3 Infancy, Toddlerhood, and Preschool 65It is unclear whether a child less than 3 years old processes death as
anything other than separation anxiety that is not relieved by crying for the
caregiver’s return. Responses tend to take the form of bodily symptoms
(stomach aches) and regressions to earlier states of functioning. Therefore, the
recommendations for care of very young children who experience a significant
death loss include assuring that there is a caregiver to provide attuned, nurtur-
ing, and consistent care (despite the caregiver’s own grief), keep the infant’s/
toddler’s routine predictable and consistent, and allow for regression such as
bedwetting and refusal to feed oneself (Hames, 2003; Hope & Hodge, 2006;
Willis, 2002). Despite the belief that children under two or three cannot con-
ceptualize death, they are grieving intensely, albeit in a manner different from
adults. Crenshaw (2002) clearly identifies adults’ tendency to disenfranchise
children’s grief in detrimental ways by ignoring, minimizing, or otherwise not
recognizing this different manner of expression as true grief and mourning.
This is dangerous for infants and young toddlers; reassurance and nurture is
necessary for them to move through their response and continue to thrive.
As the toddler grows, concepts of death evolve (Christ, 2000). Children who
are 4 to 5 years of age understand that death involves the deceased’s separation
from living people and a cessation of breathing and heartbeat. They may have
little sense of the permanence of death (www.cc.nih.gov/ccc/patient_education/
pepubs/childdeath.pdf). One study of children 3 to 5 years old found that their
struggle to understand the irreversibility of death led to “befuddlement” (Christ,
2000, p. 75), intensified reactions to other separations, and repetitious questions
about the location and condition of the deceased. Further, a sense of interchange-
ability or a sense that the lost one just needs to be replaced with another sibling/
mother/father/grandparent adds to the challenge of the surviving parent’s need to
support, nurture and respond to the child while she or he asks disturbing questions
(Christ, 2000). Yet other research indicates that these questions, when answered
directly, honestly and clearly, allow children to make meaning using idiosyncratic
blends of biological and religious explanations (Rosengren et al., 2014).
Magical thinking is common at this stage of development and children
may believe their angry thoughts caused the death of the deceased (American
Academy of Pediatrics, 2000). Clear explanations grounded in concrete
realities provide important ways for children to begin to understand death.
Attendance at funerals in order to see the body is often a positive strategy as
long as the child can be protected from adults’ uncontrolled outbursts of emo-
tion that they may find more disturbing than the death itself (Willis, 2002).
Preparing the child, answering questions, and providing for the child to be
with a trusted adult not severely affected by the death are all useful to assist
3- to 5-year-olds through the mourning process.
A fundamental aspect of loss in childhood is that the child will need to
“rework” the loss at each stage of development. Children can only understand
death within the cognitive development (and language capability) they have,
yet must live with the loss their entire lives. As they develop emotional lan-
guage skills, abstract reasoning, ability to anticipate the future, and so forth,
they will need to reassess and grieve the loss through their new perceptual
abilities, sometimes with professional help. A loss in early childhood requires
more “reworking” than a later loss as more development takes place on the
way to adult understandings.