Discussing Death With Children: A Developmental Approach

Sydney G. Kronaizl

Disclosures

Pediatr Nurs. 2019;45(1):47-50. 

In This Article

Conceptions of Death in Childhood

The concept of death is undoubtedly complex, even in adulthood because it is influenced by factors including – but not limited to – social beliefs and cultural norms, spiritual beliefs, emotions, and cognitions. Moreover, medical advancements and the evolution of mourning rituals have shaped experiences with and concepts of death for adults and children alike (Bonoti, Leondari, & Mastora, 2013; Longbottom & Slaughter, 2018; Renaud, Engarhos, Schleifer, & Talwar, 2013). As such, children's concepts of death are as unique and multifaceted as the experiences that shape them.

Two factors that have been empirically found to influence children's concepts of death and their accuracy are the child's age and his or her previous experiences with death (Bonoti et al., 2013; Longbottom & Slaughter, 2018). First, age is often, albeit incorrectly, equated with a child's ability to understand death, evidenced by the fact that many parents report avoiding discussions about death until their children get older (Renaud et al., 2013). Second, in the case of previous death experience, or lack thereof, findings are mixed. Some research suggests that previous experience with death is correlated with a more accurate death concept; other research suggests the opposite, or that there is no significant relationship between a child's death experience and the accuracy of their death concept (Bonoti et al., 2013; Wass et al., 1983). Many researchers suggest this ambivalence may be due to adults' use of euphemisms and confusing language, such as "grandma has gone to sleep" (Longbottom & Slaughter, 2018).

Research has consistently identified four components of a death concept that children come to understand over time and with direct or indirect death experiences: irreversibility, finality (non-functionality), causality, and universality/inevitability (Bluebond-Langner et al., 2012, Bonoti et al., 2013; Longbottom & Slaughter, 2018; Olin, 2016). Although there is no set timeline during which children come to understand these components, examining them relative to children's developmental stages allows us to more comprehensively understand why some components may be more difficult to grasp than others, and to identify best practices for providing information and support.

Irreversibility

In this context, irreversibility refers to an understanding of the permanence of death (Olin, 2016). That is, a child who grasps the concept of irreversibility will understand there is no reversal of death or return to life. In his theory of cognitive development, Jean Piaget posits that children do not develop the cognitions necessary to understand irreversibility until the concrete operational stage, from 7 to 11 years. It is during this developmental stage that children think more logically and gain the understanding that entities can be reversed or returned to their original state (Piaget & Inhelder, 1969). Although an understanding of the reversibility of other entities contributes to an understanding of the irreversibility of death, it may evoke frustration in a child who does not understand why some processes can be reversed but death cannot.

Finality (Non-functionality)

Finality, or non-functionality, refers to an understanding that the dead body ceases life-sustaining functions, such as walking, talking, eating, and breathing (Longbottom & Slaughter, 2018). Such understanding may be complicated by animism, or the attribution of physical and mental qualities of living entities to inanimate objects (Bonoti et al., 2013). From a developmental standpoint, a child comes to appropriately attribute life to objects in stages. In the first stage, life is attributed to almost any object, such as a toy or blanket. In the second stage, aligning roughly with the end of Piaget's preoperational stage, any object that moves is thought to be alive by the child. In the third stage, any object that moves on its own accord is considered alive by the child. It is not until the fourth stage, aligning most closely to Piaget's formal operations stage, that the child comes to understand only plants and animals are alive (Piaget & Inhelder, 1969). In providing support and resources for a grieving child, it is necessary to consider their understanding of what constitutes life or a lack thereof.

Causality

Within the context of grief and dying, causality refers to the child's understanding of what causes death, and this can fall at any point on the spectrum from concrete to abstract (Olin, 2016). From a Piagetian perspective, causality in a child in the preoperational stage will differ markedly from that of a child in the formal operations stage (Piaget & Inhelder, 1969). In the former, the child will struggle to understand the underlying mechanisms of causality, and may require reassurance that they did not magically cause the death. In the latter, the child possesses the ability to consider hypothetical situations and the implications of the death, both of which should be addressed.

Universality/Inevitability

Universality, or inevitability, refers to the understanding that all living things will eventually die (Longbottom & Slaughter, 2018). As is the case with finality, or non-functionality, a child's current understanding of animism must be considered to properly address the concept of universality or inevitability. That is, one must first recognize what the child identifies as living before he or she can assist the child in navigating the knowledge that all living things eventually die. It is also within the arena of universality that a child's personal mortality should be acknowledged and addressed.

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