Most kids experience bereavement—yet symptoms often go unrecognised

As a society, we typically equate bereavement with adulthood, but children are affected way more often than you might think. Sixty per cent of kids will lose a loved one by the age of 10, while 50% will experience parental separation or divorce—so grieving kids are very likely to show up in general practice, explains Professor Sarah Egan, a clinical psychologist from Curtin University who is involved in designing and evaluating online programs to support young people experiencing grief.

Common sources of childhood grief

Six in ten young children will experience the death of someone close to them, such as a parent, sibling or grandparent, Professor Egan says, noting the death of a pet can also be very distressing given kids often form close bonds with them.

“For children, grief also extends very much to parental separation and divorce,” she adds, “and we know one in two kids will be affected.”

Despite this, children are often overlooked in discussions of grief. “As a society, we don’t do grief well,” Egan notes. “And that includes health professionals. Even psychologists, we don’t tend to routinely ask about it.”

Key signs of grief in children

Childhood grief typically presents similarly to many other mental health problems, Professor Egan says. Look out for:

• Physical symptoms such as unexplained stomach aches
• School refusal and separation anxiety
• Low mood or anxiety
• Withdrawal or loss of interest in enjoyable activities.

In children with these symptoms, she advises gently asking if they’ve had a recent loss.

What to say—and what not to say

It’s very important to normalise a grieving child’s experience, Professor Egan says.

“A lot of kids feel a bit abnormal or that no other kids go through grief. And they’re actually surprised when they realise the rates are so high.”

Reassure them that grief is different for everyone and it’s normal to experience various feelings.

“For example, it’s quite common to feel like it’s not real, that it hasn’t really happened, or even to feel some relief,” Professor Egan says. “For example, if someone’s died and they’ve been through a lot of pain, children can feel relieved that they’ve passed away—and they can feel guilty about that.”

Children often blame themselves for parental separation or divorce, she adds, and it’s important to explain that it’s not their fault.

Avoid framing grief using outdated models like the ‘five stages,’ Egan stresses, noting language matters, too. “Don’t use terms like moving on. Talk about moving forward with their life.”

Practical tips for GPs

Professor Egan suggests the following for dealing with childhood grief in GP:

• Encourage children to stay socially engaged e.g. by taking part in their usual activities and social events.
• Promote healthy behaviours, such as time outdoors and not too much screen time.
• Watch for negative thinking, such as thinking a divorce is their fault.
• Take a gradual approach towards any avoidance behaviours, such as refusing to talk about or look at photos of a loved one who has died.

When to refer

Professor Egan suggests referring children on if grief is significantly interfering with their daily life—if they’re missing school, or have a significant problem with mood, for example.

The free online programs she and her team have developed are an accessible first step.

For children aged 6 to 12, GPs can recommend Project SKIL (Supporting Kids In Loss), which children can complete with support from a parent or carer. This program is currently being evaluated.

For adolescents, Project SAIL (Supporting Adolescents in Loss) was co-designed with young people and can be completed independently. Research currently undergoing peer review showed adolescents who took part in the intervention experienced improved wellbeing compared to controls, and a significant reduction in anxiety, depression and post-traumatic stress symptoms at four-week follow up.

Both programs are based on CBT, which research shows is effective for reducing anxiety and depression symptoms in young people who are grieving.

Children who need more intensive help can be referred to a clinical psychologist, ideally one who focuses on grief, Professor Egan says.

Key takeaways:

• Childhood grief can present as unexplained stomach aches, low mood, school refusal, separation anxiety, withdrawal and loss of interest in enjoyable activities.
• Let kids know grief is common and that different feelings are normal.
• Avoid ‘five stages’ framing and language about ‘moving on’.
• Encourage social engagement and healthy behaviours and watch for negative thinking or avoidance.
• Consider referral if grief significantly interferes with a child’s everyday life.
• You can encourage them to try the free online programs or refer for face-to-face CBT if needed.