One of the most stressful life events faced by children is the death of a loved family member or their own impending death from a life-threatening illness. Death is not an uncommon problem for young children and their families. Approximately 4% of children in the United States lose a parent through death before they reach age 18, and 1.5 million children live in single-parent families because of death (U.S. Bureau of the Census, 1993). Furthermore, as survival rates for children with life-threatening illnesses improve, many young children must deal with the possibility of their own deaths, and at the same time must live with tremendous uncertainty as they undergo stressful medical treatment for their illnesses.
Understandably, parents (and many professionals) have great difficulty knowing what to say to children about death, how to help them deal with the aftermath of a death in the family, or how to help them cope with life-threatening illnesses. Efforts to help children deal with death have been influenced by the widely held assumption that children cannot fully understand the concept of death, and that even if they do, it would be harmful for them to be exposed to information about death (Kastenbaum & Costa, 1977). Consequently, many professionals and parents have felt it best to shield young children from the experience of death. Children often are not told how or why a person died, are not allowed to participate in family rituals surrounding the death, and are encouraged to deny the finality of death. Even terminally ill children have faced their own deaths without help. Koocher and Gudas (1992) rightly state that the assumption of childhood naiveté regarding death probably reflects the discomfort adults have with death, rather than the reality of children's ability to understand and cope with death.
Despite parents' efforts to shield them, children are routinely confronted with death in their day-to-day lives—through death of a pet, television programs in which people die (often quite violently), dead animals by the roadside, and/or stories and fairy tales. As a consequence, all children think about death, and concerns and questions about death are a normal part of growing up. It is important for clinicians to be aware of the empirical literature in this area, so that they are prepared to help children and parents cope with death should the occasion arise. This chapter first reviews the literature in the following areas: (1) what children understand about the concept of death; (2) how they cope with and adjust to the death of a family member; and (3) how terminally ill children cope with their own illness and possible death. Suggestions for assessment and intervention strategies are then provided.