Veterinary medicine is increasingly recognizing the importance of the human-animal bond and communication skills. When dealing with both acute/emergency and terminally ill patients, the veterinary team is often called upon to provide bereavement counseling services to the client. Death and grief are often taboo topics in American culture, and understanding the needs and beliefs of distinct client populations will aid the veterinary team’s bereavement work.
Grief in children is a developmental process often poorly understood by adults.
From birth to age two to three years:
Children generally do not understand the concepts of “death” or “forever.” They recognize separation and absence, but usually expect a return of the deceased.
From about two to four years of age:
Children start to develop a concept of death, but they often see death as reversible. At this age the grief response is often intense, with brief duration. Children depend on the reassurance of patterns and routines. They may ask questions repeatedly and often use play as a mechanism of grief work, which can be misinterpreted by adults as inappropriate.
Around four to seven years of age:
Children develop a feeling of responsibility for death and other negative situations in their lives and believe their internal wishes and thoughts control the world. This is a time of “magical belief” and egocentricism. A child may think they have “super powers” and should have been able to stop the death or otherwise control the situation. Death may still be seen as reversible, and at this age children use more verbalization and more play. Some children may act as though nothing has happened, while many have great concern about processes and routines and ask for more details.
Around age seven to 11:
The finality of death is recognized. Death is often seen as punishment, and the child may still feel responsible. At this age the child’s response may appear morbid to adults, as s/he may ask specific questions and request graphic details. Children at this age are starting to have ability to mourn (express grief socially) and may ask for guidance from adults on how to act.
Teenage years (11 to 18):
Children begin to conceptualize death and may integrate experiences into their own identities. Intellectual understanding develops before emotional acceptance, and therefore the grief response may appear very severe, with extreme sadness, denial, regression, and risk-taking behaviors. At this age children often seek peer support vs. adult support.
To help children cope with pet loss, it is important for the veterinary team (and family members) to use positive language that frames death as a natural occurrence. Coach adult family members to let the child see adults grieve and be involved in the dying process and decisions as appropriate for age. Talk openly and directly about the pet that died and do not use euphemisms or confusing terms. Make it clear that you are there to listen and reassure children that they weren’t responsible for the pet’s death. Encourage sharing of stories and suggest ways to help children symbolize and represent the death. Provide resources such as recommendations for books or online resources designed for children about pet loss. Coach the family on things to avoid, such as getting the child a “replacement pet” immediately, trying to “shelter” the child from death, or trying to cheer up the child, all of which diminish the child’s emotional situation.
Remember that positive grieving during pet loss can help children better deal with future personal and family losses.
—Dr. Jackie Wypij, DACVIM (Oncology)