Helping Grieving Children and Teenagers

Approved by the Cancer.Net Editorial Board, 12/2015

Children and teenagers express their grief in a variety of ways. Some may be sad and verbalize the loss similar to many adults. Depending on their ages, however, they may show their sadness only sometimes and for shorter periods. Children may complain of physical discomfort, such as stomachaches or headaches. Or, they may express anxiety or distress about other challenges, such as school or sports.

Loss is more intense when the child had a close relationship with the person who died, such as a parent or sibling. However, this is not always obvious from a child’s reactions. A child’s grief may seem to come and go. And, a child may rarely verbally express his or her grief. This is normal. Your child may also re-experience the intensity of the loss as he or she grows up. This may occur more often during certain milestones in life, such as starting school or going on a first date. Even into adulthood, important events such as graduating from college or getting married may trigger renewed grief.

Understanding how children and teens view death

It is helpful to know how children understand death at different stages of development. It varies by age and often changes as a child develops emotionally and socially. Other factors influence children’s reactions. These can include personality, previous experiences with death, and support from family members. Keep in mind that children do not move abruptly from one stage of development to the next, and features from each stage may overlap.

Infants (birth to 2 years)

  • Have no understanding of death

  • Are aware of separation and will grieve the absence of a parent or caregiver

  • May react to the absence of a parent or caregiver with increased crying, decreased responsiveness, and changes in eating or sleeping

  • May keep looking or asking for a missing parent or caregiver and wait for him or her to return

  • Are most affected by the sadness of surviving parent(s) and caregivers

Preschool-age children (3 to 6 years)

  • Are curious about death and believe it is temporary or reversible

  • May see death as something like sleeping—the person is dead but only in a limited way and may continue to breathe or eat after death

  • Often feel guilty and believe that they are responsible for the death of a loved one, perhaps because they were "bad" or wished the person would "go away"

  • May think that they can make the person who died come back if they are good enough

  • Will worry about who will take care of them and about being left behind

  • Are still very affected by the sadness of surviving family members

  • Cannot put their feelings into words and instead react to loss through behaviors such as irritability, aggression, physical symptoms, difficulty sleeping, or regression (such as bed-wetting or thumb-sucking)

School-age children (6 to 12 years)

  • Understand that death is final

  • May think of death as a person or a spirit, like a ghost, angel, or a skeleton

  • By age 10, understand that death happens to everyone and cannot be avoided

  • Are often interested in the specific details of death and what happens to the body after death

  • May experience a range of emotions including guilt, anger, shame, anxiety, sadness, and worry about their own death

  • Struggle to talk about their feelings, and their feelings may come out through behaviors such as school avoidance, poor performance in school, aggression, physical symptoms, withdrawal from friends, and regression

  • Still worry about who will take care of them, and will likely experience feelings of insecurity, clinginess, and abandonment

  • May still worry that they are to blame for the death

Teenagers (13 to 18 years)

  • Have an adult understanding of the concept of death but do not have the experiences, coping skills, or behavior of an adult

  • May act out in anger at family members or show impulsive or reckless behaviors, such as substance use, fighting in school, and sexual promiscuity

  • May experience a wide range of emotions but not know how to handle them or not feel comfortable talking about them

  • May question their faith or their understanding of the world

  • May not be receptive to support from adult family members because of their need to be independent and separate from parents

  • May cope by spending more time with friends or by withdrawing from the family to be alone

Helping your child cope with loss

Explain death in simple, direct, honest terms geared to your child's developmental level. Children cannot reflect on their thoughts and emotions like adults. So they will need to have many short conversations. Adults may need to repeat the same information many times. And, children may ask the same questions often as they try to make sense of difficult information.

Here are some tips to help explain death and loss to your child:

  • Explain death using real words such as "died" rather than confusing phrases such as "gone to sleep." You can say that death means the person's body has stopped working or that the person can no longer breathe, talk, move, eat, or any of the things he or she could do when alive.

  • Share your family's religious or spiritual beliefs about death.

  • Encourage your child to ask questions, and try to answer them honestly and directly. If you don't know the answer to a question, help find the answer.

  • Use books, drawing, or role-play games to help a younger child understand death.

Here are suggestions that may help your child cope with a loss:

  • Make sure your child understands that he or she is not to blame for the death and that the person who died is not coming back.

  • Provide lots of affection and reassure your child often that he or she will continue to be loved and cared for.

  • Encourage your child to talk about his or her emotions. And suggest other ways to express feelings, such as writing in a journal or drawing a picture.

  • Without overwhelming your child, share your grief with him or her. Expressing your emotions can encourage your son or daughter to share his or her own emotions.

  • Help your child understand that normal grief involves a range of emotions, including anger, guilt, and frustration. Explain that his or her emotions and reactions may be very different from those of adults.

  • Reassure your child that it is normal for the pain of grief to come and go over time. And explain that they can’t always predict when they will feel sad.

  • If your child is older, encourage him or her to talk with an adult outside the family, such as a teacher or a clergy member. You can also consider an age-specific support group.

  • Keep routines and caregivers as consistent as possible, and continue setting limits on behavior. Care, consistency, and continuity help children feel safe.

  • Encourage spending time with friends and engaging in other age-appropriate activities.

  • Reassure your child that it is never disloyal to the person who died to feel happy and to have fun.

  • Speak with a grief counselor, child psychologist, or other mental health professional if you are concerned about your child's behavior.

Addressing daily routine and role changes

The death of a parent or other close family member can directly affect a child's day-to-day life. Family routines and roles change, such as a surviving parent having to return to work and spend less time at home. These changes are an added disruption and may add to a child’s distress. Even young children will benefit from extra preparation, conversations, and support around these transitions.

Although the death of a family member with cancer is painful, it may also lessen some of a child’s stress. For example, the death of a sibling might mean that a parent is not dividing time between a sick child at the hospital and another child at home. It is normal to have strong, mixed feelings, including some relief, when a family member’s suffering is over after a long or difficult illness. Help your child realize that these feelings are normal and that he or she should not feel guilty for having them.

Honoring and remembering the person who died

Children as young as 3 years old understand the concept of saying goodbye. They should be allowed to choose how they say goodbye to a loved one.

  • Give preschool-age and older children the choice of attending memorial services. But do not force them to attend if they do not want to.

  • Some children may want to attend a memorial service but not a viewing or burial.

  • Allow older children and teenagers to help plan memorials if they want.

  • Talk with children about what will happen at a service ahead of time. Consider visiting the church or cemetery.

  • Ask a trusted adult to help take care of young children at a service or to go home with a child who decides he or she wants to leave early.

Help your child understand that the person who died lives on in his or her memory. Parents who are terminally ill sometimes leave letters, videos, or photographs to help children remember how much they were loved. Children can also compile pictures and other special items to create their own memory. For younger children, most of their knowledge of the person who died will come from memories of other family members. Talk about the person often, and remind children of how much the deceased person loved them. Over time, children can understand that they would not be who they are without the influence of the special person who died.

More Information

Understanding Grief and Loss

Talking with Your Children

Talking with Your Teenagers

Grieving the Loss of a Sibling

Additional Resources

American Cancer Society: Grief in Children

National Cancer Institute: Grief, Bereavement, and Coping with Loss (PDQ®)

KIDSAID (a website to help kids cope with grief and loss)

Rainbows (An organization that supports youth as they navigate grief and healing after loss)