Understanding Complicated Grief in Children
When grief becomes prolonged, intense, or traumatic - and what professional support looks like
Most bereaved children grieve intensely for a period of time, then gradually adapt to life after loss. They carry the person with them, but the pain becomes less consuming. Daily life returns to some version of normal.
But for some children, grief does not ease. Months pass, sometimes years, and the pain remains as sharp as it was on day one. These children are experiencing what we call complicated grief - also known as prolonged grief disorder or traumatic grief.
This is not "failing" at grief. It is not weakness or attention seeking. It is a recognised clinical presentation that requires specific support.
If you work with bereaved children, understanding complicated grief helps you recognise when a child needs more than pastoral care. When listening is not enough. When specialist intervention is essential.
This guide explains what complicated grief looks like in children, what makes it more likely, and when to refer for professional support.
What is complicated grief?
Grief is a natural response to loss. It is not an illness. For most people, including most children, grief follows a broad pattern:
Acute grief - intense pain, disbelief, searching behaviours, difficulty concentrating
Integration - gradually resuming routines, finding ways to live with the loss
Adaptation - the person is still missed, but life has meaning again
This process does not follow a timeline. It is not linear. And it is never truly complete. But over time, most bereaved people find a way forward.
Complicated grief is when this process gets stuck.
Instead of gradually easing, the intensity remains unchanged. Instead of resuming life, the child becomes trapped in acute mourning. Grief becomes the defining feature of their existence.
In adults, complicated grief is formally diagnosed when intense grief persists for more than 12 months after a death. In children, timelines are less clear because developmental stage affects how grief is expressed. A six year old's grief looks different from a fifteen year old's.
But regardless of age, complicated grief in childhood shares common features:
Intensity that does not lessen over time
Inability to resume normal activities months after the loss
Preoccupation with the deceased that dominates thoughts
Avoidance that prevents engagement with life
A sense of being frozen in the moment of loss
If you want the wider context of how children grieve normally, read:
How children grieve at different developmental stages
How complicated grief differs from normal grief in children
All grief is hard. All bereaved children struggle. So how do you distinguish typical grief from complicated grief?
Timeframe
Normal grief: Acute pain is most intense in the first 3-6 months, then begins to ease. The child may still have difficult days, but overall there is movement forward.
Complicated grief: Six months, twelve months, eighteen months pass and the intensity remains unchanged. There is no forward movement. The child is as consumed by grief as they were in the beginning.
Daily functioning
Normal grief: After an initial period of disruption, the child gradually returns to school, friendships, activities. They may not have their full energy or focus, but they are engaging with life.
Complicated grief: The child cannot resume normal routines. School refusal persists. Social withdrawal continues. Months later, they are still unable to function.
Thoughts about the deceased
Normal grief: The child thinks about the person often. They miss them. But thoughts are not all consuming. There are moments of peace.
Complicated grief: Every thought returns to the loss. The child cannot focus on anything else. Homework, conversation, play - everything is interrupted by intrusive thoughts about the death.
Emotional range
Normal grief: Sadness comes in waves. There are moments of laughter, connection, joy alongside the pain. Emotions shift.
Complicated grief: The child is locked in one emotional state - often intense sadness, anger, or numbness. There is no variation. No lightness. No relief.
Sense of the future
Normal grief: The child can imagine life continuing, even if different. They can think about next year, growing up, things they might want to do.
Complicated grief: The future feels impossible. The child cannot imagine life beyond this moment. Everything feels pointless without the person they lost.
What complicated grief looks like in children
Complicated grief can present in multiple ways. These patterns often overlap.
Intense yearning and preoccupation
The child is consumed by longing for the person who died. They talk about them constantly. Every activity, every thought, every conversation circles back to the loss.
This is not the occasional mention or fond memory. This is all consuming focus that prevents engagement with anything else.
Examples:
Twelve months after Mum's death, Emma still spends every evening in her mother's room, going through her belongings, unable to engage with homework or family
Two years after his brother died, Jake talks about him in every conversation and becomes distressed if others do not want to discuss the death repeatedly
Persistent avoidance
The child avoids anything connected to the death - places, people, conversations, memories. They refuse to talk about the person, look at photos, or engage with anything that might trigger emotion.
This goes beyond natural protective avoidance in early grief. It becomes rigid, limiting, and prevents healing.
