Imagine you are six-years-old. You live in a happy home with your parents and younger sister. The days pass in a blur of fun, laughter, and childish playfulness.
However, overnight everything changes. Your safe, secure world comes crashing down. Your dad dies tragically in a car accident. Your home becomes silent and now feels empty. Your mum cries a lot. You keep asking when will your father come home and fear that every time your mother leaves the house, she, too, will not return.
Or maybe you are 14-years-old and are becoming an independent teenager. Your mother has cancer but has been living with it for years. But, one day, her condition deteriorates and she dies unexpectedly. You try to make sense of this shock news and cope with the sudden change in your once predictable circumstances. You find it hard to concentrate at school and to sleep at night. Sometimes, you wake up and think your mum is still alive. You wonder why she was taken from you and rail inwardly at the unfairness of life.
Children and young people may grieve just as deeply as adults, say experts, but they often show it in different ways. They can experience various grief reactions following the death of a loved one. These responses will depend on the nature of their loss and are influenced by factors such as their age, their relationship with the person, their personality, and previous experiences with death.
Emotional reactions may include fear, anxiety, confusion, anger, sadness, loneliness, and guilt while physical reactions may range from low energy and interrupted sleep or eating patterns to unexplained aches and pains.
Dr Róisín Finnegan, a clinical psychologist with the local cancer charity, Cancer Care West, said each child's grief journey is different. There is no right or wrong way to grieve. She gave a talk recently on "Helping your child or teenager cope with grief" which was organised by the charity.
"Each child or teenager will grieve in a different way so it is really important that they are given permission to have their unique experience of grief," she said.
Children's understanding of death at different ages
Age two to four years
Young children express themselves through play and live very much in the here and now. They do not understand abstract concepts such as life and death, explains Dr Finnegan.
"They see death as reversible and may ask: 'When is mom coming home?'. They may start to see death as universal and wonder will they die too or who else will die. These are the questions that might come up and can be a way to process what is going on."
Their reactions to loss may include general anxiety, crying, irregular sleep, clinginess, and a need to be held. Irritability, temper tantrums, and asking repetitive questions are other responses. It is not uncommon for them to tell their [grief] story to anyone, even strangers, according to the clinical psychologist.
Regressing to an earlier developmental stage may occur also during this stressful time. "Children who have mastered certain skills and tasks may want to be fed, for example, or be looking for a bottle or blanket. They may go back to an earlier stage of development. There may also be changes in sleep or eating patterns, concerns about the safety of others and abandonment."
Age five to eight years
Children under eight often see death as reversible. They can also feel responsible for it and worry that their wishes or thoughts caused the person to die. They may say things like: 'It's my fault, I was mad and wished she would die. If I'd been better behaved....'
Common grief responses among this age group include changes in sleep and eating patterns, repetitive questions, and concerns about the safety of others, for example, when a parent is going to work or when they are going to school. There may be short periods of strong reaction, such as anger (hitting or kicking ) mixed with acting as though nothing has happened. The child may experience an increase or decrease in energy too as well as physical complaints such as stomach or headaches or generally, being out of sorts.
Age eight to 12 years
Children in this age group are beginning to understand abstract ideas such as death and grief, said Dr Finnegan. "They begin to understand that death is permanent and they think how it will affect them in the long-term. If mam or dad or the loved person isn't there, what will it mean for them. At this stage, it is not unusual for children to focus on the details of what happens to the body when someone dies and what happens to all our bodies when we die. These are very common questions as children start to process and grasp the concept of death.
"There may be feelings of guilt and regret which can lead to concern that their thoughts and actions made the death happen. It's really important to explicitly tell the child it's not their fault that this happened. This can be very reassuring for the child to hear."
Children of this age group may become anxious following a bereavement and be very concerned for both their own and others' safety. This may take the form of hypervigilance where they "keep tabs" on family members and want to ensure that everyone is home, said the clinical psychologist.
"They might have a view of the world that it isn't safe. That hypervigilance and checking in a lot when you are going out is a way of regulating those anxious feelings and emotions. They may experience difficulty concentrating and focusing. This might be particularly hard at school. It is always really helpful to check in at school with the teachers around this. Maybe letting them know that the person has passed away and asking how the child seems. Are they themselves or is there anything they had noticed that is a little bit different around concentration."
Children of this age will experience a wide range of emotions, including rage, revenge, guilt, sadness, relief, and worry. It is not unusual for them to have an increased sensitivity to light, noise, movement, and change. They may also begin to withdraw from social situations.
Again, like younger age groups, they may experience sleep disturbances. "You might notice nightmares and intrusive thoughts. There may be physical complaints too, such as tummy aches, headaches, and tiredness - all those are quite common. Children will often use play to recreate the event [the death] maybe using teddies or dolls and playing hospital. Some of the characters will die in this play. That's really, really normal and is how children can process what is happening."
Age 13 to 18 years
These children are able to understand and process abstract concepts about life and death, she said. "They understand that death is permanent but might have some unspoken magical thoughts that maybe the person has gone on a long trip. They may delve into questions about the meaning of life, death, and other traumatic events such as: 'Why has this happened to us?' or 'Why has this happened to our loved one?' Their questions are a bit deeper than the other groups."
They may respond to the death by withdrawing from their family and support network and focusing on their connections with their peers. This is very normal behaviour, according to Dr Finnegan. "There may also be an increase in risk taking or unsafe behaviour such as drug or alcohol use, or reckless driving. They may have difficulty with concentration, their attention may be easily distracted, and they may not remember tasks or chores you asked them to do.
"They may also push themselves really hard to succeed at school, focusing on homework, or on the gym. That can be a way of coping. Sleep difficulties are a common theme throughout all ages. They might be really exhausted because there is an awful lot to process emotionally."
Some children's appetites may be affected as they try to cope with the death of a beloved parent, grandparent, sibling, or special person in their lives. "They may experience a lack of appetite or eat too much or have unpredictable intense emotions such as anger, sadness, guilt, relief, or anxiety. They may find it uncomfortable discussing the death, too. There can be a lot of confusion, especially if the death is of a parent or caregiver. They may try to take on this role for their siblings as a way of coping."
This age group, like children of other ages who suffer a bereavement, may also have increased sensitivity to noise, movement, light, and touch and may think about suicide and self-harming, she said.
Next Week. Part 2. Talking to children about grief and the best places and times to begin this conversation.
