Grief and bereavement

An important first step in understanding what lies ahead for your child and family is familiarizing yourself with the basics of grief. The detailed information on the following pages will help you gain a better understanding of the grieving process, and to recognize when your child may need professional help to deal with his feelings. 

What is grief and bereavement?
When someone dies—whether it’s a parent, sibling, friend or other loved one, or even a beloved pet—it’s perfectly normal to experience a period of profound sadness, loss and mourning. This is known as grief and bereavement.

Everyone, including young children, goes through grief after a loss. Though the feelings associated with bereavement are painful, the process is a natural part of human life and emotional healing. It is only when grief seriously interferes with a child’s day-to-day activities, routines and outlook on the future that it can become a problem.

What are some of the “dos” and “don’ts” in helping a child who is grieving?

Don’t:

• insist that no one bring up the person who has died around the child
• berate the child for asking questions about the death, or try to change the subject
• hide your own sadness (including tears) from the child
• assume that if the child doesn’t cry, he “doesn’t care” or isn’t grieving in his own way

Do:

• encourage the child to talk about his feelings, about the person who died and even about the death itself
• reassure the child that it’s ok to cry, and it doesn’t mean he’s “weak”
• include the child in honoring and celebrating the life of the lost loved one (whether in formal memorial services or in informal family remembrances)

What is the difference between grief and depression?
Although grief usually includes feelings of being sad and depressed, bereavement itself is not considered a mental health disorder. Grief is a normal part of the human experience and a child’s emotional development.

When grief affects the child’s life more significantly than expected, it can cause an episode of dysthymia (mild depression) or major depression. Some symptoms of grief—sleeping too much or too little, loss of appetite and energy—are also symptoms of depression, but the main difference is in what prompts these symptoms.

A child who is grieving may experience emotional difficulties, sleep disturbances and appetite problems in the immediate aftermath of a loved one’s death, and on occasions linked to the loss (for example, on the anniversary of the death or on a holiday the loved one particularly enjoyed celebrating). However, he will feel better and more “like himself” at other times as he moves through the healing process.

A child who is clinically depressed, on the other hand, will feel consistently sad, lethargic or restless, regardless of what is happening around him. Your child may be experiencing depression if he exhibits any of the following signs for a period of at least two months:

• is preoccupied with death and dying, beyond the specific death of the lost loved one
• complains of being “worthless” or “a bad person”
• is excessively guilty about his life and relationships, above and beyond guilt tied to the loved one’s passing
• struggles to complete basic daily tasks, like getting out of bed, finishing schoolwork and maintaining personal hygiene 

Learn more about recognizing the symptoms of depression and seeking treatment. 

What are the warning signs that a child may be feeling suicidal after a loss?
It is normal for a grieving child to feel and express a powerful yearning to see the lost loved one again. However, some children and adolescents are so devastated by a death that they begin contemplating suicide to escape the pain of their grief and “rejoin” the person who has died.

Warning signs that a grieving child may be feeling suicidal include:

• saying things like, “I want to kill myself,” “I want to die” or “I just want to leave this world so I can go be with Mom”
• making threats or statements like, “Don’t worry, I won’t be a problem much longer” or “If anything happens to me, I just want you to know…”
• giving away or discarding favorite possessions
• writing a will
• writing a suicide note
• writing or expressing apologies to loved ones for “all the things I’ve done” or “all the trouble I’ve caused”
• obtaining, or attempting to obtain, a firearm, knife or rope
• obtaining, or attempting to obtain, large quantities of medication
• becoming suddenly cheerful or tranquil after an extended period of depression (this may indicate that the child has made a final plan to commit suicide, and so feels “at peace”)

Always treat any sign, suggestion or threat of suicide as a genuine cry for help. It is essential to seek immediate professional help for your child—do not wait, even if your child tries to claim she is “better” or “didn’t mean it.”

Learn more about the symptoms of suicidal thinking and how Children’s can help.