Examples:
Eighteen months after Dad's funeral, Lily refuses to visit his grave, look at photos, or allow anyone in the family to mention his name
After Grandma's death, Tom avoids the entire street where she lived, which means he cannot see his best friend who lives nearby
Inability to accept the death
The child intellectually knows the person is dead but emotionally cannot accept it. They wait for them to return. They set places at the table. They talk as if the person is still alive.
In very young children, this can be a normal part of early grief as they develop understanding of permanence. But if it persists beyond developmental expectations, it signals complicated grief.
Examples:
Ten year old Sarah still leaves notes for her mother a year after her death and becomes distraught when they are not answered
Fourteen year old Marcus refuses to accept his father died and insists he is "away" or "missing"
Intense anger or bitterness
Anger is a normal grief response. But in complicated grief, rage becomes all consuming. The child is hostile toward everyone. They blame others for the death - doctors, family members, God. Nothing soothes the fury.
For more on anger as a grief response, see:
Why angry children are often grieving children
Severe emotional numbness
The opposite extreme - the child feels nothing. No sadness, no anger, no connection. They describe feeling hollow, empty, like a shell. This is not quiet grieving. It is dissociation from overwhelming emotion.
Examples:
Months after her sister's death, Mia describes feeling "like I am not here" and "like nothing is real"
After his father's death, Nathan stops crying, stops talking about feelings, and moves through days mechanically with flat affect
Disrupted sense of identity
The death has shattered who the child believed they were. They cannot imagine themselves without the person. Their entire identity was built around that relationship.
This is particularly common when a parent or sibling dies.
Examples:
After losing her twin, Chloe says "I do not know who I am without her" and struggles with basic decisions
After his mother's death, Aiden repeatedly says "I am nothing now" and cannot engage with school or friends
Intrusive distressing thoughts about the death
The child is haunted by images of the death, particularly if traumatic. They see the scene repeatedly. They cannot stop thinking about how the person died. The thoughts are intrusive, unwanted, and overwhelming.
This overlaps with post traumatic stress and often requires trauma focused intervention.
Examples:
Six months after witnessing her father's sudden death, Sophie has nightmares every night and cannot stop replaying the scene in her mind
After his brother's car accident, Ryan is consumed by thoughts of what his brother experienced in his final moments
What increases the risk of complicated grief in children?
Not every bereaved child develops complicated grief. Certain factors increase vulnerability.
Nature of the death
Sudden or traumatic death significantly increases risk. When a child has no chance to prepare, when death is violent or witnessed, when circumstances are shocking, complicated grief is more likely.
Examples: car accidents, suicide, murder, medical emergencies
Ambiguous or stigmatised deaths also create complications. When the circumstances are unclear, shameful, or socially unacceptable, children struggle to process the loss.
Examples: suicide, overdose, deaths surrounded by secrecy
Relationship to the deceased
Parent or primary caregiver deaths carry the highest risk. The child has lost not just a person but their source of safety and identity.
Sibling deaths can be profoundly destabilising, especially for twins or children very close in age.
Death of someone with whom the relationship was conflicted creates complicated grief because unresolved feelings have no outlet.
Lack of support
Children who grieve alone are more vulnerable. This includes:
Surviving parent who is overwhelmed by their own grief and unable to support the child
Family that does not talk about the death or suppresses emotion
Lack of extended family or community support
School environment that does not recognise or accommodate grief
Pre existing vulnerability
Children already struggling are at higher risk:
Previous trauma or loss
Mental health difficulties before the death
Neurodevelopmental conditions that affect emotional regulation
Attachment difficulties or history of instability
Developmental stage
Very young children (under 5) and adolescents are particularly vulnerable, though for different reasons.
Young children have limited capacity to understand death and fewer emotional regulation skills. They are entirely dependent on adults to help them make sense of loss.
Adolescents are already navigating identity formation. Grief during this stage can derail development and create lasting complications.
For age specific grief responses, see:
How children grieve at different ages
When to refer for specialist support
Most grief does not require therapy. Most bereaved children need understanding, safety, and time - not clinical intervention.
But complicated grief is different. These children need professional support beyond what schools, families, or pastoral care can provide.
