Understanding and supporting young people through grief

A nurse with Willow Grove Adolescent Unit (WAGU) at St Patrick's University Hospital discusses how we can help children and young people understand and deal with grief.

Adults know that it’s inevitable we will experience a bereavement and feel the grief that comes with the loss of a loved one. We can also understand the significance of death and the finality of it, grieving in our own way and usually know to expect a period when things just won't feel right. It’s important to understand that children and adolescents can grieve in different ways to adults. This can sometimes leave them in the background, lost and unheard.

How children process grief

Children's understanding of death and grief can depend on their age and development. As a child matures, their understanding of grief and death develops with them.

Younger children may not understand that death is final and universal and may not grieve in that moment, however, they will notice the change around them. They will notice the absence of the person who has died and the sudden change in daily routine and atmosphere. This has the potential to cause them distress.

An older child will have the capacity to understand death and the impact of someone they know dying. They might ask more specific questions about what happened and why. They tend to understand the permanency of death better than a younger person and this may stir more severe feelings such as anger, shock and upset. They may withdraw socially from their normal activities. They also may avoid speaking about the person that has passed away.

Children can be the “forgotten mourner”. They may appear to be managing the loss of someone well or present as unaffected by the loss. They may seem to accept the death and appear to be coping well; they may not ask a lot of questions and may want to return to their school and friends quickly afterwards. Sometimes they crave the normal life they once had and are happy to return to it, other times they are hiding their feelings; this can often happen when the death occurs within the immediate family such as the loss of a parent or sibling.

Children may recognise the pain others are in and may disguise their upset or grief to protect surviving parents or siblings. This disguise can last a long time and may create complications in their own grief. This can lead us, as adults, to believe they have been unaffected and have moved on from the loss, which may not be the case.

The impact of death on an adolescent

When death occurs in the life of an adolescent it can sometimes cause greater upset and grief than younger children. Adolescence is a difficult time to navigate in general; it is a time when one explores and attempts to understand their identity and when young people need to contend with the transition from primary to secondary school and find their place fitting in with their peers. When an adolescent experiences a loss during this time, it can cause an intense emotional reaction such as upset, fear, anger, confusion, guilt, and loneliness.

Unlike younger children, adolescents have a clear understanding of death and how permanent and final death is. They understand that no one is exempt from death and that when someone dies, it is forever. They may find it difficult to manage the many emotions that can arise with this reality when a loved one dies. Along with emotional reactions, they may experience changes physically, such as low energy, disrupted sleep, and loss of appetite. They may find it difficult to concentrate, experience irritability or even become aggressive in moments. These reactions can just add to the challenges they already face being an adolescent and create more of a divide between them and their peers.

Supporting a child or young person through grief

There are a few things you can do to help support a child or young person to deal with the loss of an important person.

For younger children:

• It is important to continue with life that is familiar to them, for example play familiar music and play games with them.
• Try to keep their routine as similar as possible to how it was before the death of this person, doing things such as attending school, having regular mealtimes and play times etc.
• If the child is open to it, it is important to encourage open discussion and chat times to give them space to ask questions about this loss.
• It can be helpful to create a space for them to remember the person they are grieving, such as looking at photo albums, creating memory boxes or having story time about the loved one.
• Ask other family members or family friends to spend time with them to talk about the memories with this person that has died.

For older children and adolescents:

• Ensure that they know it is ok to ask questions. Create an environment that encourages open talking about the loved one and memories.
• Support them in continuing their life, such as returning to school (they may want to do this earlier than expected), returning to their extra-curricular activities, rejoining their friends and general outings.

Answering difficult questions

If a child, young person or adolescent are asking questions, it’s important to answer them with appropriate language and content for their age. Sometimes, when these questions are not answered about a loss, they will fill in the blanks themselves and they may create ideas around death and the meaning of death which may be worse than the reality. They may repeatedly ask the same questions and may need repeated explanations for them to understand the information they have been told.

Grief has no fixed timeline

It is important to remember that when a child experiences a loss, they may revisit that grief each time they develop a new understanding of life and death. As a parent or guardian, you may need to support them at different times throughout childhood until adulthood, or even beyond.

Each time they may have a strong grief reaction; it might be helpful to revisit the loss and discuss answers to the questions they have. This can be challenging for a parent or family members who may have learned to live with the loss, accepted the loss or find it difficult revisiting the loss.

It is important that the young person has someone that can give them answers, explore their grief, and talk about memories of the loved one. Similarly, life events such as anniversaries, birthdays, school or college graduation and births, may intensify the grief at later times throughout life.

Remember, grief is not linear - there are no fixed set of rules or stages that everyone universally goes through which can make it very difficult to navigate, particularly for young people.

What to do if things get complicated

Intense grief can come and go and change over time but how do we know when things are getting complicated? Complicated grief can present as a very intense and persistent grief that has a significant impact on the young person's life. In addition, the young person's mental health may be affected. They may experience mental health difficulties, potentially in the form of anxiety disorders, mood disorders or use of substances that can sometimes lead to addiction.

• Anxiety: The young person may present as particularly clingy to a parent, they could develop obsessive compulsive thoughts or behaviours, they may feel anxious or nervous about socialising or being around people or even develop panic attacks.
• Mood: The young person may experience a persistent low mood that impacts their daily functioning or experience negative or harmful thoughts about themselves. They may have low energy, decreased motivation and severely decreased appetite resulting in weight loss.
• Addiction: Some young people can develop dependence on alcohol or other substances.

If you feel the young person's grief has become complicated and is affecting their mental health, it would be important to explore more external supports such as your GP, a Psychiatrist, Psychologist or Psychotherapist.

Every person, young and old, has their own journey around grief, and some may learn to live with the grief quicker than others, some oscillate between coping and being completely lost in their feelings. The important thing is to recognise this grief, leave space for the memory of the person who died, and invite conversation about how everyone is feeling. 

Vicki Walsh is a Clinical Nurse Manager 2 with WAGU and has a Masters degree in Bereavement and Loss. WAGU is a specialist mental health service for young people aged between 12-17 years, located at St Patrick’s University Hospital.