Childhood developmental understanding of death

Infants and toddlers (0 to 2 years)

Developmental context: establishing attachment and trust

Have no understanding of finality of separation, but feel absence of a familiar caregiver
May be distressed by disruptions in routines
Will be affected by the emotional distress/grief of surviving adult caregivers

Pre-schoolers (3 to 6 years)

Developmental context: driven by egocentrism, magical thinking, associative logic

Are not able to understand that death is irreversible and permanent
May attribute death or survivors' emotional distress to own actions or attributes
Distress and behavioral changes may be fueled by disruption in routine

School-age children (7 to 12 years)

Developmental context: mastering skills, fairness, cause and effect logic, peer relationships

Understand that death is final and irreversible
May have difficulty with abstract/spiritual issues
May ask factual questions that can be painful or offensive to adults
May struggle with unfairness of loss

Adolescents (13 and above)

Developmental context: working on separation-individuation, identity formation

Understand that death is final, irreversible, and universal
May struggle with existential issues
May focus on personal effects of loss

From: Muriel AC, Rauch PK. Talking with families and children about the death of a parent. In: Oxford Textbook of Palliative Medicine, 4th ed, Hanks G, Cherny NI, Christakis NA, et al (Eds), Oxford University Press 2010. Reproduced by permission of Oxford University Press. Copyright © 2010. www.oup.com.

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Childhood developmental understanding of death