Clear indicators for referral
Refer immediately if:
The child expresses suicidal thoughts or engages in self harm
There are signs of severe depression - persistent hopelessness, inability to experience any positive emotion, significant weight loss
The child is experiencing intrusive trauma symptoms - flashbacks, nightmares, hypervigilance
Daily functioning has not improved after 6-12 months
The child is engaging in risky or destructive behaviour
There is complete withdrawal from all relationships and activities
The family system is unable to support the child
Consider referral if:
Intense grief symptoms persist beyond what is developmentally expected
The child is stuck in one grief response (anger, avoidance, yearning) with no movement
School attendance or academic functioning has collapsed and is not improving
There are significant behavioural changes that are worsening over time
The child has additional trauma or complex needs
What specialist support looks like
Complicated grief in children typically requires:
Trauma focused cognitive behavioural therapy (TF-CBT) if the death was traumatic
Grief focused interventions such as complicated grief treatment adapted for children
Family therapy to address the wider system and help surviving caregivers support the child
Psychiatric assessment if there are concerns about depression, PTSD, or other mental health complications
Consistent therapeutic relationship over time - complicated grief does not resolve quickly
What schools and families can do
Even when specialist support is in place, the child still needs understanding and accommodation in daily life.
For schools
Recognise that time passing does not equal healing. A child who is still struggling a year after a death is not being dramatic. They are experiencing complicated grief.
Adapt expectations without lowering standards permanently. The child needs temporary flexibility, not pity or reduced challenge forever.
Maintain connection even when the child withdraws. Keep reaching out. Let them know they matter even if they cannot engage fully.
Communicate with families and professionals. Be part of the support network, not an isolated system.
Do not punish grief responses. Anger, school refusal, withdrawal - these are symptoms, not discipline issues.
For more on schools supporting bereaved children:
Creating grief informed classroom environments
For families
Trust your instincts. If you feel your child is not coping, if the grief feels different from what you expected, seek support. You know your child.
Do not wait for it to pass. Complicated grief entrenches over time. Early intervention is more effective.
Accept that you cannot fix this alone. This is not a failure of parenting. Some grief is too complex for love and patience alone.
Look after your own grief. You cannot support your child if you are drowning. Seek your own support.
Maintain routine and structure. Even when everything feels broken, predictability helps.
Case example: Recognising complicated grief
Fifteen year old Daniel's father died suddenly when Daniel was thirteen. In the immediate aftermath, everyone said he was coping remarkably well. He returned to school after two weeks. He did not cry much. He seemed strong.
Two years later, Daniel was barely attending school. He had withdrawn from all friendships. He spent hours alone in his room going through his father's belongings. He could not talk about anything except his dad. He described feeling like life stopped the day his father died.
His mother assumed this was normal grief. Teachers assumed it was adolescent moodiness. No one recognised complicated grief because Daniel had not shown obvious distress early on.
Finally, a new school counsellor recognised the pattern. Daniel was stuck. He needed specialist support.
With trauma focused therapy and family work, Daniel slowly began to move forward. It took time. But two years of being frozen ended because someone recognised this was not typical grief.
The lesson: Complicated grief does not always look dramatic. Sometimes it looks like quiet, persistent inability to move forward.
Training for professionals
If you work with bereaved children in schools, care settings, or youth work, recognising complicated grief is essential. It is the difference between a child who gets support early and one who suffers for years.
Our Child Grief Coach Training includes:
How to recognise normal grief versus complicated grief across developmental stages
When and how to refer for specialist support
Practical tools for supporting bereaved children in everyday settings
A structured 6 week programme you can deliver
Full accreditation from ACCPH and IPHM
This is not therapy training. It is practical, trauma informed support designed for professionals who work with children but are not mental health clinicians.
Find out more about the training
Related resources
How children grieve at different ages - developmental patterns from toddlers to teens
Why angry children are often grieving children - understanding explosive behaviour
School refusal after bereavement - why bereaved children avoid school
Somatic tools for grieving children - body based approaches
Supporting children in residential care - considerations for looked after children
Final thoughts
Complicated grief is not a character flaw. It is not evidence that a child is not trying hard enough or that adults have failed them.
It is a recognised clinical presentation that develops when grief overwhelms a child's capacity to process it.
The good news is that with appropriate support, most children with complicated grief do move forward. Specialist intervention works. But it requires recognition first.
If you are reading this and thinking of a specific child, trust that instinct. If grief feels stuck, if months have passed without movement, if the child seems frozen in the moment of loss - seek support.
Because the alternative is years of suffering that could have been prevented.
Every child deserves adults who understand that some grief is too heavy to carry alone.
Be the adult who sees it. Who names it. Who gets the help that child needs.
If you support bereaved children professionally and want structured training in recognising and responding to grief - including complicated grief - our accredited Child Grief Coach Training provides practical tools, clear frameworks, and a deliverable programme.
