Grief in children and adolescents

Grief, the price we pay for love

Psychiatrist Murray Parkes said, "The pain of grief is part of life, just like the joy of love; it is the price we pay for love, the cost of the bond."

Where there has been love, there is pain when loss occurs. This seemingly simple statement takes on a special complexity when we talk about children and adolescents , because loss not only affects a relationship, but also occurs at a crucial time when identity, security, and understanding of the world are still being built. The death of a significant person in a child's or adolescent's life abruptly disrupts a stage of life in which the foundations of security, identity, and understanding of the world are still being established. However, children's suffering is often silenced, minimized, or misinterpreted, as if their pain were less profound or less real than that of adults.

Grief is a universal human experience, but it is not always recognized when it occurs in childhood and adolescence. An article in the journal Pediatrics on grief begins with this sentence: "The death of a significant person in a child's life is one of the most stressful events they can experience."

Grief in childhood and adolescence is a highly prevalent and potentially disruptive experience, but it remains insufficiently recognized and addressed by health, education, and social systems.

Although the loss of a parent, sibling, or close person is one of the most stressful developmental experiences, it has received far less attention than other childhood adversities, such as abuse or neglect.

Grief is not an illness or a mental disorder. It is a natural response to the loss of a loved one. However, in childhood and adolescence, this process has its own characteristics, conditioned by emotional, cognitive, and relational development. Children and adolescents do not process grief in the same way as adults, but this does not mean they do not experience it with the same intensity.

Grief affects much more than just emotional well-being; it has a global impact on a child's or adolescent's life: on physical health, academic performance, social relationships, and sense of security. Although most grief follows an adaptive course, it is also a risk factor, especially when there is a lack of support or other pre-existing vulnerabilities.

This article aims to offer a compassionate and respectful perspective on grief in children and adolescents. It seeks to break down taboos, understand how they experience loss according to their age and stage of life, and provide tools for talking about death and supporting those who grieve. Because only by recognizing childhood grief as a profound and meaningful experience can we help children integrate loss into their life story and continue to grow.

Taboos and myths about grief in children and adolescents

We live in a society that has distanced death from everyday life. Death is hidden, pushed out of the domestic sphere, and becomes an uncomfortable, almost invisible topic. This distancing does not facilitate grief; on the contrary, it makes it more difficult. When death lacks a symbolic place and a shared narrative, children are left without the tools to understand what is happening and to make sense of the absence.

One of the biggest obstacles in supporting children through grief is the myths that still persist in the collective imagination. It's often said that children don't realize what's happening, that they don't suffer as much as adults, or that they adapt to everything. These beliefs stem from an adult perspective that confuses children's different ways of expressing pain with an absence of suffering. Children, even the very young, deeply perceive absences, emotional shifts in their environment, and the breaking of significant relationships. They may not be able to verbalize what they feel, but they express it through their bodies, play, behavior, or silence. Their suffering is no less; it's simply different, and often more difficult to recognize.

With the intention of protecting children, many adults choose not to talk to them about death, to avoid rituals, or to distract them from the pain. But this apparent protection can end up becoming a form of neglect: overprotecting is a way of neglecting .

Other myths, such as the idea that not talking about it will lessen a child's suffering or that distraction will help them get over it faster, stem from adults' discomfort with grief rather than from children's actual needs. Silence doesn't protect; it leaves the child alone with their fears, fantasies, and feelings of guilt. Distraction can offer moments of respite, but it doesn't replace the grieving process. When loss isn't addressed verbally, children construct their own explanations, often more distressing than the reality itself. Supporting children through their grief involves acknowledging their pain, speaking truthfully, and providing a safe space where they can express their feelings at their own pace.

One of the most frequent mistakes is confusing protection with concealment . Hiding information, avoiding rituals, not talking about the deceased person, or changing the subject when the child asks is usually more a response to adult discomfort than to the child's real needs.

