Death in the family - helping children to
cope: information for parents, carers and anyone who works
with young people
About this leaflet
This is one in a series of leaflets for parents, teachers and
young people entitled Mental Health and Growing Up. The
aims of these leaflets are to provide practical, up-to-date
information about mental health problems (emotional, behavioural
and psychiatric disorders) that can affect children and young
people. This leaflet looks at how a death in the family may affect
a child or young person, and offers advice on how to cope with this
situation.
Introduction
How does a child respond to death?
Death in the family affects everyone. Children, in particular,
need to be thought about even if it is a difficult time for the
whole family. How they react depends on a number of factors, for
example:
How close the person who died was to the
child, and the family, is important. How involved the person was in
their lives is also a factor.
Whether the death was expected or the person
had been ill.
The child's age and level of understanding
and how the death affects their life. Infants may feel the loss
mainly because it affects the way in which they are looked after
and their daily routine. They are very sensitive to the unhappy
feelings of those around them, and may become anxious, difficult to
settle and more needy of attention. Pre-school children usually see
death as temporary and reversible - a belief reinforced by
cartoon characters that `die' and `come to life' again.
Children from about the age of 5 are able to understand basic
facts about death:
- it happens to all living things
- it has a cause
- it involves permanent separation.
They can also understand that dead people do not need to eat
or drink and do not see, hear, speak or feel. Teenagers are able to
understand death much more like adults, and are very aware of the
feelings of others.
Most children get angry and worried, as well as sad, about
death. Anger is a natural reaction to the loss of someone who was
essential to the child's sense of stability and safety. A child may
show this anger in boisterous play, by being irritable, or in
nightmares. Anxiety is shown in `babyish' talk and behaviour, and
demanding food, comfort and cuddles.
Younger children believe that they cause what happens around
them. They may worry that they caused the death by being naughty.
Teenagers may find it difficult to put their feelings into words,
and may not show their feelings openly, for fear of upsetting
others.
The circumstances of the death also affect
the impact on the child. Each family responds in its own way to
death. Religion and culture will have an important influence on
what happens. Other factors that can make a big difference from the
child's point of view are:
- how traumatic the death was - a traumatic death can be harder
to cope with
- whether the death was sudden or expected, a relief from
suffering or a `crushing blow'
- the effect of grief on other family members, especially if they
are not able to cope with giving the child the care they need
- how much practical support is available to help the family
cope.
Helping a child to cope with death
Being aware of how children normally respond to death makes it
easier for an adult to help. It also makes it easier to identify
that a child is finding it particularly hard to cope with.
Early stages
Adults sometimes try to protect children from pain by not telling
them what has happened.
Experience shows that children benefit from knowing the truth at an
early stage. They may even want to see the dead relative. The
closer the relationship, the more important this is. Adults can
also help children to cope by listening to the child's experience
of the death, answering their questions, and reassuring them.
Children often worry that they will be abandoned by loved ones, or
fear that they are to blame for the death. If they can talk about
this, and express themselves through play, they can cope better and
are less likely to have emotional disturbances later in life.
Young children often find it difficult to recall memories of a
dead person without first being reminded of them. They can be very
upset by not having these memories. A photograph can be a great
source of comfort. Children usually find it helpful to be included
in family activities, such as attending the funeral. Thought should
be given as to how to support and prepare a child for this. A child
who is frightened about attending a funeral should not be forced to
go. However, except for very young children, it is usually
important to find a way to enable them to say goodbye. For example,
they can light a candle, say a prayer, or visit the grave.
Later on
Once children accept the death, they are likely to display their
feelings of sadness, anger and anxiety on and off, over a long
period of time, and often at unexpected moments. The surviving
relatives should spend as much time as possible with the child,
making it clear that they can show their feelings openly, without
fear of upsetting others. Sometimes a child may `forget' that the
family member has died, or persist in the belief that they are
still alive. This is normal in the first few weeks following a
death, but may cause problems if it continues.
Warning signs that a child is not coping
- a long period of depression, with loss of
interest in daily activities and events
- inability to sleep, loss of appetite, prolonged fear of being
alone
- acting like a much younger child for a long time
- denying that the family member has died
- imitating the dead person all the time
- talking repeatedly about wanting to join the dead person
- withdrawing from friends
- a sharp drop in school performance, or refusal to attend
school.
These warning signs indicate that professional help may be
needed. A child and adolescent psychiatrist or child
psychotherapist can help the child to accept the death, and also
assist the survivors to find ways of helping the child through the
mourning process. Your general practitioner will be able to offer
you help and advice, and can refer you and your child to your local
child and adolescent mental health service. The team includes child
psychiatrists, psychologists, social workers, psychotherapists and
specialist nurses.
References
- Carr, A. (ed.) (2000) 'What Works with Children and
Adolescents?' - A Critical Review of Psychological Interventions
with Children, Adolescents and their Families. London:
Brunner-Routledge
- Rutter, M. & Taylor, E. (eds) (2002) 'Child and
Adolescent Psychiatry' (4th edn). London: Blackwell.
- Scott, A., Shaw, M. & Joughin, C. (eds) (2001) 'Finding
the Evidence' - A Gateway to the Literature in Child and Adolescent
Mental Health (2nd edn). London: Gaskell.
Sources of further information
- Heegard, M. (1991) 'When Someone Very Special Dies -
Children can Learn to Cope with Grief' Minneapolis, MN:
Woodland Press.
- CRUSE
Bereavement Care promotes the well-being of bereaved
people and to enable anyone bereaved by death to understand their
grief and cope with their loss.
- Winstons
Wish supports bereaved children and families.
- The Child
Bereavement Trust (CBT) is a national charity, that
works to help bereaved families where a baby or child has died, or
where children are bereaved of someone important in their
lives. It trains and supports those who come into contact with
child bereavement in the course of their work within healthcare,
education, social care, the emergency services and the voluntary
sector. It also offers a confidential information and support
service for professionals and families, providing a listening
ear and, if appropriate, signposting to further local and
national sources of support specific to the particular situation.
Information and support helpline: 0845 357 1000
- The Mental Health and Growing Up series contains 36
leaflets on a range of common mental health problems, including
discipline, behavioural problems and conduct disorder, and
stimulant medication. To order the pack, contact Book Sales at the
Royal College of Psychiatrists, 17 Belgrave Square, London SW1X
8PG; tel: 020 7235 2351, ext. 146; fax: 020 7245 1231; e-mail:
booksales@rcpsych.ac.uk, or
you can download them from this website.
© [2004]
Royal College of Psychiatrists. This leaflet may be downloaded,
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