Death in the family

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 and how involved that person was in their lives.
• Whether the death was sudden or expected (a relief from suffering or a ‘crushing blow’). How traumatic the death was can also affect how they cope with it.
• 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:
  • 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.

How do children in different ages understand death?

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.

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.

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.

Help in the early stages after death

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.

Helping later on

Some of the warning signs that your child may need more help include:

• a long period of sadness or depression, with a reduced interest in daily activities
• withdrawing from friends
• inability to sleep, loss of appetite, prolonged fear of being alone
• a sharp drop in school performance, or refusal to attend school.
• 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.

These warning signs mean that professional help may be needed. Your general practitioner will be able to offer you help and advice, and can refer you and your child to specialists who can offer bereavement counselling or your local child and adolescent mental health service (CAMHS). They can help the child to accept the death, and also assist the family to find ways of helping the child through the mourning process.

"Mum and dad separated when I was a 3 month-old baby, but I always spent every other week-end with dad. I loved staying with him even though the flat was always messy and he spent most of the week-end down the pub. But I had my mates upstairs, two brothers, who became my best friends.

One week-end dad complained of terrible pains in his chest and my friends’ mother called the ambulance – dad nearly died in hospital and I was with him. I wasn’t allowed to tell mum about it because dad was worried that I wouldn’t be able to see him again. When mum picked me up from hospital, Dad told her that he had had an ulcer which had burst.

Dad died not long after that, funnily enough on Father’s Day. He died of alcoholism – I was eight. I find it difficult to talk about him, even to this day, because mum and dad were divorced and she was still angry with him. I also felt very guilty that I wasn’t with him as I am sure that I could have saved him. I get very down about that.

When my school friends found out that he had died, they didn’t know what to say to me and somehow I always felt different to the others. Even if their parents were separated or divorced, they still had two parents and I only had one.

I have two framed pictures of my dad in my bedroom, but I have forgotten his face and this makes me feel very guilty. Sometimes I dream of him, but he will always be the 46 year old man that I loved and knew – he will never grow old.

Recently dad’s brother died and I met up with all the grand-parents, aunts, uncles, nieces and nephews from his side of the family. It was wonderful to speak about him openly and remember him."

Children’s Bereavement Charity - A national charity, which works to help bereaved families where a baby or child has died, or where children are bereaved of someone important in their lives.

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.

Winston's Wish - Supports bereaved children and families.

Further reading

Heegard, M. (1991) 'When Someone Very Special Dies - Children can Learn to Cope with Grief' Minneapolis, MN: Woodland Press.

References

Diane Melvin and Diane Lukeman(2000): Bereavement: A Framework for those Working with Children Clinical Child Psychology and Psychiatry October 1,5:521-539

K Schultz (1999): Bereaved Children. Canadian Family Physician, 45, 2914-2921.

Rutter, M. & Taylor, E. (eds) (2008) 'Rutter’s Child and Adolescent Psychiatry' (5th edn). London: Blackwell Publishing.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Education Editorial Board.

Series Editor: Dr Vasu Balaguru

With grateful thanks to Dr Fareeha Amber Sadiq.

Ths leaflet reflects the best possible evidence at the time of writing.