What Are Common Grief Reactions in Early Childhood?

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Let's talk about grief reactions. There are a couple of things I want to point out before we get into more specifics related to different age groups. Reactions to any type of change, especially death, depend on the child's personality, age, stage of development, spirituality within the family system, and relationship. When I say relationship, it could be the relationship with the person who's no longer present or the relationship with the people around them. This also includes the quality of those relationships and how communication goes within the family. Other factors include how much we talk about things or don't talk about things and how much we include the kids and how much we don't. As you know, children have so much development happening and so much change in the early childhood years that every child is so different. You have to look specifically at the needs of that child and how they're reacting and what interventions or tools are going to fit best for them.

The other thing that influences reactions is the nature of the death or the nature of the change in general. Is it sudden? Is it something that happened in a traumatic fashion or something the child witnessed or was in the middle of a difficult situation? Was this something more anticipated that the child may have had some time to adjust to? There are positives and negatives for both of those, but I just want to point out that it does influence the way a child will grieve. Here are some ideas and things to look for regarding what it typically looks like, but remember there's no prescription to this. If you've experienced a loss and have experienced grief and continue to grieve, you know that this is a lifelong process that depends on so many different factors.

As we look at each age group remember these things are typical but can be very different depending on the child and their situation, any significant needs that they have, and any disabilities the child has. All of that will also influence their reactions.

Infants and Toddlers

Figure 1. Grief reactions of infants and toddlers.

While infants and toddlers don't have that mature concept of death, they can sense change. They're not able to really understand death as permanent and just see this as a separation. Separation is still quite challenging for children because of the importance of attachment at this age. There is a risk that adults will underestimate, or what we call disenfranchise, the grief of children because we don't think children can grieve or are grieving at this age. Adults often think since they don't understand they can talk in the kitchen if they're in the living room and they're not going to hear what we're talking about anyway. But we know that children pick up on things and if we ignore or minimize their reaction, then that could actually make the reaction stronger. Those kids could either withdraw more or act out more. There is a high risk for this especially for non-death losses if parents or caregiver don't understand that children at this age group do grieve and do need support.

Typically at this age, we see a sense of security and wellbeing is challenged. So often there's a fear of separation from the remaining caretaker and we see some of that stranger or separation anxiety at certain ages in this area. If that child has a significant loss or change, then that might be increased or you might see a lot of crying and clinginess to their primary caregiver when that child's dropped off. Depending on the situation, we do see kids who go the other way who will go to anybody. When I was working in a grieving center and working in the preschool room, the biggest challenge was separating kids from their caregiver who was bringing them because they had lost somebody close to them, and they just weren't going to let that person go.

We also see excessive crying, whining, biting, and other anxiety-related behaviors and regression. Regression is very common during changes like this throughout early childhood where a child doesn't use the bottle anymore, has given up their pacifier, or started toilet training and all of that goes backwards. Maybe the bottles are back out again, they want their pacifier now, or toilet training doesn't go so well anymore. Sometimes we'll see physical symptoms. This is a time where caregivers may misinterpret that a child has a stomachache or a headache or something and they may not be able to express that. If they're old enough to be able to verbally express that we don't often connect it to grief or the changes that child has experienced, but we do know. We know as adults, when we are stressed or grieving or anxious or depressed, all those things go together. We have physical symptoms, so our children would have the same as well.

Preschool

Figure 2. Grief reactions of preschoolers.

Let's look at the preschool age group. As I said, these are a little fluid, depending on the child's cognitive abilities and so many different things. Thinking back to the magical thinking children may have, they may think they have caused the death or loss. I've seen this in kids, five and six years old when the magical thinking is very strong, but I've also seen this in children as old as 10 or 11 years old. I had a little girl say to me, "I really think that if I would've got better grades and not been mouthy to my mom, that she wouldn't have died." It threw me for a minute the first time that this child said that because I thought, oh, you're not in that age group. Like we learned that by that age, you should understand that your behavior doesn't control those types of things. But I think there's a sense of deservedness or a little bit of a sense of karma, or if I just would've been good, then these bad things wouldn't have happened to my family. This can continue more into middle childhood as well. But we also know that these children can sense emotional distress and have a little bit better understanding than the toddler group.

