Children’s understanding of death and dying at various stages of childhood.

A child’s understanding of death

Each child is unique in their understanding of death. This understanding is largely influenced by the child’s developmental level and chronologic age. There can be tremendous overlap, however, between the age groups because children and adolescents move from one developmental level to another at very different rates. As mentioned children are cognitively not able to understand that death is universal, inevitable and irreversible when they are very young but develop a more mature understanding of death as they grow older. Their understanding of death will also differ according to personal experience of death.

Babies from birth to 12 months 

  • Very young babies have no concept of death but they will react with displeasure to separation from a parent, painful procedures, and any change in their routine.
  • A baby who is terminally ill will need as much physical and emotional care as any age group.
  • It is important to keep a consistent routine for a baby and their caregivers.
  • Because babies can’t talk about their needs, fear is often expressed by crying.

Toddlers from 12 to 36 months 

  • For the toddler, death has very little meaning.
  • They may respond to the loss of a family member by being anxious and afraid and they will pick up on and respond to the feelings of anger, sadness and depression of those around them.
  • Toddlers don’t understand the concept of death being permanent.  If something goes away, they expect it to come back again just like in the game of ‘Peek-a-boo’.

Preschoolers from 3 to 6 years 

  • Preschoolers sense that adults don’t like to talk about death and may display great curiosity as a result.
  • Death is often explained to this age group as someone has “gone to heaven” which may leave them wondering when the person will come back. When will my mommy be home?
  • Most children within this age range don’t understand that death is permanent, that everyone and every living thing will eventually die, and that dead things don’t eat, sleep, or breathe. It is important not to tell them that an animal or a loved one has “gone to sleep” as they may fear falling asleep. 
    How will they eat or breathe?
  • Due to their ‘magical thinking’ the preschool child may feel that their thoughts or actions have caused the illness, leading to feelings of guilt and shame. It’s my fault. I was mad at my mother once and I told her I wish she would die and then she died.
  • When children in this age group become seriously ill, they may think it’s punishment for something they did or thought about.  It is also possible that a preschool-aged sibling of a dying child will believe they caused the illness or death so they will need comforting and reassurance at this time.

School age children from 6 to 12 years

  • School-aged children have a more realistic understanding of death.
  • Although death may be personified as an angel, skeleton, or ghost, this age group is starting to view death as permanent.
  • They know that everyone dies.
  • They may be very curious about the physical process of death and what happens after a person dies. Do your fingernails and hair keep growing when you
    die?
  • They may fear their own death because of uncertainty of what happens to them after they die.
  • Fear of the unknown, loss of control, and separation from family and friends can be the school-aged child’s main sources of anxiety and fear related to death.

Adolescents from 12 to 18 years

  • Most adolescents understand that death is permanent, and that everyone dies.
  • At this age, it is likely they have experienced the death of a family member, friend, or pet.
  • Adolescents are establishing their identity and tend to believe that they are immortal and exempt from death.
  • A realisation that they may die as a result of a serious illness will threaten everything they believe and could lead to anger, defiant attitudes and personality changes.
  • A sense of isolation can occur as they believe they no longer fit in with their peers and they are not understood by their parents.

How do you discuss death with a child?

  • Timing –when is the right time?
  • Honesty – TELL THE TRUTH
  • Use simple language that can be understood – dead, dying, died
  • Avoid use of euphemisms – pass on, go to sleep, not wake up
  • Let the child’s questions guide you – what makes you think that, what do you think is going to happen to them after they have died?
  • Give small chunks of information at a time, go at the child’s pace – let the child’s conversation guide you

This short videoclip below gives insight into children’s understanding of loss and death and how they might subsequently grieve.