How do children grieve?

Children of all ages grieve after the death of a family member, friend, or other important person. Grieving children can show a range of emotions and reactions. Sometimes they appear sad and talk about missing the person. Other times they play, interact with friends, and do their usual activities. In addition to intense sadness, children may show changes in behavior (e.g., be less interested in usual activities, be irritable, have changes in sleeping or eating), changes in their social interactions (e.g., be more withdrawn), and/or question their faith. When adjusting to the loss, children typically are able to participate in “tasks” considered helpful to the grieving process:

• Understanding the person cannot come back
• Coping with feelings about the person and the death
• Adjusting to changes in life without the person
• Talking about memories and what that person meant to them
• Committing to relationships with new people
• Continuing on a healthy developmental path

1. What is Childhoold Traumatic Grief?

In Childhood Traumatic Grief, children have traumatic stress reactions to a death which interfere with their ability to accomplish the tasks of bereavement. When this happens, even happy thoughts and memories of the person remind children of the distressing way the person died. A younger child may be afraid to sleep alone at night due to nightmares about a shooting that she witnessed, while an older child may avoid playing on the school baseball team his father used to coach because it brings up painful thoughts about his father’s death in a terrible car accident. These children get “stuck” on the traumatic aspects of the death and cannot process their grief successfully. When children with Traumatic Grief have scary thoughts, upsetting memories, and negative feelings related to how the person died. They may also have uncomfortable physical symptoms. To control and minimize the unpleasant feelings and reactions, they try to avoid the scary memories; avoid talking or thinking about anything related to the person or way the person died; and also avoid people, places, or things that trigger upsetting thoughts and feelings. These reactions and the fear of stirring up scary reminders make it difficult to remember positive things or to talk about the person and what the person meant to them.

2. Who develops Childhood Traumatic Grief?

Most children recover and adjust to the death of a family member, friend, or other important person. But a smaller number will develop Childhood Traumatic Grief, which can occur following a death from sudden, unexpected causes such as a homicide or suicide, mass shooting, disaster, accident, or an unexpected medical condition such as a heart attack. However, children can also develop symptoms even if the death was due to natural causes, advanced age, or a terminal illness such as cancer, especially if the child was surprised or scared by the death or was witness to complex or frightening medical procedures.

3. What are the signs a child might have Childhood Traumatic Grief?

Grief related traumatic stress reactions may include the following:

• Intrusive reactions such as upsetting thoughts, images, nightmares, memories, or play about the frightening way the person died
• Physical or physiological distress such as headaches, stomachaches, symptoms mimicking the way the deceased died, jumpiness, trouble concentrating
• Avoidance reactions such as withdrawal; acting as if not upset about the death; or avoiding reminders of the person, the way the person died, places or things related to the person, or events that led to the death
• Negative mood or beliefs related to the traumatic death such as anger, guilt, shame, self-blame, loss of trust, believing the world is unsafe
• Increased arousal such as irritability, anger, trouble sleeping, decreased concentration, dropping grades, increased vigilance, and fears about safety of oneself or others; self-destructive or risk-taking behaviors (e.g., substance abuse,suicidality)

4. What can you do to help children with Traumatic Grief?

Parents or other important caregivers play a key role in helping children or adolescents with Traumatic Grief. The following are some ways to support a child who may have Traumatic Grief:

• Allow time for children to talk or to express thoughts or feelings in creative ways. Listen carefully and ask questions in a non-judgmental manner to understand how they are doing. Encourage open communication with children when they are ready, without forcing them to talk when they don’t want to.
• Practice calming and coping strategies with your child.
• Take care of yourself, model coping strategies for your child, and seek out supportive people.
• Keep in mind the signs of Traumatic Grief. Seek out guidance from a professional when troubling reactions seem to go on too long, interfere with school work or relationships with friends or family, or if you are unsure of how your child is doing.
• Children with Traumatic Grief and their parents or caregivers may benefit from professional counseling with a therapist trained to treat childhood trauma and grief issues.
• Currently two treatment models have scientific evidence of helping children recover from Childhood Traumatic Grief:
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for children ages 3-18 years and their parents or primary caregivers provided in 12-15 individual or group sessions. More information is available here:
    https://www.nctsn.org/interventions/trauma-focused-cognitive-behavioral-therapy
  • Trauma Grief Components Therapy for Adolescents (TGCT-A) for teens ages 13-17 years, provided in groups. More information is available here: https://www.nctsn.org/interventions/trauma-and-grief-component-therapy-adolescents

***The National Child Traumatic Stress Network (NCTSN) is the primary author and publisher of this article.