The child perceives the changes, absences, and suffering in their environment, even if no one puts words to it. When they don't receive explanations, they construct them. And often these internal explanations are more distressing than reality: guilt, fear of abandonment, fear of their own death or the death of the surviving parent.

In many cases, children's grief is silenced because it doesn't fit adult expectations: the child plays, laughs, seems "distracted." But play isn't the absence of pain; it's a way of processing it. Children move in and out of grief, as if they need to ration their suffering in order to bear it.

Grief in childhood is not a "minor" grief. Nor is it incomplete or superficial. It is a different kind of grief, expressed with its own language and pace. The challenge for adults is not so much "preventing the child from suffering," but rather learning to recognize suffering when it differs from our own and responding appropriately.

Grief in adolescents

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How to explain death to children and teenagers

Talking to children about death shouldn't begin only after the loss has already occurred. Life offers numerous opportunities to develop an understanding of death: the death of a pet, a news report, a story, a film. When these situations are avoided, a crucial educational opportunity is lost.

Integrating death as a part of life allows us to demystify it without trivializing it, and prepares children to face future losses with greater emotional resources. When we don't know how to respond, it's okay to say so. The important thing is not to cut off the question.

How grief affects children and adolescents

Grief in childhood is not a uniform process. The way a child experiences and expresses loss is profoundly influenced by their developmental stage, cognitive and emotional development, the type of bond they had with the deceased, and their family context. Therefore, understanding grief at different ages is essential to avoid confusing normal expressions with behavioral problems or, conversely, to avoid trivializing signs of suffering.

It's important to remember that children's grief isn't always visible . They may play, laugh, and appear normal even amidst profound loss. This emotional fluctuation often confuses adults, but it's part of their natural coping mechanism. They move in and out of grief, as if they need to regulate it to be able to bear it. Mistaking this capacity for an absence of suffering is a common mistake.

A key element is that children do not grieve in isolation, but within families also affected by the loss. Secondary changes associated with death, such as economic insecurity, changes in residence, or disruptions to routines, can amplify the distress. The surviving caregiver's ability to offer emotional warmth and structure emerges as a crucial protective factor.

Regardless of age, grief in children and adolescents does not follow a linear or predictable process. Children may revisit grief at different stages of development, reinterpreting the loss as they acquire new cognitive and emotional abilities. What cannot be understood at age five may resurface at age ten or fifteen, with new questions and different emotions.

However, grief can temporarily interfere with key developmental tasks such as acquiring autonomy, emotional regulation, cognitive development, or peer relationships.

How grief is experienced at different ages:

Babies and very young children (0–2/3 years)

At these early ages, children don't have a developed concept of death. They can't understand what has happened or put words to the loss, but they do deeply perceive the absence and the change. Grief is expressed primarily as a response to the rupture of the bond with their primary caregiver, usually the mother or main caregiver.

The manifestations may include inconsolable crying, irritability, changes in sleep and appetite, apathy, or, in some cases, apparent indifference. The baby may also show anxiety in response to the emotional reactions of those around them, as they sense the suffering of adults without being able to understand it. When the mother or caregiver is grieving, even if the child never met the deceased person, their emotional state is affected by the sadness and overwhelming emotions of the caregiver.

Toddlers (2-6 years)

At this stage, magical, concrete, and literal thinking predominates. The child may experience death as something temporary and reversible, similar to a separation or a journey. This leads them to repeatedly ask when the deceased person will return or to interpret death as a consequence of some action of their own, often with very intense but difficult-to-express feelings of guilt.

Grief can manifest as regressions (loss of bowel and bladder control, excessive need for contact), separation anxiety, new fears, or seemingly immature behaviors. It is also common for children to alternate between sadness and play and laughter, which can be disconcerting for adults. This play does not indicate an absence of pain, but rather is a fundamental way in which children process grief.

School-aged children (7–11 years)

As children grow, they begin to understand the irreversibility and universality of death, although this understanding is often accompanied by significant fears. It is common for them to experience fear of their own death or the death of their parents, as well as excessive worry about the health or safety of their surroundings.

