The concept of death is presented as something abstract and complex, whose understanding varies according to various factors such as age, education, emotional aspects, and religious beliefs (Ordoñez Gallego & Lacasta Reverte, n.d.). The understanding of loss and the grieving process in children is strongly influenced by their age or developmental stage. There are five fundamental elements that intervene in the understanding of death and that will change with age. In correspondence with Artaraz Ocerinjaúregui et al. (2017), death is characterized as universal, affecting all living beings; irreversible, as after death one does not come back to life; non-functional, as the body ceases to function; uncontrollable, as death does not depend on thoughts; and represents the end of life, generating a mystery about the continuity or not of another form of life.
The grieving process in children can be divided into three phases (Ordoñez Gallego & Lacasta Reverte, n.d.). In the first phase, known as protest, the child longs for the deceased loved one and cries pleading for their return. In the second phase, called despair, it is characterized by the gradual loss of hope that the loved one will return, with intermittent crying and possibly a period of apathy. Finally, in the last phase, called breaking the bond, the child begins to relinquish part of the emotional bond with the deceased and shows interest in the world around them. The duration of grief in children can vary from a few months to over a year. According to Ordoñez Gallego & Lacasta Reverte (n.d.), most children who face the death of a parent overcome grief without significant complications, processing the loss appropriately.
Just like in adults, there are normal manifestations of childhood grief, including shock and confusion over the loss, anger manifested in violent play, nightmares and anger towards other family members, fear of losing another loved one, regression to earlier stages of emotional development, guilt derived from difficulties in the relationship with the deceased or belief of having caused their death, and sadness manifested with symptoms such as insomnia, anorexia, and decreased academic performance (Ordoñez Gallego & Lacasta Reverte, n.d.). In children, physiological manifestations predominate due to difficulty expressing emotions, while in adolescents psychological distress is more common (Ordoñez Gallego & Lacasta Reverte, n.d.). According to Caraballo (2020), common physiological symptoms include loss of appetite, inability to sleep, crying, frequent sighs, physical fatigue, feeling of emptiness and heaviness, palpitations, nervousness, lack of energy, motor retardation, restlessness, and shallow breathing.
Psychological disorders in childhood grief are similar to those in adults, but possibly with more anxiety in children and greater changes in their life circumstances, such as moving or changing schools (Ordoñez Gallego & Lacasta Reverte, n.d.). Three notable differences are that children tend to use denial more, they maintain the ability to enjoy pleasant situations more easily, and they do not lose self-esteem (Ordoñez Gallego & Lacasta Reverte, n.d.). In general, in correspondence with Ordoñez Gallego & Lacasta Reverte (n.d.), the younger the child, the less their grief resembles that of an adult.
Children and Death: How They Understand and Express Their Grief
When children are between two and five years old, they often experience bewilderment and confusion about the death of a close person (Ordoñez Gallego & Lacasta Reverte, n.d.). They try to search for them and don't understand why they are not there. Additionally, they may show signs of regression, such as not wanting to separate from the caregiver, complaining, wetting themselves, or thumb-sucking. Their attitude is ambivalent: sometimes they ask questions and express their emotions, and other times they are indifferent and silent. They may also feel irritability and anger at feeling abandoned, or fear of losing another family member and being left alone. Therefore, they seek to establish emotional bonds with someone who resembles the deceased. Children under 3 or 4 years old do not have a clear idea of what death means and do not consider it as something definitive (Ordoñez Gallego & Lacasta Reverte, n.d.). According to Artaraz Ocerinjaúregui et al. (2017) and Ordoñez Gallego & Lacasta Reverte (n.d.), they do not understand that death is irreversible: they believe it is temporary.
For children aged four to seven, death is not a definitive or irreversible fact, but they think that the dead retain feelings and biological functions (Ordoñez Gallego & Lacasta Reverte, n.d.). They imagine that the body of the deceased loved one continues to function in some way, that it can feel cold or hot, that it can hear or speak (Artaraz Ocerinjaúregui et al., 2017). Consequently, in correspondence with Ordoñez Gallego & Lacasta Reverte (n.d.), they may ask questions about how the deceased eats or if they need to go to the bathroom.
They may also have "magical thoughts" and believe that their bad thoughts or wishes caused the death of their family member (Ordoñez Gallego & Lacasta Reverte, n.d.). Or conversely, they may think that if they wish strongly enough, they can bring their loved one back from death (Artaraz Ocerinjaúregui et al., 2017). These magical thoughts can generate feelings of guilt, either because the child feels responsible for the death or because they believe they did not do enough to prevent or reverse it (Artaraz Ocerinjaúregui et al., 2017). Ultimately, in accordance with Artaraz Ocerinjaúregui et al. (2017), children under five do not understand the three fundamental aspects of death: that it is irreversible, definitive, and permanent; that it implies the cessation of all vital functions and that it is universal, meaning that nobody can avoid dying.
