Helping Grieving Children and Teenagers

Approved by the Cancer.Net Editorial Board, 06/2013

Key Messages:

  • How your child or teen understands and reacts to the death of someone close varies with his or her age.
  • You can help your child or teen cope with the loss by having several simple, direct conversations and encouraging your child to express his or her feelings in a healthy way.
  • It is important to allow your child or teen to say goodbye in a way that makes him or her comfortable.

Children and adolescents grieve differently than adults. Most children do not feel the sustained intense emotions that adults feel when grieving. They may show their sadness only occasionally and for brief periods, or they may complain of physical discomfort, such as stomachaches, instead of expressing sadness.

A child's grief comes and goes, but is more intense when the relationship between the child and the person who died was close, such as a parent or sibling. Beyond the immediate sadness, a child has lost the life-long influence of a parent or sibling. Your child may feel the loss repeatedly as he or she grows up, especially 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

To help your child cope with grief, it is important to understand how children and teens view death in general, as it varies by age and often changes as a child develops emotional and socially. A child’s emotional and social development also influences how he or she reacts to a loss and the type of support needed. Other factors, including personality, previous experiences with death, and the support provided by family members, influence children's reactions. 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 two 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 (three to six years)

  • Are curious about death and believe death 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 have "magical thinking" and understand the world as a mix of reality and fantasy
  • Are naturally very focused on themselves and see themselves as the cause of events around them
  • 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, which include irritability, aggression, physical symptoms, difficulty sleeping, or regression (such as bed-wetting or thumb-sucking)

School-age children (six 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
  • Understand that death happens to everyone and cannot be avoided (by age 10)
  • 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
  • Continue to have difficulty talking 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 fears of 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 do not feel comfortable talking about them
  • The reality of death contradicts a teenager's view of himself or herself as invincible, and teenagers may question their faith or their understanding of the world
  • The need to be independent and separate from parents can interfere with the ability to receive support from adult family members
  • Coping strategies may create tension with family members, as adolescents may cope by spending more time with friends or by withdrawing from the family to be alone

Helping your child cope with loss

Explaining death should be done in simple, direct terms with information that is 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. Children and adolescents need honest information and other types of support.

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

  • Explain death using real words like "died" rather than confusing phrases like "gone to sleep." You can explain it by saying that death means the person's body has stopped working or that the person can no longer breathe, talk, move, eat, or any of these things he or she could do when alive.
  • Share your family's religious or spiritual beliefs surrounding 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 they will continue to be loved and cared for.
  • Encourage your child to talk about his or her emotions and suggest other ways to express his or her feelings, such as writing in a journal or drawing a picture.
  • Without overwhelming them, share your grief with the child; 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, and 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 that periods of intense grief are not always predictable.
  • If your child is older, encourage him or her to talk to 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 to set limits on behavior. Care, consistency, and continuity give children a sense of safety.
  • Encourage spending time with friends and participating 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.

The death of a parent or other close family member directly changes 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 also a major loss and add to a child’s overall grief.

Although the death of a family member with cancer is difficult, sometimes it may actually make a child's life easier. Perhaps the death of a sibling means that parents won't have to spend all of their time at the hospital anymore. It is normal for a child to feel some relief when a family member dies after a long or difficult illness. It is important for you to help your child realize that these feelings are normal and that he or she should not feel guilty for having those thoughts.

Honoring and remembering the person who died

Children as young as three years old understand the concept of saying goodbye and should be allowed a choice in how they say goodbye to a loved one.

  • Preschool-age and older children should be given the choice of attending memorial services but should not be forced to attend if they do not want to.
  • Some children may want to attend a memorial service, but not a viewing or burial.
  • Older children and teenagers should be allowed to help plan memorials.
  • Talk to children about what will happen at a service ahead of time and consider visiting the church or cemetery.
  • Ask a trusted adult to help take care of young children at a service or go home with a child who decides he or she wants to leave early.

Help your child understand that the person who died is never truly gone, but 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 come to 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

How to Cope With Losing a Sibling to Cancer

Additional Resources

American Cancer Society: Grief in Children

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

KIDSAID (a website where kids can cope with grief and loss)