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Bright Futures

Articles and Updates from Phoenix Children's

April 15, 2020, Sahli, Amanda ,
Preparing Children for COVID-19-Related Grief


COVID-19 Guidance

The past few weeks have been a whirlwind of information and change. As adults, we are feeling anxious, confused and overwhelmed. Children are feeling these things, too. Even if you are limiting your child’s exposure to TV and social media, COVID-19 is still the topic of conversation in most households. While we may just be starting to feel the impact of this virus on our day-to-day lives, experts are saying that it’s going to get worse before it gets better: More and more people will know someone impacted by coronavirus. People you know will become infected and some may die. Being prepared to discuss these issues with your children is better than trying to figure out how to do so in the confusion of those moments.

How they might react to COVID-19 and red flags to watch for by age level (Source SAMHSA):

0-5 years old –

  • Regression in developmental milestones
  • More clingy
  • May talk about the virus during their play; make up exaggerated stories about it
  • Eating and sleeping habits may change
  • Unexplained aches and pains
  • Things to watch for:
    • Crying for no reason
    • Aggressive behavior
    • Withdrawing from their normal “safe people”
    • Not playing with toys

6-10 years old –

  • May have fears about going out in public
  • Regression in developmental milestones
  • Things to watch for:
    • They stop having interest in normal activities
    • Feelings of guilt for being “unaffected” (10yo and older)
    • Aggression

11-19 years old –

  • Have more difficulty coping due to physical and emotional changes that are occurring naturally within their developmental stage
  • Heightened anxiety
  • Things to watch for:
    • Denial of feelings/reaction
    • Start arguments at home or school
    • Resist authority
    • Engaging in risky behaviors; drugs, alcohol, etc.

Talking with your child about the virus at an age appropriate level (Source: SAMHSA):

0-5 years old –

  • Get down to their level when talking with them. Use a gentle voice and words that they can understand; do not describe the virus as a cold or the flu. We are still in cold and flu season and if they or someone they know contract a cold or the flu, they will associate the response surrounding COVID-19 to their situation and cause unnecessary stress.
  • Tell them that you take care of them and will continue to do so; give them tangible examples such as hand washing, cleaning the house, limiting exposure to other people.
  • Keep routines as normal as possible; meals at regular times, normal bedtime, etc.

6-19 years old –

  • Ask what worries them and what might help them cope.
  • Offer comfort with gentle words or just being present.
  • Spend more time with them than usual
  • Encourage children to have quiet time to express their feeling through writing or art

Talking with your children about death, how they might react, and how you can support them (Source: New Song Center for Grieving Children):

Infants and Toddlers:

  • Experience:
    • Death is understood as “all gone.” Recognize separation and change in the emotional atmosphere
  • Behavior:
    • Irritability, excessive crying and clinging behavior. Changes in sleeping and eating patterns.
  • Needs:
    • Stability, security, touch, play. Routine is a protective force for young children amid major disruptions.


  • Experience:
    • Death is considered reversible and temporary. Very concrete and literal thinkers.
  • Behavior:
    • Repeat questions and stories again and again. Magical thinking starts to develop. Temporary regression (baby talk or thumb sucking).
  • Needs:
    • Maintain regular schedules. Simple clear language about death. Avoid euphemisms (They went to heaven, they went to sleep, etc.) It’s important to use the words death and died.

Early School Age:

  • Experience:
    • Begin to understand the permanency of death. Still do not understand universal or causal concepts. View death as a visual form. i.e.: boogeyman, monsters, and angels. Physical symptoms like stomach aches ore headaches.
  • Behavior:
    • Death anxiety can be high. Feelings of guilt may begin. Difficulty in concentrating. Problems sleeping and intrusive thoughts are common.
  • Needs:
    • Truthful and honest explanations. Ask what they understand. Take extra time to clear up misunderstandings.

Middle School Age:

  • Experience:
    • Begin to appreciate abstract nature of death and concept of spiritual continuation. Understand death’s physical manifestation. Interested in biological facts, pain and suffering.
  • Behavior:
    • Anger and acting out may arise or they may withdraw and internalize.
  • Needs:
    • Adult-like explanations and honesty are expected. They need outlets for physical, emotional and behavioral expressions.


  • Experience:
    • Have full understanding of death concept and may be resistant to expressing any emotions. May struggle to find meaning.
  • Behavior:
    • Will move between defying death and fantasizing about death. May engage in negative behaviors like alcohol, sex, cutting, or social withdrawal to deny or lessen their pain.
  • Needs:
    • Peers and peer support become more important. Adults should provide a balance between empathetic understanding and continued structure in their environment. Encourage expression of grief in healthy ways.

Young Adults:

  • Experience:
    • Often forgotten mourners. Feelings of isolation may be great.
  • Behavior:
    • Striving for independence and identity development. Who am I and who do I want to be? Am I living the life I want for myself?
  • Needs:
    • Expressive arts and grief work with this age focus on relationships, identity, and their emotions.

Primary needs for children experiencing grief (source: New Song Center for Grieving Children):

  • Truth:
    • Honest, developmentally sensitive information.
    • Children need to understand what happened.
    • Fears grow when children are left in the dark.
    • Balance between desire to protect the children and their need for truthful and accurate information.
  • Support in identifying and expressing emotions:
    • Children often have a difficult time verbally expressing what is happening internally.
    • Anxiety and fears addressed openly and honestly.
    • Often where there is a complex language of emotions
      • Withdrawal, Acting Out, Being Overly Good
  • Acknowledge the loss.
  • Appropriately memorialize the loved one.
    • When planning funerals give children the opportunity to add ideas and participate at their comfort level
  • Remain a child
    • Sustaining and unrelenting connection with grief is potentially harmful. Child will need diversions from the intensity.
  • Experience Security & Safety
  • Be an Active Family Member

Red Flags:

  • Persistent:
    • Inability to talk about the death
    • Aggressive behavior resulting in harm and/or property damage
  • Prolonged:
    • Physical complaints
    • Eating and sleeping disorders
  • Dramatic social withdrawal
  • Depression
  • Evidence of school and academic difficulties
  • Suicidal ideation and/or attempts
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