At this stage, grief can manifest as persistent sadness, difficulty concentrating, poor school performance, or physical symptoms such as headaches or stomach aches. Some children may exhibit an overly responsible attitude, trying to "take care" of adults or assuming roles inappropriate for their age. Others may display anger, withdrawal, or difficulties in peer relationships. Often, the child is aware that they "should" feel something, but struggles to identify and express their emotions.

Adolescents (12–18 years)

In adolescence, grief is intertwined with a pivotal period of significant physical, emotional, and identity-related changes. The task of constructing one's own identity, differentiating oneself from family, and finding one's place in the world is compounded by the loss of a significant figure. This double burden can generate confusion, anger, withdrawal, or risky behaviors, and is frequently misinterpreted as a behavioral problem when, in reality, it is an expression of grief.

Adolescents can already understand death in an abstract and existential way, but often lack the emotional resources to integrate it. The loss of a significant person can profoundly challenge their understanding of the meaning of life, justice, and their own identity.

The manifestations of grief at this stage can be especially complex and indirect. Irritability, anger, feelings of guilt, and isolation are common, as are, at the opposite extreme, risky behaviors such as substance abuse, reckless driving, or uninhibited sexual behavior. Many adolescents express their grief outside the family setting, with their friends, while at home they may appear distant or withdrawn. This apparent indifference often masks intense suffering and a profound sense of loneliness.

Should children attend a funeral?

This is one of the most frequently asked questions among families. Rituals help transform a chaotic experience into a shared and symbolic one. Rituals offer structure, meaning, and emotional support. They are not merely social or cultural acts: they are symbolic spaces that allow the loss to become real, to be shared with others, and to begin the process of integrating the absence. Depriving children of rituals can hinder their understanding of the reality of death and prolong confusing fantasies. The key is not so much whether or not the child should participate in the rituals, but how this participation is prepared.

Should children attend a funeral?

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How to help grieving children and teenagers

Supporting children and adolescents through grief doesn't require perfect answers or extraordinary words. It requires presence, listening, time, and truth. It requires accepting that pain is a part of life and that it can't always be eliminated, but it can be sustained. Giving space to emotions, validating them, and offering security are some of the fundamental pillars of this support.

The family plays a central role in how children process grief. In most cases, a grieving child is part of a grieving family. The adults in their lives are often immersed in their own suffering, with limited emotional resources. How the adults cope with the loss, how they express or conceal their emotions, and how they allow the deceased person to be discussed, profoundly shapes the child's experience.

Worden's (1996) tasks can help you organize needs. These tasks are not linear, are not completed all at once, and have no fixed time limit. They are often reactivated throughout development as the child acquires new cognitive, emotional, and symbolic abilities. Expanding on each task allows for a better understanding of what the child needs and what role adults play.

Accepting the reality of the loss.

Helping a child accept that a loved one has died is a particularly delicate task, because it clashes with their way of thinking and understanding the world.

In young children, this acceptance is neither immediate nor definitive: they may understand it one day and the next day ask when the deceased person will return. This doesn't indicate resistance, but rather developmental limitations in understanding irreversibility. Accepting the reality of loss requires clear words, repeated patiently, avoiding euphemisms that generate confusion, and allowing the child to see that adults are not shying away from the topic.

Participation in age-appropriate rituals, such as visiting the funeral home, saying goodbye, making a drawing, or writing a letter, helps to make tangible an absence that might otherwise remain in the realm of fantasy.

In adolescents, this task can take the form of an internal struggle between "I know they're dead" and "it can't be," with more subtle forms of denial, such as acting as if nothing happened or avoiding any memory altogether. Accepting reality doesn't mean emotional resignation, but rather being able to acknowledge death intellectually and symbolically.

Working through the pain of grief

The second task is to help the child feel and express pain, rather than avoid it.This is often the point that makes adults most uncomfortable, because it involves tolerating intense and changing emotions.

In children, pain is rarely expressed continuously: it can appear in short bursts, at unexpected moments, and disappear suddenly to make way for play or carelessness. Validating this fluctuation is essential.