How can professional treatment help a grieving child?
When a child—and family—are struggling to deal with a loved one’s death, professional treatment can be very beneficial to the healing process. A qualified mental health professional can help the child:

• vocalize thoughts and feelings about the death
• identify and confront fears or worries relating to the loss
• realize that the death was not his fault
• share the grieving process with other family members in an emotionally healthy, comforting way
• learn coping strategies for facing sadness, anger and anxiety in the future
• accept the loved one’s passing while finding ways to remember and honor them
• return to daily routines and enjoyable activities

Signs and symptoms

What are the common symptoms of grief?
Every child will experience grief differently, depending upon her age, how close she was to the lost loved one and the circumstances of the death. It’s important to know your child and watch closely for signs that she is struggling.

Your child may show all, some or a few of the following symptoms:

• sadness: A deep sense of sadness and loss is the most common symptom of grief in children (and in adults, as well). Your child’s sadness may be intermingled with feelings of hopelessness and helplessness, and a sense of being alone in the world. She may cry frequently or experience rapid shifts in mood.
   
• disbelief: Your child may struggle to acknowledge and believe that her loved one is really dead. She may deny the death, insist the person is still alive and expect to see them again, even after being told they are gone and cannot come back.
   
• guilt: Your child may feel guilty about anything she said or did (or didn’t say or do) while the loved one was alive—for example, agonizing over a past argument with a deceased parent, or not saying “I love you” the last time she saw a sibling who has died. If the loved one died after a lengthy illness, your child may have felt some relief at the death (which is normal) and may now be inwardly punishing herself for thinking that way. She may even feel guilt over not somehow preventing the death, regardless of how the person died.
   
• blame: Your child may lash out at surviving family members for not stopping the loved one’s death, or even for somehow causing it (for example, blaming an unruly sibling for a parent’s heart attack).
   
• anger: Your child may feel very angry about her loved one’s death, regardless of the circumstances. Her anger may target the doctors and nurses caring for the loved one, God or even the person who has died for “abandoning” the child.
   
• fear: Your child’s grief is likely to trigger a sense of fear, as well—fear that something may happen to another loved one, or to her. She may experience bouts of anxiety and panic, and possibly separation anxiety at the prospect of being physically away from the surviving parent or other family members.

Grief can also manifest itself as physical symptoms with no identifiable medical cause, including:

• headaches
• stomachaches
• sleeplessness
• excessive sleep
• sudden weight loss
• sudden weight gain

What are the symptoms of a child who is experiencing grief so profound, it requires professional help?
Whether a child needs professional treatment to help her manage her grief is determined not by how long she grieves—grief can go on for years—but by how significantly the grief interferes with her daily life. 

Your child may need professional help if she:

• is consistently angry or irritable
• feels or behaves as though she is “numb”
• states that she has “no one to talk to” or “no one who understands her”
• is preoccupied with worrying about her own death or the death of other loved ones
• is afraid to be physically removed from a loved one “in case something happens”
• is fixated on death and dying beyond her own personal loss (for example, seeking out morbid books, movies and news stories)
• cannot stand to be “left alone with her thoughts”—is always seeking something to “keep busy”
• is avoiding anything that reminds her of the loved one who has died
• refuses to discuss the loved one who has died
• withdraws from family and friends, wanting to be alone at all times

You should always seek immediate treatment for a child who is:

• using drugs or alcohol
• cutting or otherwise deliberately injuring themselves
• partaking in dangerous, risk-taking behaviors (for example, speeding while driving; engaging in criminal activity)
• threatening physical violence
• physically attacking others
• threatening or talking about suicide 

FAQ

Q: Is grieving common?
A: Yes; anyone who experiences a loss will grieve in one form or another. It’s when symptoms do not get better, or interfere with daily life and experiences, that grief is a cause for concern. 

Q: What are the stages of grief?
A: Grief generally begins with shock, disbelief and numbness that lasts anywhere from several hours to a few days. Gradually, these feelings give way to intense feelings of protest (anger) and anguish (sadness), which can last for days, months or even years.  

Eventually, grief will abate into a more manageable feeling: it becomes resolution. The child continues to miss and mourn the loved one, but is able to move forward with his own life and relationships. It is when a child is “stuck” in his grief—unable to proceed with day-to-day life, or look to the future—that professional intervention becomes necessary. 

