living things die. Death is irreversible (the dead do
not come back), and the body becomes nonfunctional
(all functions and activities associated with the physi-
cal being cease). The causes of death, ranging from
the deterioration of old age, illness, accidents, and
homicides, to perhaps extreme psychological distress,
are also fairly well known. In contemporary Western
societies, it is rare to find widespread belief that
magic, bad thoughts, or evil spirits are the sources of
death. Finally, a foundation of most Western (and
Eastern) belief systems is that some intangible dimen-
sion of persons—their soul or spirit—continues be-
yond the death of their physical bodies, a concept
known as noncorporeal continuation.
A classic 1948 study by Maria Nagy of almost 400
Hungarian children aged three to ten revealed that
arriving at a mature concept of death requires devel-
opment through three stages. ‘‘Auntie Death,’’ as
Nagy was called, learned through interviews and pic-
tures drawn by the children that between the ages of
three and five years (Stage 1), children believed that
death involved a continuation of life, but at a reduced
level of activity and experiences. The dead do not do
much, their condition resembles sleep, and they can
return to the world of the living. Of greatest concern
to the youngest children was the fear of separation,
not necessarily the fear of dying or being dead. Dur-
ing Stage 2, identified by Nagy as from five to nine
years of age, children progressed to an understand-
ing that death is final and irreversible. Death takes on
concrete imagery and a personality, in the guise of
skeletons, or the ‘‘boogeyman.’’ Such personification
leads to another interesting belief of this period:
Death can be evaded, if you can only outsmart or out-
run that nasty boogeyman! Thus, universality in
death is a concept yet to be achieved. Final, the
achievements of Stage 3 (age nine and older) reflect-
ed the mature components of death.
Although this research was done in the mid-
twentieth century, Nagy’s findings continue to be ap-
plicable. Subsequent research has suggested that chil-
dren arrive at a mature concept of death at an earlier
age than suggested by Nagy, that children do not per-
sonify death to the extent that Nagy found, and that
modern technology has found its way into their
descriptions (death is like a hard drive crash). Fur-
thermore, there is a strong connection between
death concepts and overall cognitive development, so
that children’s understanding of what causes death
changes from magical (‘‘I wished he was dead and
now he is’’), naive (‘‘You die from eating a dirty bug’’),
and moral (‘‘My Daddy died because I was a bad
child’’) to a more scientific, rational approach (‘‘You
die when your body wears out or when you get an in-
curable disease’’). Researchers have also learned that
it is too simplistic to view just age as the determining
factor with regard to death concepts. Children who
have experienced a parent’s death, who are dying
themselves, or who have witnessed violent, traumatic
death will perceive death in an adultlike manner at
much earlier ages than children who have not had
such experiences.Children Who Are Dying
As difficult as it is to acknowledge that children
think about death, it is even harder for adults to con-
ceive of children dying. The significant accomplish-
ments of modern medicine have certainly made this
a relatively rare event. However, there still are many
children and families who must cope with the realities
of terminal illnesses such as cancer, AIDS, or cystic fi-
brosis.
In the 1970s and 1980s Myra Bluebond-Langner
spent countless hours listening to the stories of dying
children and their families. What she learned has of-
fered an important window to the experiences of the
dying child, and those of their healthy siblings. Ac-
cording to Bluebond-Langner, children who are
dying become very sophisticated about the nature of
their illness and hospital procedures. As they enter
repetitive cycles of sickness, treatments, and remis-
sion, and as they observe children with similar illness-
es dying, their self-perceptions gradually change
from ‘‘I am sick but I will get better’’ to ‘‘I am sick and
eventually I will die from this illness.’’ These children
know about death at much earlier ages than do
healthy children. These children also quickly learn
that it causes great pain for their parents and other
adults if they bring up the possibility of their dying.
In their efforts to protect their elders and to ensure
their continued visits and care, many terminally ill
children engage in a game of ‘‘mutual pretense’’
wherein everyone knows they are dying but they are
reluctant to talk about it in an open and meaningful
way.
Bluebond-Langner also found that the well sib-
lings of dying children were in significant need of
care and nurturance. As the demands and psychologi-
cal stress of the illness took its toll on their parents,
the healthy siblings were frequently neglected and liv-
ing in ‘‘a house of chronic sorrow.’’ Furthermore, sib-
lings’ roles in their families were ambivalent and
undefined. ‘‘Should I parent my parents?’’; ‘‘Should
I take the place of my dead brother (sister)?’’; ‘‘Why
do I feel both happy and sad that she died?’’; ‘‘Should
I just disappear?’’—these were some of the concerns
of the siblings.
The knowledge gained from these trying circum-
stances is important. Children who are dying need114 DEATH