Working through pain involves legitimizing all emotions—sadness, anger, fear, jealousy, guilt—without judgment, and accepting that they will often be expressed indirectly: stomach aches, irritability, regressions, oppositional behaviors, or silence.

In adolescence, pain can manifest itself with intense anger, withdrawal, apparent cynicism, or risky behaviors, which can easily be misinterpreted as behavioral problems.

Helping in this task means helping to identify what is happening, facilitating the expression of emotions (giving permission to feel) and seeking resources to process the overwhelming emotions.

Adapting to a world without a loved one

The third task is especially complex in childhood, as the loss is not only emotional but also structural. The child must readjust to a different daily reality: changes in routines, family roles, the emotional availability of adults, and often, their sense of security. In some cases, children try to take the place of the deceased or assume responsibilities beyond their years as a way to cope with the loss or protect the adults. Supporting this process involves helping the child understand what has changed and what hasn't, preserving routines as much as possible, and preventing emotional or functional overload.

Internally, the child must also adapt their identity to the absence: "Who am I now without that person?", a question that becomes especially prevalent during adolescence. Adults must offer a consistent and predictable presence, even if they themselves are grieving, so that this adaptation can take place without adding to the insecurity.

To emotionally reposition the deceased person and continue living

The fourth task is not about forgetting, but about transforming the bond. For children, this means integrating the deceased person into their life story in a way that doesn't hinder their continued growth. Remembering, talking, maintaining memorial rituals, sharing anecdotes, and preserving meaningful objects allow the loved one to remain present in a different way. In adolescence, this task may involve re-evaluating the meaning of the bond, integrating learned experiences, and gradually opening up to new relationships and projects without feeling betrayed. Adults play a key role in legitimizing this continuity of the bond and, at the same time, giving permission to live, laugh, and project themselves into the future.

Relocating is not about closing the grieving process, but about learning to live with the absence without getting trapped.

Helping a grieving child or adolescent using Worden's framework involves understanding that childhood grief is a dynamic process that unfolds over time and requires sustained adult support. It's not about "teaching" grief, but about creating the conditions for these tasks to unfold healthily, with time, truth, and supportive relationships.

When should you seek specialized help for a grieving child or adolescent?

It is recommended to seek help when one or more of the following criteria are detected:

1. Intensity and persistence of discomfort

• Symptoms of intense sadness, anguish, guilt, or anger that do not lessen over time.
• Persistence of suffering beyond what is expected according to age, developmental stage and time elapsed since the loss.
• Emotional inhibition or sustained inability to express pain.

2. Significant impairment of functioning

• Significant and sustained deterioration in school functioning (performance, absenteeism, disengagement).
• Progressive social isolation or loss of interest in previously meaningful activities.
• Persistent developmental regressions (enuresis, infantile behaviors, excessive dependence).

3. Associated psychopathological manifestations

• Symptoms of intense anxiety, depression, sleep or eating disorders.
• Self-harm behaviors, suicidal ideation, or verbalizations of a desire to die.
• Serious disruptive behavior, disproportionate aggression, or risky behavior in adolescents.

4. Characteristics of the loss

• Sudden, violent or traumatic death (accidents, suicide, homicide).
• Multiple or cumulative losses in a short period of time.
• Death of a parent, sibling, or primary attachment figure.

Childhood grief in a loss by suicide

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5. Previous or concurrent vulnerability factors

• Personal history of mental disorder, emotional difficulties, or neurodiversity.
• Previous history of adversity (abuse, neglect, forced migration, severe poverty).
• Unresolved grief or intense suffering in primary caregivers that limits the capacity for emotional containment.

7. Contextual warning signs

• He lacks a family or social support network.
• Invalidating, silencing, or contradictory adult responses to the child's grief.
• Serious family conflicts associated with death.

Seeking help does not imply pathology, but rather the need for more specialized support when grief ceases to be an adaptive process and becomes a risk factor for emotional, relational, or academic development.