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Section 2
Grief in Parentally Bereaved Children

CEU Question 2 | CEU Test | Table of Contents | Grief
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track we discussed how to introduce a child to an expected death.  Four ways parents can introduce a child to an expected death are taking a death history, using correct language, reading about death with the child, and looking for death education opportunities. 

You already know that children experience the same range of emotions as adults.  Anger, fear, pain, and guilt can be satellite feelings of grief experienced by children and adults alike.  Would you agree that what makes grief different for children is the developmental stage of the child? 

On this track and the next track we will discuss how grief reflects stages of development.  I have found that death is perceived by children differently depending on the stage of development the child is in when grief begins. 

Three Stages of Development
The three stages of development we will discuss on this track are ages two to six, ages six to nine, and ages ten to thirteen.  We will also discuss the three key concepts of death as stated by Dr. David Schonfeld.  The three key concepts of death are "nonfunctionality" of the body, death is final and death is universal.  As I describe the different perceptions of death applicable to each stage of development, you might consider using this information as a checklist for clients you may be treating.

#1 Ages Two to Six
Sue’s husband, Ray, died after ten months of intense cancer treatment.  Sue, age 29, had a three-year old son, Robbie, who talked about death a lot.  Robbie’s age as well as his mental capacity put him in the first of three stages of development, ages two to six.   

Several family members were shocked at Ray’s wake, when Robbie skipped over to Sue and said, "Mommy, Daddy’s dead, right?"  Sue stated, "Yes, honey, he is."  Robbie looked puzzled and asked, "So when is he going to take me to the fair?"  Sue struggled with this and finally stated, "Robbie, he can’t.  Daddy’s body doesn’t work anymore."  Robbie continued, "But he’ll be home for Christmas, right?"  Sue winced. 

In our counseling session, Sue stated, "I’ve tried to tell him about death, but he just doesn’t get it."  I explained to Sue that telling a child about death is like teaching a baby to walk.  I stated, "No matter how much we try, babies won’t walk until their bodies are developed enough.  Similarly, an understanding of death develops over time." 

Dr. David Schonfeld, a professor at Yale observed that preschoolers struggle with three key concepts of death.   In my practice, I find it helpful to explain these three key concepts of death to parents of grieving children. I explained to Sue that the first concept is the "nonfunctionality" of the body.  I stated, "It is important for children to realize that death is not simply being ‘less alive’.  Death means that bodies don’t feel and hearts don’t beat.  The second concept is that death is final.  Have you had experience treating clients like Robbie, who believed that death is reversible?

In addition to the nonfunctionality of the body and death is final, the third concept that Dr. Schonfeld identified is death is universal.  I asked Sue, "Do you feel that children should learn that death is universal or happens to everyone?"  Sue stated, "Well, everybody dies… so Robbie needs to understand that death is universal.  That way he doesn’t misunderstand death as an accident that people can avoid if they’re careful enough." 

Are you counseling a family with a child who still grapples with separating fantasy from reality?  Is your Robbie confused by death? Would it be beneficial to explain Dr. Schonfeld’s stages to the parents?

#2  Ages Six to Nine
The second of the three stages of development is ages six to nine.  In my experience, children ages six to nine begin to understand the finality of death, but have difficulty understanding their own vulnerability.  Also at this stage, children that I have counseled tend to be fascinated by the biological aspects of death. 

Robbie’s sister Tara, age 9, described to me all the tubes in her father’s body before he died.  Tara went as far as to tell me the color of the body fluids passing through her father’s tubes.  Sue, her mother, stated, "Tara has a lot of questions about death.  She has asked me about decomposition, embalming and other things I find difficult to discuss with her." 

I have found, like you, that parental education can be positive.  For instance, if Sue had not answered Tara’s questions, Tara would have used her imagination to fill in the answers.  I stated to Sue, "As you know, a child’s imagination may conjure images far more frightening than reality."  She replied , "But what if I don’t really have the answers?" 

Have you had counseling experience where parents are unsure how to approach subjects like death that they know little about?  I stated to Sue, "Remember, if a subject comes up and you are unsure how to explain it, simply say, ‘I don’t know.  Let’s find out together.’" Think of your Sue.  Is she being asked questions he or she does not know the answer to?
#3 Ages Ten to Thirteen
The three key concepts of death we discussed were "nonfunctionality" of the body, death is final and death is universal.  I have found that by ages ten to thirteen, the three key concepts of death are understood by the grieving child.  Have you found that children ages ten to thirteen begin to struggle with why death happens? 

Also, these older children tend to see death in the form of some tangible being, such as a ghost, a bogeyman, or a hooded figure with a scythe.  As you know, ten to thirteen year olds begin to experiment with theories about death.  Have you heard abstract thinking children between ten and thirteen ask questions such as Billy, age 11, asked?
1. "Is death a way to get rid of old people and make room for new ones?" 
2. "Does someone really die every time a baby is born?" or
3. Billy also asked, "Is it true that death comes in threes?"

I have also found that children ages ten to thirteen begin to consider how death affects relationships.  You may have heard statements like:
1. "Grandpa won’t be able to take me fishing anymore." or
2. "Dad used to love taking us camping."

In my practice, I often find that children ages ten to thirteen also begin to identify more strongly with adults of their own gender.  Would you agree that these pre-adolescent grieving clients begin to identify with cultural rules about grieving and gender roles? For example, a young boy may hear something like "big boys don’t cry."  Clearly, this statement may force him to choose between denying his feelings or deny being one of the guys. 

Have you had experience counseling a child who is confused not only by what he or she is feeling, but by how he or she should deal with those feelings?  Do you find the three stages of development to be an effective tool in making a preliminary decision about how a child may perceive death?

On this track we have discussed how grief reflects stages of development.  The three stages of development we have discussed are ages two to six, ages six to nine, and ages ten to thirteen.  We will also discuss the three key concepts of death as put forth by Dr. David Schonfeld.  The three key concepts of death are "nonfunctionality" of the body, death is final and death is universal.  

On the next track we will continue to discuss how grief reflects stages of development.  We will discuss the adolescent stage of development.  I have found that there are three phases of adolescence.  The three phases of adolescence we will discuss are early adolescence, middle adolescence, and late adolescence. 

Peer-Reviewed Journal Article References:
Griese, B., Burns, M. R., Farro, S. A., Silvern, L., & Talmi, A. (2017). Comprehensive grief care for children and families: Policy and practice implications. American Journal of Orthopsychiatry, 87(5), 540–548. 

Salinas, C. L. (2021). Playing to heal: The impact of bereavement camp for children with grief. International Journal of Play Therapy, 30(1), 40–49.

Sandler, I. N., Ma, Y., Tein, J.-Y., Ayers, T. S., Wolchik, S., Kennedy, C., & Millsap, R. (2010). Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 78(2), 131–143. 

Stutey, D. M., Helm, H. M., LoSasso, H., & Kreider, H. D. (2016). Play therapy and photo-elicitation: A narrative examination of children’s grief. International Journal of Play Therapy, 25(3), 154–165. 

Talen, M. R. (2019). A silver lining playbook? My mom’s death. Families, Systems, & Health, 37(3), 260–262.

Yopp, J. M., Deal, A. M., Nakamura, Z. M., Park, E. M., Edwards, T., Wilson, D. R., Biesecker, B., & Rosenstein, D. L. (2019). Psychological and parental functioning of widowed fathers: The first two years. Journal of Family Psychology, 33(5), 565–574.

Online Continuing Education QUESTION 2
What are the three key concepts of death? To select and enter your answer go to CEU Test.

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