Table 2. Grief and Developmental Stages
| Age | Understanding of Death | Expressions of Grief |
| Infancy to 2 years | Is not yet able to understand death. | Quietness, crankiness, decreased activity, poor sleep, and weight loss. |
| Separation from mother causes changes. | ||
| 2–6 years | Death is like sleeping. | Asks many questions (How does she go to the bathroom? How does she eat?). |
| Problems in eating, sleeping, and bladder and bowel control. | ||
| Fear of abandonment. | ||
| Tantrums. | ||
| Dead person continues to live and function in some ways. | Magical thinking (Did I think something or do something that caused the death? Like when I said I hate you and I wish you would die?). | |
| Death is temporary, not final. | ||
| Dead person can come back to life. | ||
| 6–9 years | Death is thought of as a person or spirit (skeleton, ghost, bogeyman). | Curious about death. |
| Asks specific questions. | ||
| May have exaggerated fears about school. | ||
| Death is final and frightening. | May have aggressive behaviors (especially boys). | |
| Some concerns about imaginary illnesses. | ||
| Death happens to others; it will not happen to ME. | May feel abandoned. | |
| 9 and older | Everyone will die. | Heightened emotions, guilt, anger, shame. |
| Increased anxiety over own death. | ||
| Mood swings. | ||
| Death is final and cannot be changed. | Fear of rejection; not wanting to be different from peers. | |
| Even I will die. | Changes in eating habits. | |
| Sleeping problems. | ||
| Regressive behaviors (loss of interest in outside activities). | ||
| Impulsive behaviors. | ||
| Feels guilty about being alive (especially related to death of a brother, sister, or peer). |
