22.2 Developmental Concepts of Death
Learning Objectives
- Describe how attitudes about death and death anxiety change as people age
Dying and Grieving in Children and Adolescents: Developmental Concepts of Death
When we think of death and dying, we naturally focus on the elderly, and when we think of children in this process, we typically think of adult children, who often act as caregivers for their aging and dying parents. However, children and adolescents are also involved in both dying and bereavement. An understanding of age-appropriate grief reactions and conceptions of death are important when assessing a child’s response to their own terminal illness and how they are dealing with the death of a loved one. This section reviews key developmental concepts and describes strategies for supporting children and adolescents who are grieving as well as those who are dying.
Children grieve differently than adults. They often grieve in spurts and can re-grieve at new developmental stages as their understanding of death and perceptions of the world change. Childhood grief may be expressed as behavioral changes and/or emotional expression. The two most important predictive factors of a child’s successful resolution after suffering a loss are the availability of one significant adult and the provision of a safe physical and emotional environment.
Infancy (0-2 years)
Children at this age have no cognitive understanding of death. If they themselves are dying, they are not aware of this fact. Their reactions are based completely on local conditions, including their contact with caregivers and their own current levels of pain and suffering. Infants can be comforted by the presence of secure attachment figures and palliative care to reduce pain. The process of dying is much more psychologically painful for caregivers than for infants, but hospitals and hospice care know how important the active participation of a caring and responsive attachment figure can be, one who is making medical decisions based on the balance between the probability that a treatment will be effective (vs. prolonging the dying process) and the pain that treatments cause.
In terms of infants’ reactions to the death of a loved one, even if infants are not cognitively aware of death, they are cognizant of separation and loss, and so separation anxiety and grief reactions are possible. Behavioral and developmental regression can occur as children have difficulty identifying and dealing with their loss; they may react in concert with the distress experienced by their caregiver. There is a need to maintain routines and to avoid separation from significant others.
If the death is the primary attachment figure, the presence of grief and the severity of the infant’s reaction will depend on their age and the quality of care they receive from their new primary caregiver. Before the age of 6 months, the long term effects of maternal death depend almost entirely on whether a sensitive responsive