Helping Children Cope with Grief and Loss: Pediatric Guidance for Healing and Support

Introduction

Grief isn’t just an adult emotion—it’s something even the youngest children can experience, often in ways that are confusing and hard to express. From changes in behavior to emotional outbursts, children grieve deeply, but differently. Curious how grief shows up at each age, what signs to watch for, and how pediatricians, counselors, and parents can support a child’s healing journey? Read on to understand how to help children navigate loss with compassion and care.

How children understand grief

Children as young as infants and toddlers can sense when something around them has changed. Actually, most young kids are aware of death due to many factors, like cartoons, movies, and hearing from friends, as some of their friends may have already lost a loved one.

Children and teens can feel grief just as strongly as adults, but they often show it differently. They tend to learn how to cope by watching the adults around them and depend on adults for support during tough times.

Emotional reactions and behaviours will vary depending on the child’s age, with each stage of development influencing how they process and express grief.

As a parent or caregiver, you can’t shield a child from the pain of loss, but you can help them feel safe and understand their feelings. Encourage them to talk about what they’re going through and help them build healthy ways to cope for the future.

Signs of grief in children:

• Emotional changes: Irritability, crying, or sudden outbursts of anger
• Social withdrawal: Loss of interest in interacting with others or reluctance to engage in usual activities
• Regressive behavior: Younger children might show clinginess or bedwetting.
• Academic struggles: Difficulty focusing on studies, leading to a drop in grades or engagement in schoolwork
• Physical complaints: Persistent stomach pain or headaches with no medical cause

Common emotional responses by age

Babies (0-2 years):

Babies have no understanding of the concept of death yet, but they react to the absence of a loved one and the changes in routine caused by the loss and express their distress through their behavior, like showing changes in sleep, eating, or bowel and bladder habits. They become more irritable and clingier.

Toddlers and preschoolers (2-5 years):

Children in this age group can begin to grasp the concept of death, often triggered by seeing a dead bird, insect, or animal. However, their understanding is still limited—they may see death as temporary or reversible, asking if the person will come back, if they’re just sleeping, or if they’ve simply gone away.

They exhibit behaviours like separation anxiety, bedwetting, altered appetite, less interest in play, and sleep disturbances.

Primary school-age children (5-9 years):

This age group gradually begins to develop an understanding that death is permanent and irreversible and that the person who has died will not return. Kids may personify death as separate entities (ghosts, etc.), and some children might feel that somehow what has happened was their fault.

In this age group, signs of distress may include nightmares, regression to earlier behaviours, aggressive or violent play, and attempts to take on the role of the person who has died.

Pre-adolescent (9-12):

This age group understands that death is permanent and that it will happen to everyone, including themselves, but some kids view death as punishment. Their grief response is fear of the death of other people they love, anxiety about death, and curiosity to know more about how the death has happened.

They show signs of distress, withdrawal from friends, regression, problems in school, suicidal thoughts, and extreme weight loss or gain.

Adolescents (13 and older):

Adolescence is a period of major growth and change, and experiencing grief during this time can affect a young person’s journey from dependence to independence.

This age group understands death cognitively, struggles with spiritual beliefs surrounding death, searches for real meaning behind the death, and understands the possibility of their own death.

Grief responses may include acting out, may express that “life is not fair,” and prioritize discussing their feelings with their friends, and may develop an “existential” response.

They show signs of distress, such as poor school performance, intense anger or guilt, long-term withdrawal from friends, opposition, or defiance.

Role of Pediatricians and counsellors

Pediatricians and counselors play a vital role in helping children cope with grief. As the first point of contact for many families, they can identify signs of grief early, offer immediate support, and guide families toward appropriate therapeutic resources and interventions.

Pediatrician’s role:

• Initial assessment of changes in behavior due to grief, such as sleep abnormalities, loss of appetite, etc., and provides initial support
• Educating the families on how to communicate with the child about death and loss
• Helping them understand their own grief and how to best support their child
• Pediatricians can refer families to grief counselors or therapists when the grief of a child is severe, complicated, or prolonged.

Counselor’s role:

A grief counselor provides counseling that includes a variety of techniques tailored to their individual needs and developmental stages. Those methods include:

• Cognitive & Behavioral Therapies
  • Cognitive Behavioral Therapy (CBT)
• Family & Social-Based Therapies
  • Family therapy
    • Parental support
    • Group therapy
• Expressive & Creative Therapies
  • Play therapy
    • Art therapy
    • Narrative therapy
    • Journaling
    • Bibliotherapy
• They work individually with parents and children to address grief, communication patterns, and family dynamics related to the loss.
• They can help in identifying and addressing complicated grief reactions, including anxiety, sadness, or depression, and provide specialized interventions to help children process their emotions and heal from loss.

Benefits of bereavement counselling

• Safe expression
• Coping strategies
• Personalized support
• Emotional connection

Support techniques for parents

The following are thoughtful techniques parents can use to support children in coping with the loss of a loved one, while fostering open communication, emotional safety, and healthy understanding:

• Create a safe place for children to talk and ask questions
• Gently, but directly use words like dead, death, and died within short explanations
• Be genuine on a developmental level, and the child can understand
• Be mindful that they need a balance of play and communication
• Identify misconceptions and fears, offer reassurance, and provide opportunities to create legacy items to help kids remember deceased loved ones
• Estimate your child’s capacity to understand the concepts of death

Avoid this

• Focusing too much on your own emotions
• Discussing too many medical details
• Not allowing silence
• Setting an agenda
• Showing anger toward them

Long-term emotional health

Grief in kids, particularly after the loss of their loved one, can have significant long-term emotional health impacts.

While most kids adapt to loss over time with support, some may experience ongoing psychological or behavioural problems and exhibit the symptoms of anxiety, depression, PTSD, and other difficulties that can impair their daily functioning.

Factors influencing long-term impact:

• Type of loss
• Age and developmental stage
• Traumatic nature of death (violent or unexpected death)

Resources for grief management include helplines, counselling services, and support groups. Organizations like the Children’s Grief Centre and SoulUp offer special help for children dealing with loss. Helplines like iCALL’s CHAMPS Helpline and Kids Helpline are also there to give support right away. Schools and communities can help too, through counsellors and programs that support children after a loss.

Conclusion:

Supporting children through grief requires understanding their emotional and developmental needs at every stage. With the right guidance, open communication, and therapeutic support, most children can build healthy coping skills to process their loss. Early intervention from a behavioral pediatrician or pediatrician can make a lasting difference in their emotional recovery and long-term well-being.