D word: Children’s understanding of Death and Dying Matters
The aim of this article is to explore the developmental perspective of how children understand the process of Death and Dying as it affects children and adolescents.
Death is a universal phenomenon that affects children and especially adolescents, however, in grieving situations, little is considered and communicated about how children and adolescents experience the loss and death. The concept of death from a child’s perspective is very different from an adult’s understanding of death. Furthermore, as the child grows and matures, his/her earlier ways of thinking about death will change.
It is essential for the adult to have a sense of how children conceptualize death at different ages so that when the time comes to talk about death, whether of a pet or a loved one, the adult can respond in a manner appropriate to the child’s developmental age. The ages given below are not meant to be exact but rather representative of the differing developmental stages.
CONCEPTS OF DEATH BY AGE GROUP
- Birth to 1 Year: at the age of four months, a child can understand that an object exists even when the baby cannot see it. Out of sight truly means out of mind. Although there is no ability to conceptualize death, this may be felt as a vague absence or experiential sense of something different. a loss may bring a response from 4 months to 1 year. A loss is seen in the form of distress at being left alone.
- 1 to 2 Years: The death of the primary caregiver will usually result in displeasure and depression. The child can feel the loss with limited ability to understand or attribute meaning. Infants can be influenced by the parent’s tense and emotional grief reactions to a death in the immediate family.
- 2 to 6 Years: Death is understood as temporary and reversible. The child does not get the concept of reversibility, the notion that if something is done, it can also be undone. There is no concept of a personal death; death only happens to other people. The deceased person or a pet is broken and can be fixed; is asleep and can be awakened; is gone and will be back. Well-developed 4-6 years olds often think about, and are pretty interested in, death and often want to see and touch dead things.
- 6 to 9 Years: At this age child’s concept of death becomes clearer. Increased curiosity in the physical and biological aspects of death now develops. “Magical thinking” predominates with the belief that thoughts can make things happen—even accidents and death. By nine years of age, the child’s concept of death is remarkably like an adult. Death is not reversible or temporary but only happens to some people. Death is often thought of as a person or a “ghost” figure. According to Nagy, in this second stage, death is imagined as a separate person (such as a grim reaper, skeleton, ghost, or death angel). Death is identified with the dead themselves so that the children do not distinguish between death and dead persons. Nagy interpreted this concept as a personification of death, which means that the existence and definitiveness of death have been accepted. However, because of children’s strong aversion to the thought of death, death is depicted as a person or reality that is outside or remote from them. In this way, death is conceived as final, but avoidable or not inevitable and not universal. Those caught by the external force do die; those who escape or get away from the clutches of that force do not die.
- 9 to 12 Years: A child’s concept of death expands to that held in adult life. Awareness of the possibility of personal death is now fully developed. An objective curiosity grows: “What does the body look like?”, “Is the blood blue?”, “The body stiff?” Cold?” Even though there is a cognitive awareness of death and its universality and finality, there is a strong tendency towards denial. There is an increased interest in what happens after death.
- 12 Years of Age Through Adolescence: Older children’s concepts are more sophisticated than younger children’s, and they do not view Death abstractly and subjectively. Death is now considered abstractly and subjectively. There is strong egocentrism and a tendency to think of themselves as immortal. Subjective curiously develops: “What is the meaning of life?”, “What is my special mission?”, “Why doesn’t anyone besides me understand the implications of life and death?” Death is often romanticized as beautiful and tragic; paradoxically a gesture or statement that will somehow endure. Due to television and movies, they see loss experienced through death as easy to deal with. Although there is much objective philosophizing about death, it is still seen as something that happens to others.
Children’s Ability to understand Death depends on their developmental level, life Experiences, Individual personality and patterns of communication and support.
Life experiences are critical in a way that the quantity and quality of a child’s encounters with death are likely to be influential in their understanding of death. Each child’s individual personality will be a powerful variable in the ways he or she can and does think about death. And the death-related thoughts that a child shares with others will depend on his or her ability and willingness to communicate, together with the support and comfort that he or she receives from those others.
Mark Speece and Sandor Brent identified five principal sub-concepts, each of which is a central aspect in children’s concepts of death according to their cognitive representation of death: Universality, Irreversibility, Non-functionality, Causality, and Noncorporeal continuation.
- Universality refers to the concept of death that involves the recognition that all living things must eventually die and brings together the idea of all-inclusiveness (everything dies), inevitability (everything has to die), and unpredictability (death happens at/to all ages) in death.
- Irreversibility refers to the concept of death (a dead thing can never be alive again; dying can’t be reversed).
- Nonfunctionally (death involves cessation of all life functions).
- Causality (what events or conditions cause death).
- Noncorporeal Continuation (what happens after death).
According to these theoretical concepts, for a 4-year-old, death is reversible, which means if someone has died, they can come back to life. Children also do not fully conceptualize the fact that they are mortal. Instead, they believe death happens to older people and, in some instances, evil people. By the age of 8–10, children now comprehend personified death as an unavoidable life event.
Parents and adults working with children who are grieving, or experiencing a loss of someone close, should consider exploring children’s understanding and needs as part of the communication process.
These needs could include:
- adequate information
- fears and anxieties addressed
- reassurance to reduce child’s guilt and that they are not to be blamed
- empathetic listening and validation of individuals’ feelings
- help with overwhelming feelings
- involvement in loss and grief process and making them feel included
- promoting routine activities
- Witnessing modeled grief behaviours that gives the child opportunities to remember the deceased one or talk about their illness.
If the matter of death is left unaddressed and unanswered, children anticipate negative outcomes fear for themselves and struggle with questions like. These fears could include:
- Did I cause the death?
- Is it going to happen to me/you?
- Who will take care of me?
The main tasks for Grieving for Children and Adolescents include:
- To understand or seek to make sense out of what happened
- To grieve or express emotional and other strong reactions
- To commemorate in some way the person who died, and to learn how to integrate the loss into one’s life
It is essential to explore in detail how children think about death related matters.