceres & Torres, n.d.). Others may have outbursts of anger. However, in line with Figueroa, Cáceres & Torres (n.d.), it is important to consider that these behavior changes are likely manifestations of unexpressed emotions, such as confusion or frustration.
School - Age Stage (From 5 Years Old)
During the school - age stage, children begin to show curiosity about death and social relationships (Francisco, 2018). At this age, they already understand that certain internal factors can cause illnesses. However, they often think that death is selective, affecting only the elderly (Francisco, 2018). Therefore, it is common for them to believe they can avoid death through their cleverness (Paris, 2011). At this stage, children also tend to personify death, associating it with a skeleton or the angel of death (Paris, 2011). These images can trigger nightmares in some children (Paris, 2011). For this reason, it is crucial to provide simple and honest explanations about what has happened and then ask them what they understand (Figueroa, Cáceres & Torres, n.d.). According to Salek & Ginsburg (2016), it is essential for adults to take the time to clarify any misunderstandings or misinterpretations.
During the school - age stage, children may need help from adults to find the right words to express their emotions and find ways to feel better (Figueroa, Cáceres & Torres, n.d.). Therefore, primary caregivers should provide repeated opportunities for children to feel comfortable talking about their feelings (Salek & Ginsburg, 2016). Common reactions to death at these ages may include difficulty concentrating in school, sleeping problems, and recurrent thoughts about death (Figueroa, Cáceres & Torres, n.d.). In accordance with Figueroa, Cáceres & Torres (n.d.), they may experience physical reactions such as stomachaches and headaches that can be triggered by staying in places that remind them of the deceased person.
Between 7 and 13 Years Old
In this phase, it is observed that children begin to fully understand that death is irreversible, that all living beings die, and that they will also die someday (Paris, 2011). This understanding often leads them to frequently elaborate philosophical ideas about life and death or seek the meaning of life, although their anchoring in the present prevents them from imagining that someday it will come for them. Facing and fearing death, they are trying to overcome their fears and "control" mortality (Paris, 2011). At this stage, the structuring of the mind allows them to understand abstract processes, meaning they differentiate between fantasy and reality (Carrera et al., 2020). Moreover, they become aware of violence, differences in society, and the difficulties that may arise. Therefore, according to Carrera et al. (2020), this is a stage where high levels of frustration can develop.
On another note, children between seven and thirteen years old perceive their surrounding environment much better and, therefore, may be more prone to seek companionship in grief (Carrera et al., 2020). Adults in their surrounding environment must be very clear that, having an understanding of abstract processes, such as the rituals performed after a person's death, can be explained to them without fear of the purpose of these rituals and how they help us bid farewell to the loved one. In line with Carrera et al. (2020), when faced with their questions or concerns, it is fundamental to clarify to children in this stage how the body or organs stop functioning, as this will help them better understand that death is not a consequence of their thoughts.
During this stage, support networks are expanding, with the presence of friends and authority figures outside the family becoming more important. Therefore, a child should not be forced to isolate themselves to prevent them from expressing their feelings or finding peace by force or habit. This is a crucial moment to let them know how important they are and how good it is to have them close. Additionally, it is possible to work with children to build or strengthen a self-care structure with communication and respect-based strategies, keeping them away from risky behaviors. Also, according to Carrera et al. (2020), it is important to prevent the uncertainty that generates frustration and a lack of understanding of death from affecting them and preventing them from engaging in activities they used to do in their daily lives.
Communication with the Child About the End of Life
Talking about death with children is one of the most challenging situations that adults face (Francisco, 2018). It is evident that the child has the capacity to learn about illness, even if there is an attempt to hide it. Therefore, it is important to discuss these topics with them, always in a manner suitable for their level and respecting their needs. By using language that is easy for the child to understand and allowing them to share drawings, stories, or narratives, they are given the opportunity to explore their fears. According to Francisco (2018), this will provide comfort, as well as equip them with arguments to counter the "temptation" to believe that they are responsible for someone's death due to misbehavior.
One of the most important communication skills will be active listening since many boys and girls talk about death through puzzles, story characters, television series, or comics (Francisco, 2018). Similarly, non-verbal communication is crucial, as children may use posture, tone of voice, or gaze to express their fears or unpleasant sensations that they cannot articulate with words. Finally, it is necessary to be attentive and, at the same time, be mindful of how one communicates with them. Ideally, communication should be calm and without dramatization. In this way, in line with Francisco (2018), concern or sadness can be expressed, but with confidence, assuring them that they will be accompanied at all times.
References
Carrera, M., Gutiérrez, K., Hernández, O., Ibarra, S., Poiré, R., & Sabbagh, L. et al. (2020). Recomendaciones para Abordar el Duelo y la Muerte con Niñas, Niños y Adolescentes. Enduelo.org. Recuperado 7 octubre 2021, a partir de https://enduelo.org/descargas/guia_ninos_enDuelo.pdf
Figueroa, M., Cáceres, R., & Torres, A. Duelo: Manual de Capacitación Para Acompañamiento y Abordaje de Duelo. Unicef.org. Recuperado 4 octubre 2021, a partir de https://www.unicef.org/elsalvador/media/3191/file/Manual%20sobre%20Duelo.pdf
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Paris, E. (2011). Etapas del Niño en la Comprensión de la Muerte. Bebesymas.com. Recuperado 4 octubre 2021, a partir de https://www.bebesymas.com/desarrollo/etapas-del-nino-en-la-comprension-de-la-muerte
Reguera, L. (2019). Comprender el Duelo de Nuestros Pequeños: Una Ayuda en Momentos Difíciles. La Mente es Maravillosa. Recuperado 4 octubre 2021, a partir de https://lamenteesmaravillosa.com/comprender-duelo-pequenos-una-ayuda-momentos-dificiles/
Salek, E., & Ginsburg, K. (2016). Cómo Entienden los Niños la Muerte y qué Debe Decir. HealthyChildren.org. Recuperado 4 octubre 2021, a partir de https://www.healthychildren.org/Spanish/healthy-living/emotional-wellness/Building-Resilience/Paginas/how-children-understand-death-what-you-should-say.aspx
Sánchez, I. (2013). La Vinculación Afectiva y el Camino de la Vida. Apego, Pérdida y Psicopatología Infantil. Psiquiatria.com. Recuperado 5 October 2021, a partir de https://psiquiatria.com/trabajos/usr_555289354.pdf
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