Infants and Toddlers

• Recognize absence of person despite inability to comprehend concept of death.
• Often experience insecurity, separation anxiety as a result of loss and change • may protest by crying more than usual, becoming more irritable or demanding.
• May have changes in sleeping or eating patterns • need more physical comforting, holding, rocking, nurturing • may show apathy, detachment, or withdrawal.
• May experience bladder or bowel disturbances.
• May experience temporary slowing of development or regression 2 to 5 year olds.
• May initially seem unaffected by news of death (“Oh, can I go play now?”).
• Perceive death as temporary and reversible.
• Use “magical thinking”; often create and believe magical explanations for death and fantasies about return of the deceased loved one.
• Need concrete explanations of death and its meaning (e.g. “the body stopped working”, “dead means never breathing, eating, talking, or moving again”).
• Express confusion and emotion through art and play.
• May experience eating, sleeping, bladder, bowel disturbances.
• May express somatic complaints (stomach aches, headaches, etc.).
• Demonstrate “protest” in acting out behaviors (e.g. tantrums) or regression (return to bed-wetting, clinging, thumb-sucking, etc.)
• Frequently have fears and separation anxiety following death.
• Take comfort in usual routines (meal time, play time, bedtime).
• Deal with feelings in “approach-avoid” manner, demonstrating fleeting bouts of sadness, crying, anger, agitation.
• May openly talk about death, even to strangers • may talk about wanting to die to go visit deceased loved one.

6 to 9 year olds

• May use denial of death to cope.
• Still employ “magical thinking”, so may have difficulty understanding permanence of death at first.
• Often deal with feelings in “approach-avoid” manner, demonstrating fleeting bouts of sadness, crying, anger, agitation.
• “protest” and anger shown in acting out behaviors and/or regression
• May have difficulty expressing feelings or questions • express emotion and confusion through art and play
• Strongly attuned to grief/emotional responses of key adults in their lives; may reflect adult moods in their own moods.
• May experience intense fear of other attachment figures dying.
• School phobias and separation anxiety are not uncommon

10 to 12 year olds

• Better understanding of death intensifies shock and sadness responses
• May experience school phobias and separation anxiety
• May express somatic complaints (headaches, stomach aches)
• May stop expressing grief in order to “protect” parents or siblings or to appear strong and “in control”
• Need encouragement and opportunities to express feelings and memorialize deceased loved one
• Tend to identify strongly with deceased loved one, adopting habits, mannerisms, or interests of that person.
• Vulnerable to “parentification”, i.e. trying to take on adult roles to help overwhelmed, grieving family members.
• Grief process complicated by early changes of puberty and associated developmental challenges.

Adolescents

• Grief complicated by intense challenges of adolescence (increased independence and responsibilities, physical changes, sexuality, identity development, etc.).
• Well developed abstract thinking skills may allow sophisticated understanding of death and spiritual issues
• May experience fears about own mortality, or be in denial of this and test their mortality through reckless or risky behavior
• May become fixated on the topic of death and can develop suicidal ideation
• May employ maladaptive behaviors to self-soothe and provide comfort (substance abuse, skipping school, shoplifting, etc.)
• Temporary decreases in school performance are common
• Often experience depression, guilt, and concerns about things said of left unsaid
• Anger is common and may manifest in tantrums, defiance, or withdrawal
• Vulnerable to “parentification”, i.e. trying to take on adult roles to help overwhelmed, grieving family members.