Each child grieves the death of a significant person in his or her own way. Reactions can vary according to age, ability to understand death, and personality, and children in the same family may react differently. Any death can be difficult for a child, and a wide range of emotional and behavioral responses are common including changes in sleeping pattern or appetite; sad, angry, or anxious feelings; social isolation; persistent thoughts about the death; or feeling the person's presence nearby. Children’s difficulties with grief vary according to a child’s age, developmental level, previous life experiences, emotional health before the death, and family and social environment.

Some children develop traumatic grief responses, making it harder for them to

• Remember or enjoy positive memories of the deceased person
• Cope with the many changes that occur as a result of the death, and
• Continue with normal development.

Any thoughts of the person—even happy ones—can lead to upsetting images or memories of the way that person died. These images may occur repeatedly in the child’s mind and—because they are so upsetting—the child may avoid thinking or talking about the person or even going places or doing things associated with the person or the death. Traumatic reactions may exacerbate existing mental health issues, disrupt learning, and be misinterpreted by parents, teachers, and others.

Difficulties specific to childhood traumatic grief that may occur across developmental stages include the following:

• Intrusive memories about the death. These can appear through nightmares, guilt, or self-blame about how the person died, or recurrent or intrusive thoughts about the horrifying manner of death.
• Avoidance and numbing. These can be expressed by withdrawal, the child acting as if not upset, or the child avoiding reminders of the person, the way she or he died, or the event that led to the death.
• Physical or emotional symptoms of increased arousal. These can include irritability, anger, trouble sleeping, decreased concentration, drop in grades, stomachaches, headaches, increased vigilance, and fears about safety for oneself or others.

In childhood traumatic grief, the interaction between trauma and grief symptoms is such that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, or memories of how the person died.

Three types of reminders may trigger distress in children experiencing childhood traumatic grief:

• Trauma reminders: places, situations, people, sights, smells, or sounds reminiscent of the death. These may include the street corner where a fatal accident occurred, the bedroom where a parent died, or the sound of an airplane reminding a child of a mother who died in a crash.
• Loss reminders: people, places, objects, situations, thoughts, or memories that are reminders of the person who died—for example, photo albums or a new coach who has replaced a parent who previously headed a child’s sports team.
• Change reminders: situations, people, places, or things reminding the child of changes in his or her life resulting from the death—for example, moving to a new house or having to walk home with a babysitter rather than with an older sibling who died.