Grieving varies from person to person, and from child to child. The stages of grief can be experienced in any order, and for any duration of time. These stages typically include:

Denial

• The child feels numb or in a state of shock.
• He may insist (to himself or to others) that the death has not occurred, and that those who claim it has are “lying.”
• He expects to see the loved one again, and may even wait for them or seek them out.

Anger

• The child is outraged and furious that the death has happened.
• He may blame and accuse others (a surviving parent or sibling, doctors and nurses, God) of causing the death or “letting it happen.”
• He may be angry with the loved one who has died for “leaving him.”
• He may be angry with the world for “allowing this to happen” or being an unfair place.

Bargaining

• The child may seek to make a “compromise” with God or the universe (“I promise to behave/go to church every day if you just bring Grandma back.”)
• He may attempt to equate something he has done with the death (“It’s because I yelled at my little sister that she got sick.”)
• He may question family members, teachers and clergy, asking, “Why did God let this happen?” and “What did we do to deserve this?”
• He may start to feel intense guilt.
• He may become preoccupied with finding a logical reason for the death, even if it was a tragic accident.

Sadness

• The child’s predominant feeling is intense, painful sorrow.
• He can no longer deny the loved one’s death.
• He may experience a lost or excessive appetite, and accompanying weight loss or weight gain.
• He may have trouble sleeping, or may want to “escape” by sleeping all the time.
• He may have difficulty concentrating at school and on other activities.
• He may wonder whether he will ever feel better.

 Acceptance

• The child has accepted the loved one’s death and incorporated it into his own life experience.
• He continues to miss the person who has died and to feel strong emotions about the death, but is able to manage these feelings while going about his daily routine.
• He may experience resurgent feelings of grief at certain times—the loved one’s birthday, the anniversary of the death, on holidays—but recognizes his feelings as part of grief, and moves forward while accepting them.

Q: My child is suffering intense grief over the loss of a pet – is this normal?
A: Yes; pets are beloved members of the family, and children can feel especially close to their companion animals. In addition, the loss of a pet is often the first death a child has to process and deal with—the experience of losing his treasured animal friend can form the basis of his feelings and expectations about death and grief in general. 

When a pet dies, it’s very important that parents and other family members:

• do not trivialize the death (“It was just a dog”) or make the child feel ashamed of being so upset by it
• do not attempt to hide the pet’s death (“Kitty ran away and we can’t find her; she must have found another home somewhere”)
• encourage the child to grieve openly for the pet, including asking questions
• do not seek to immediately “replace” the pet by getting another animal before the child has come to terms with the loss (this may cause the child to wonder if he, too, is “replaceable,” or to blame or resent the new animal)
• include the child in the process of the pet’s death (for example, allowing him to say goodbye before the animal is taken to the vet to be put to sleep) as much as is appropriate for his age and the circumstances
• include the child in memorializing the pet through a “funeral service,” writing letters to the animal to be placed at the grave, planting a memorial tree or marker, compiling a photo album or simply sharing funny and heartwarming memories with other family members

Q: Why are support groups a recommended approach to dealing with grief?
A:  Although no support group can take away a child’s hurt and sorrow—nor magically “cure” her grief—being able to speak and listen to others who have suffered a loss can be very cathartic.

A child may feel as though others who haven’t experienced a death cannot understand what she is going through. In addition, she may express anger, sadness and guilt more freely with “strangers” than around family members, as she may worry that being honest about her feelings will hurt her surviving loved ones who are also grieving. 

Q: Can antidepressant medication help in dealing with grief?
A:As a general rule, normal grief does not call for the use of medication. Although antidepressant medications can dilute some of the intensity of the feelings of grief, they cannot treat the underlying cause: the death of someone the child loves. In addition, improper use of medication may prevent the child from managing his grief in a healthy way, delaying and complicating the bereavement process. 

If a child’s grief is so severe that it leads to clinical depression, her treating doctor may prescribe antidepressants as an addition to talk therapy. Depression can only be diagnosed by a qualified mental health professional, and medication should only be prescribed after a thorough evaluation and consultation with the child and family.

Here at Children’s, medication is never a standalone treatment—we only prescribe it in conjunction with talk therapy. Learn more about how Children’s prescribes psychiatric medication.