Core Concepts for Grief-Sensitive Care
Children's Grief
Children’s grief is often misunderstood, which can lead to misconceptions that interfere with effective support. Rather than expressing grief primarily through words, children often communicate distress through behavior, play, questions, or physical symptoms.
They may move in and out of grief quickly, showing sadness or anger in one moment and appearing engaged or playful in the next.
Adults may observe these behaviors and assume a child is unaffected by the loss, when in reality the child may be grieving in ways that are natural and developmentally appropriate. Overestimating a child or teen’s resilience, or interpreting behavior as a sign that grief is absent, can result in missed opportunities to provide guidance, reassurance, and comfort.
Grief-sensitive care involves recognizing how children express grief, offering clear and age-appropriate information, and providing consistent reassurance, presence, and opportunities for expression.
Children's grief is not mini-adult grief.
How Development Shapes Children’s Grief
Understanding common developmental stages can offer a helpful framework for recognizing how grief may be experienced and expressed at different ages. While each child is unique, these stages can provide general guidance about a child’s developing concept of death and the ways grief may show up behaviorally, emotionally, or physically.
Recognizing Grief Beneath Behavior
When adults are unfamiliar with how grief may show up in children and teens, normal responses to loss can be misinterpreted as behavior problems, neurodevelopmental differences such as ADHD, or learning challenges. These misunderstandings can have lasting effects.
Grief Responses That May Be Misinterpreted
After a loss, some children and teens may show irritability, impulsivity, hyperactivity, forgetfulness, emotional outbursts, regression, risk-taking, or increased reliance on numbing behaviors such as excessive screen use.
While these behaviors can have many contributing factors, noticeable changes that are atypical for a child or teen may reflect grief rather than intentional misbehavior.
Grief-related responses may be viewed as defiance or dysfunction, particularly for youth with marginalized identities, including children who are Black, Indigenous, or people of color, and those who identify as LGBTQ+.
This can place them at risk for suffocated grief, a term identified by Tashel Bordere, which refers to grief that is punished, silenced, or pathologized rather than supported.
Scenario: During a wellness visit, a parent shares concerns that their child has been getting in trouble at school since the recent death of the child’s grandfather. Teachers report increased irritability, distraction, or acting out.
Grief-sensitive language you may use: "You mentioned that your child’s grandfather, whom they were close to, died earlier this year. Many children express grief through behavior rather than words. Do you think that loss could be playing a role in what you’re hearing from the school?”
Viewing these behaviors through a grief-sensitive lens can help shift from judgment and punishment to understanding what the child or teen may be experiencing, supporting more compassionate and appropriate responses. Learning to recognize the nuances of children’s grief is crucial to providing effective support and fostering healthy coping mechanisms.
Secondary Losses and Children
Secondary losses are the ripple effects that follow a primary loss. These may include shifts in identity, or changes in community, routine, traditions, or faith. For children and teens, a death, diagnosis, or other significant loss can disrupt daily routines, sense of stability, and emerging identity.
Financial changes may result in different living arrangements, new neighborhoods or schools, separation from friend groups, or reduced access to activities and hobbies. These layered changes can compound grief and intensify distress beyond the initial loss itself.
“Who will make me breakfast now?”
“Does this mean I can’t play catch anymore?”
“Who will do the bedtime routine like my mom?”
Children often experience grief through disruptions to daily life rather than abstract ideas about death. Because young children rely on caregivers for safety and predictability, secondary losses may be felt as concerns about routines, care, and who will meet their needs. Children may ask about everyday activities, such as who will help them get ready in the morning, continue bedtime routines, or take them to soccer practice. These questions are not signs that a child is unaffected by the loss. They reflect a developmentally appropriate way of seeking safety, reassurance, and continuity.
Stability and Routine as Medicine
For healthcare professionals, supportive responses are concrete, honest, and focused on stability.
Grief-sensitive language you may use with parents or caregivers:
- “Children often focus on very practical questions after a loss. That’s one way they seek reassurance and stability.”
- “These questions don’t mean your child isn’t grieving. Focusing on day-to-day routines is a common and healthy way for children to make sense of change.”
Grief-sensitive language you may use with children:
- It makes sense to wonder about that. A lot has changed, and it’s okay to ask questions.
- “There are adults working together to make sure you’re cared for, even if some things look different right now.”
These conversations often unfold over time. Encouraging caregivers to keep communication open and revisit questions as they arise, while validating for children that it is okay to wonder about these concerns, can help support a child’s sense of safety and trust as they adapt to the loss.
Sudden Temporary Upsurges of Grief (STUGs)
A loss does not need to be recent to affect a child or teen. Grief often resurfaces as children reach new developmental stages, gain a deeper understanding of death, or encounter milestone moments such as birthdays or graduations. Therese Rando introduced the term Sudden Temporary Upsurges of Grief (STUGs) to describe brief, intense waves of grief that can be activated by environmental reminders, ranging from something fleeting, like a smell or a song, to situational cues, such as a school event focused on parents or caregivers.
These responses may appear emotionally or behaviorally and typically do not indicate dysfunction. They reflect the ongoing presence of a meaningful loss and the ways grief can be reactivated as life unfolds.
Grief-Sensitive Care for Children
Children’s grief is ongoing, developmental, and shaped by relationships, routines, and life transitions. Grief-sensitive care recognizes that children may revisit loss repeatedly as they grow, ask practical questions to feel safe, and express distress through behavior rather than words. When adults respond with curiosity, honesty, and stability, children are more likely to feel supported as they adapt and build healthy coping over time.