Talking to kids about death amidst the fantasy of Halloween

"It's often difficult for children to grasp abstract concepts and the finality of death can be hard for a preschool and middle-school child to understand, especially around Halloween when death may be perceived as a means for 'fun' or just a trick," said Theodote K. Pontikes, MD, pediatric psychiatrist at Loyola University Health System and assistant professor in the departments of Psychiatry and Behavioral Neurosciences and Pediatrics at Loyola University Chicago Stritch School of Medicine.

According to Pontikes, Halloween isn't the only way our culture sends mixed messages to our kids. For instance, video games characters typically have more lives after defeat or self-destruction. Immortality is often a characteristic of superheroes in cartoons and movies as well.

"Children go through developmental stages in which their understanding of death evolves. To a preschool child, for example, death can seemed fantasized, impersonal and reversible. This can be confusing at a young age when trying to understand why a deceased loved one won't be visiting anymore," Pontikes said.

"Children typically truly understand that death is irreversible, with a personal dimension, sometime between the middle-school years and adolescence. During this time, children and teens often also reflect on their family's faith tradition for guidance regarding a framework or philosophy for the meaning of life and rituals for honoring and memorializing the deceased," she said.

When talking to kids about death and grief, Pontikes suggests trying to approach them at their level of comprehension, as children develop at different rates and have unique ways of expressing themselves. For preschoolers or young school-age children, explanations need to be brief, simple and concrete, with familiar examples such as a flower that no longer blooms or a pet that no longer breathes or eats or runs.

"Children may not immediately respond or react and often need to repeat their questions, as they learn, absorb and process information and their emotional responses. It's critical for children to know that death is not a taboo subject that is avoided; but one that is 'talk-about-able.' It's okay for parents to let children know that they may not know an answer to a question or that there are many different viewpoints held by people regarding cultural and religious beliefs, such as those pertaining to an afterlife."

She also said it's important for parents and caregivers to be open and honest about their own grief.

"Children are very perceptive. They know if an adult is keeping something from them and it can make them feel unsafe. They may even feel they have done something wrong or that this pain is their fault. Balance is so important when it comes to talking to kids about grief. We have to create an environment where they feel free to ask questions and express their fears, but also assess what they can safely comprehend and process," Pontikes said.

She also stresses the importance of children understanding that not all illnesses lead to death, so a child is not scared if a parent gets a cold or a friend is out of school with a stomach bug.

Also, parents should watch for signs that a child might be distressed. If so it's important to talk to a pediatrician about a referral to a pediatric psychiatry expert for an evaluation, especially if a child's normal routine has not resumed six months after the death of a significant attachment figure. These include:

• Regression in activities of daily living (e.g, bedwetting)

• Difficulty separating from parents

• Trouble sleeping (e.g., nightmares)

• Guilt

• Anger

• Irritability

• Withdrawing

• Depression

• Physical aggression

"Death is a natural part of the life cycle and a topic that shouldn't be avoided. It's extremely important that children and adolescents feel safe and that they can ask questions. Parents need to make sure they are communicating with their children about death in a way the child can understand. Opportunities from daily circumstances and surroundings can and should be taken to begin a meaningful dialogue," Pontikes said.