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Death and Dying in Children

By Steven D. Blatt, MD

Many families have to deal with the difficulties surrounding an ill and dying child. Adults often have a difficult time dealing with death, and children may have a particularly difficult time trying to make sense of the death of a friend or family member (see also Introduction to Death and Dying).

Death of a Child

Most often the death of a child happens in the hospital or emergency department. Death can occur after a long illness, such as cancer, or suddenly and unexpectedly, such as after an injury or sudden infant death syndrome ( SIDS). It is difficult for families to understand and accept the death of a child. For parents, the death of a child means that they must give up their dreams and hopes for their child. While grieving, parents may be unable to attend to the needs of other family members, including other children. Counseling by a specialist who is skilled in working with families who have experienced the death of a child may be helpful.

Sometimes parents respond to the death of a child by quickly planning another pregnancy. A "replacement child" is conceived before the parents have had time to mourn and accept the loss of the dead child. Parents may place their feelings about and expectations of the dead child on the replacement child. Parents may be overprotective and think the replacement child needs special care and protection from perceived harm.

It is normal for parents who are grieving the loss of a dead child to struggle with an inability to attach to a new child. Counseling for the parents and new child is helpful.

Death of a Family Member or Loved One

How much children can understand about death depends largely on their developmental level. Children need to have the death of a loved one or friend explained to them at a level that makes sense to them. For example, preschool-age children may have limited understanding of death. Parents may try to explain death by relating it to a previous event, such as the death of a beloved family pet. Older children may be able to understand death more easily. Although it might make sense to do so at the time, death should never be equated with "going to sleep and never waking up," because the child may become fearful of sleeping.

Visiting Ill Children or Adults

Parents can ask their child's doctor or other health care practitioners whether they should allow their child to visit severely ill children or adults. Some children may ask to visit family members or friends who are dying. Parents should prepare children for such a visit so they will know what to expect. Parents can help prepare their children by telling them that the person may look different but is the same person. The person may have lost or gained weight or may have lost their hair because of the illness.

Attending a Funeral

Parents often wonder whether to bring children to a funeral. This decision should be made individually, and children should be involved in making the decision if possible. When children attend a funeral, a close friend or relative should accompany them to provide support throughout, and children should be allowed to leave if necessary.

Parents should understand that children may be curious and ask lots of questions about death. Parents should let children know that it is alright for them to ask questions.

If tragedy affects someone else, children may feel more confident, and less helpless, if they can contribute. For example, children can

  • Pick flowers

  • Write or draw a card

  • Wrap a present

  • Collect food, money, clothing, or toys

If a child appears withdrawn or sad after experiencing a death, refuses to engage in usual activities, or becomes aggressive, the parent should seek professional help.

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* This is the Consumer Version. *