Preschool Children’s Emotional Understanding of Death: A Forgotten Dimension

Introduction: Scientific evidence regarding children’s understanding of the concept of death is scarce. This has recently been pointed out by the International Children’s Palliative Care Network as a priority area of research. In particular, the avoidance of emotion in this area of research is an important shortcoming. This study aims to develop an in-depth view of the emotional dimension of the child’s understanding of death, also seeking to relate it to the cognitive dimension. Material and Methods: We interviewed children (three to six years old) using a book illustrating a hypothetical scenario in which a child faced the death of a relative. We asked questions to assess the cognitive subconcepts of death and the emotional dimension (what the child would feel and what parents should say). Results: Of the 54 participants, the majority said that the child would feel sad (n = 46, 85%) and that parents should inform her/him (n = 47, 87%); these responses did not vary significantly with age. The cognitive understanding of the concept of death in children who reported sadness was significantly higher. Discussion: Even the youngest children feel death, and it is not possible to disconnect cognitive and emotional understanding. Additionally, children should be informed in order to foster a proper and multidimensional elaboration of death. Conclusion: This study provides valuable information to health professionals and other interested adults about the way preschoolers position themselves in relation to death.