We see some of the same types of things with regression, sadness, anxiety, some irritability, and still that fear of separation with a level of clinginess to the remaining caregiver. There are still repeated questions and some curiosity, wanting to know more. This can be challenging for adults because if they're grieving, irritable, and tired, and they're having all of those reactions themselves and the child is being curious and clingy and irritable all at the same time, it can be a very difficult kind of interaction going on between the caregiver and the child or children, who are grieving as well.

Children at this age may have difficulty communicating their distress in words. They're going to be more likely to communicate through their behavior or act things out in their play. They take their cues from others' behaviors. So if their caregivers or siblings are crying and it's okay, no one's telling them to stop crying, then they may cry as well. We often see that modeling within families of how they're dealing with the loss as well. We know also that children of this age can only deal with emotional pain, concern, or worry for so long. Often at this age, they will ask questions or cry for a little bit or feel upset and then they go and play or go back to whatever they were doing or watching their show. Then maybe an hour later, they come back with more questions or they want to talk about it again. What we found is that children at this age need that intermittent kind of ability to grieve or to talk about what's going on or to share what they're feeling in whatever way that they can. 

Young Children

Figure 3. Grief reactions of young children.

Young children, so just a little bit older, are starting to understand death and loss in a different way. They have the cognitive ability to understand some of those factors of the mature concept of death. We said often it's by about age seven that a child would still be considered a young child and able to understand some of these things. They may develop more fears associated with the death of a surviving parent, or if someone else going to leave if it's not a permanent loss, like a death. We often see more anxiety in this age group, as well as feelings of insecurity and still some separation issues. They may not be so physically clingy, but there are still some separation issues.

I had a little girl who was six or seven when I was working with her and her mom had died. She was living with her dad and was an only child. She had a very difficult time separating from her dad to go into school at each day. She was so worried about him and something happening to him because her mom's death was very sudden. We had to do a couple of things to make sure that she could separate. They brought her at a different time, which helped so she was a little bit earlier than all of the other kids and the chaos of all the children coming in for the school day. Her dad was able to get a picture of mom and put it in a necklace so she could have that all day. She was also able to call dad about lunchtime. She made a phone call to dad to check in on him, and eventually like that faded and she didn't need that anymore. Those were some of the ways that we helped her feel more secure and to be able to separate so she could keep functioning and doing the things that she needed to do during her school day.

We also see kids who have aggressive behavior and sometimes term them as hyperactive. We often think of these kids as disruptive and may not recognize that these could be grief reactions as well. There's anxiety and all this stuff built up for this child who's fearful, worried, and doesn't know what's going to happen next. The child feels like the world is outside of their control. Sometimes it comes out in an aggressive or disruptive way. It could also come out in a withdrawn and sad way as well. So we have both ends of the spectrum. Then there are all the children who fall somewhere in between.

We do see a lot of issues with nightmares or difficulty sleeping and children still having regressive behaviors. The sleep issue we often see is with kids who've been told that the person who died is sleeping or the child has nightmares when the child hasn't been given much information about the change, or if there's been a divorce or a not permanent separation that the child may not have all the information. So in their dreams or nightmares, or as they're trying to get to sleep they create a kind of understanding or their own picture of what has occurred.

Children aged five to seven are particularly vulnerable to complications of grief, so they can understand some of those permanent ramifications. They understand their own mortality, the mortality of other people around them, and how change can happen very quickly. At the same time, they lack independent coping skills. Maybe we haven't done a great job with our young preschool children and young school children in helping them to independently cope. It takes a while to learn coping skills. As adults, we are all still learning coping skills and how to use them appropriately. This is where we see some pretty significant risk of children experiencing grief as they try to understand the death of someone very close to them and the permanency of it, but not being able to cope with it, especially if they don't have the support in their family or in their caregiving situation.

This Ask the Expert is an edited excerpt from the course, Loss and Grief in Early Childhood, presented by Tami Micsky, DSW, MSSA, LSW, CT.