They also do not usually cry much for grief before that age (Ordoñez Gallego & Lacasta Reverte, n.d.). What they mostly show is bewilderment and confusion. That's why they ask over and over again about the deceased: where they are and when they will come back (Ordoñez Gallego & Lacasta Reverte, n.d.). Children under six may also have intense fears that cause them to regress in some learning (Caqueo Urízar et al., n.d.). The three most common fears in childhood grief are: Was I the cause of death? Will this happen to me? and Who will take care of me now? Indeed, according to Ordoñez Gallego & Lacasta Reverte (n.d.), the death of a loved one is an experience that changes the way the child perceives their world.
It is observed that children aged six to nine deny what happened and may appear indifferent as a defense mechanism against the loss of a loved one, allowing them to establish an imaginary relationship with the deceased person (Ordoñez Gallego & Lacasta Reverte, n.d.). Likewise, they feel guilty, especially if they cannot express the sadness that overwhelms them. This generates fear and vulnerability, which can manifest in a certain aggressiveness towards people in their surrounding environment. In correspondence with Ordoñez Gallego & Lacasta Reverte (n.d.), some children take on the role of the deceased, such as taking care of younger siblings, to feel closer to him or her.
Children over six years old experience emotional and physical distress, such as stomach pain, loss of appetite, and disruption of sleep patterns (Caqueo Urízar et al., n.d.). They also present attention and concentration problems, anger, behavioral problems, and confusion (Caqueo Urízar et al., n.d.). At this age, the magical thinking that made them believe that their thoughts caused death or the return of the deceased disappears (Artaraz Ocerinjaúregui et al., 2017). However, it is not until six or seven years old when they understand that death is irreversible and consists of the definitive cessation of all biological functions. From then on, they begin to question whether the death of others or their own is possible, although it will not be until eleven or twelve years old, when they accept their own death and that of others realistically. As a result, according to Artaraz Ocerinjaúregui et al. (2017), fears of losing their own life and that of their loved ones arise.
Adolescents experience mood and behavioral changes, anger, frustration, and withdrawal in the face of the death of a loved one (Caqueo Urízar et al., n.d.). Their understanding of death and grief processing is similar to that of an adult, but they experience emotions more intensely (Artaraz Ocerinjaúregui et al., 2017). They are interested in what happens after death, whether there is life after it or not. Adolescence is a stage of change and transition towards independence from the adult world, which generates more conflicts in the relationship with their caregivers. This can cause feelings of guilt if one of the parents or close people dies. They are aware of their own death and may fantasize about it, or even think about suicide as a way out of their suffering or the problems caused by the loss. Often, according to Artaraz Ocerinjaúregui et al. (2017), they do not want to share the emotions derived from the loss, considering that they do not need others, or not wanting to appear vulnerable.
They do not want to be different from their peers, nor do they want their pain to be interpreted as a sign of weakness or not be understood by their peers (Artaraz Ocerinjaúregui et al., 2017). These situations can cause the adolescent to give up experiencing their own grief. After the death, they tend to praise the qualities of the deceased loved one, forgetting about other less pleasant or more conflicting aspects, which before death were the subject of intense criticism. Finally, according to Artaraz Ocerinjaúregui et al. (2017), they may feel pressured to behave like adults.
References
Artaraz Ocerinjaúregui, B., Sierra García, E., González Serrano, F., García García, J. Á., Blanco Rubio, V., & Landa Petralanda, V. (2017). Guía Sobre el Duelo en la Infancia y la Adolescencia: Formación para madres, padres y profesorado. Colegio de Médicos de Bizkaia. https://www.sepypna.com/documentos/Guía-sobre-el-duelo-en-la-infancia-y-en-la-adolescencia-1.pdf
Caqueo Urízar, A., Martínez, J., & Santelices, M. P. (s. f.). ¿Cómo apoyar a niños, niñas y jóvenes frente al duelo? Cuida.uc.cl. Recuperado 29 de enero de 2024, de https://cuida.uc.cl/wp-content/uploads/2020/06/guia_duelo_infografia_nna.pdf
Caraballo, E. (2020, agosto 30). ¿Cómo Reconocer el Duelo en los Niños? Elena Caraballo. https://www.elenacaraballopsicologia.com/post/cómo-detectar-el-duelo-en-los-niños
Ordoñez Gallego, A., & Lacasta Reverte, y. M. A. (s. f.). El Duelo en los Niños (La Pérdida del Padre / Madre). Sociedad Española de Oncología Médica. Recuperado 27 de enero de 2024, de https://www.seom.org/seomcms/images/stories/recursos/sociosyprofs/documentacion/manuales/duelo/duelo11.pdf
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