Mother hugging distraught daughter Considering that adults often have trouble talking about grief among themselves, it’s no surprise that explaining death, dying and grieving to children can be even more difficult.

The Pediatric Advanced Care Team (PACT) at Children’s Hospital of Philadelphia (CHOP), which works with children facing life-limiting conditions and provides support to their families, understands the struggles families have discussing grief. The team also knows how important it is to open the conversation and to give parents/caregivers and children some tools to express themselves when they may face the loss of a loved one.

Here are tips for families to help navigate times of grief.

Communication

Communication is the cornerstone of dealing with a death. Even if parents or caregivers are initially uncomfortable, talking to their children about death and grief may be important. Examples of times it can be helpful are if there is a terminal illness in the family or if a loved one has died. Caregivers should:

  • Use concrete language instead of euphuisms. Don’t say, “Grandpa went to sleep.” Instead, using age-appropriate words, say: “Grandpa’s heart was sick, and it stopped working. He died. We won’t see him anymore, but we can look at pictures/videos when we miss him and tell stories about him when we are sad.” If you have religious beliefs, you can layer in beliefs within your concrete explanation
  • Allow children to ask questions; don’t do all the talking. Pauses give children time to formulate questions. Silence is OK! Be as honest as you can in your responses.
  • Allow space when needed. If a young child asks to go play, let them. This is them waving a red flag saying they are overwhelmed and need a break.
  • Explain what will be happening. If the child will attend a funeral/memorial service, talk through what they may see and hear so they’re prepared. If the child’s routine will change because of the death, tell them the new plan.
  • Use resources such as books. If you find a book with a story that may help you explain death and grieving, or someone gives you one, read the book yourself first to make sure it doesn’t conflict with what the child knows or with your beliefs.
    • If there is a page you don’t like, omit reading it or paperclip it to the other pages so you skip it while reading.
    • If the child isn’t old enough to read yet, use it as an advantage to say the name of the deceased as much as you can while reading. Feel free to change the name of the character in the book to the deceased person’s name, if it fits.

Creating legacy or memory items

If a loved one is sick and you are anticipating their death, consider creating legacy projects with children and their loved ones. Some of these can be done with the materials you might already have on your own, while others can be purchased.

These can be:

  • Family handprints
  • Photos/scrapbooks/videos
  • Fingerprint jewelry

If a loved one has already died, engage the child in creating a “memory box.” They can decorate the outside and fill the inside with items that remind them of their loved one. Children can also use photos to put together a scrapbook dedicated to their loved one or get creative and make a video to share their memories.

Continue to talk about the loved one and share stories with your children. Ask them to share stories, too. They could draw a picture of an event or of a special time or place they visited with their loved one, for example, and add it to the memory box.

Other ways to remember their loved one who died is to continue to celebrate milestones on the days that were special for the loved one or start a new tradition that honors the loved one (like volunteering together or visiting a favorite location).

Differences in grief

Each child’s reaction to death will look different. Some children may act out or have trouble sleeping. Some children may not show much emotion, while others may cry or express fear. All are normal reactions. It is also normal for children to ask the same question repeatedly over time. As children move through behavioral stages, new questions about their loved one’s death will arise. None of these scenarios should make you worry.

The key is to create a safe space for each child to ask questions and feel supported, regardless of age. Continuing to check in with them over time can help normalize their emotions and reassure each child that there is no specific timeline for their grief.

When you are also grieving

As you talk about grief with children, it is likely that you, too, are grieving. We want to validate how challenging these conversations are and provide some encouragement. 

First, do not worry about expressing emotion in a child’s presence. Seeing caregivers experience sadness, worry or fear validates a child’s own emotion. Seeing examples of adults experiencing challenging emotions and later also having days full of joy and laughter, children learn resilience.

Second, there are no perfect answers to the hard questions that grieving children will ask. However, they will likely not remember the exact words, but rather your kind honesty and your supportive presence. If you need time to gather your thoughts, ask a question back. “Tell me what made you think of that?” It is also OK to not know. Respond instead with, “I don’t know the answer to that question, but I can do my best to find it for you.” Leave room for silence and let the child guide the conversation.

Lastly, be as patient with yourself as you are with the children you are supporting. This is difficult but important work that will help you, and your children, work through grief in a healthy way.

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Contributed by: Elizabeth Spellman, MSW, LSW, Kelly Goldin, BS, CCLS, CTRS