Grief is something we all experience at some point in our life. But, children process loss differently than adults. For very young children, loss or death lacks finality. It may even be viewed as reversible. It’s not until about age eight that kids begin to grasp what death really means.

“Children under eight generally think, ‘Oh, grandpa went to heaven, but grandpa can come back or grandpa can give me a call.’ So the concept of death has not finalized. In older children, that’s not the case. They know exactly what’s going on. They know that death is final,” states Dr. Raunak Khisty, child and adolescent psychiatrist with Riverside Behavioral Medicine.

Symptoms of Unhealthy Coping

A common reaction children will express is anger. While some anger is acceptable, physical anger often represents unhealthy coping mechanisms. Acting out, getting aggressive at school or home, throwing things, breaking things—these are all warning signs children need help navigating how they’re feeling.

“We also see self-harming behaviors like cutting or harming oneself, voicing thoughts of suicide, voicing wishes to be dead, especially voicing wishes to be dead so they can be with the deceased loved one,” explains Dr. Khisty.

Other symptoms of unprocessed grief include taking on a more infantile persona, such as wetting the bed or demanding more attention. Very young children will also often believe they were “responsible” for the person’s death, because they had wished negative thoughts about that person in the past.

Honoring the Loved One

Parents who are struggling with their own grief may not know how to help their children process the loss in a healthy way. It’s helpful if a family member or friend can step in and provide emotional support—especially at the funeral ceremony. “If at any point the child wants to leave, I think that dedicated person should escort them out so they don’t become more traumatized,” advises Dr. Khisty.

He also cautions against forcing a child to attend the funeral. If that is the case, parents should have a plan to honor the loved one in some way, such as lighting a candle, saying a prayer, making a scrapbook, reviewing photographs, or telling stories. “They should be allowed to express feelings about their grief or loss in their own way,” adds Dr. Khisty.

When Is Medical Intervention Needed?

When symptoms of grief persist for months following the death, or if children start to display signs of depression—trouble falling or staying asleep, losing interest in previously-enjoyable activities, fear of being alone—it’s time to consider medical intervention. Grief counseling can be very effective in many instances.

“At Riverside Medical Center, we have our hospice program which also offers grief counseling to not only adults but also children. I think that can be a very healthy way of processing your grief. I think children also benefit from getting back into their routine, seeing their parents are also getting back to their routines. I think that really helps,” shares Dr. Khisty.

An additional option is the partial hospitalization program, where the child comes into Riverside Medical Center during the daytime hours for treatment and then returns home. However, if symptoms become more severe, Dr. Khisty says full hospitalization is likely needed. “At any point, if a child starts having thoughts of suicide or wanting to harm others, that’s when you want to bring them to the emergency room, and we may have to consider hospitalization at that point,” he advises.

One important takeaway Dr. Khisty says parents shouldn’t do is to ignore the loss—or ignore the fact that children are having a difficult time processing grief. “Long-term denial of death or avoidance of grief can be very emotionally unhealthy. Not only for our kids, but adults as well. It can lead to more severe problems later on, related to depression, mood instability, and aggressive behaviors,” he cautions.

To reach the behavioral medicine helpline, call 844-442-2551.