What Do Preschool Children in India Understand About Death?: An Exploratory Study

Abstract

Most people avoid talking about death with children even when required, as they are unsure at what age children start understanding the concept of death. Although this question has been researched in the west, it has not been answered in the Indian context. Therefore, this study was conducted in India with 25 children (14 females, 11 males; 3–5 years), using play and joint story construction method, along with semistructured interviews. Results indicated that majority of the children understood that everyone has to die, including significant people like their own parents (i.e., universality) and also, many children understood that death is final (i.e., irreversibility). However, only few children understood that all cognitive/behavioral functions cease at death (i.e., nonfunctionality). In conclusion, only a small proportion of preschoolers seems to have had a mature concept of death.

Keywords

death concept children India

Introduction

Death, as conceptualized by adults, is like a final closure, a full stop to all vital functions, whereas death seems like an enigma to a young child. They often tend to wonder, how is it that people disappear and never return? Where do they go, what do they do? What does it mean to be burned or buried? Is being buried like a seed or a bulb—a preparation for coming back? Or, how do they feel and think? Who takes care of them? Do they become a star or do they live with God? Among lay people, there seems to be a belief that children do not understand death. On the other hand, a long tradition of research has found that even very young children (as young as 18 months of age) appear to have some concept of death, whereas the normative adult conceptualization develops gradually (Bates & Kearney, 2015; Poltorak & Glazer, 2006). Some children seems to view life and death as coexisting states in the same person, like sleep and wakefulness, instead of understanding that being alive and dead are distinct, mutually exclusive states (Speece & Brent, 1984).

Research suggests that around 5 years of age, children gradually start developing a full/mature understanding of death, which means an understanding of subconcepts of death (i.e., finality, universality, and nonfunctionality). Seven years is considered to be a model age for acquiring each of these subconcepts and between ages 5 to 7 years, 60% of children achieve a mature understanding of all three subconcepts (Speece & Brent, 1992). However, it is important to note that majority of research on this topic has been done in the United States, and therefore more research is required from other countries and especially non-Western cultures.

Review of Literature

In scientific literature, the mature concept of death involves the three subconcepts of finality, universality, and nonfunctionality, and children may gradually come to grasp it. Factors affecting such mature understanding of death have also been studied, which is briefly presented below.

Subconcepts of Death

Finality of death (i.e., irreversibility or irrevocability or permanence)

It is the understanding that death cannot be reversed; once the life is gone, a living being’s physical body cannot be made alive again. This component is limited to the physical body, and it should be kept separate from beliefs about a spiritual afterlife. Prior to this understanding, children may view death as temporary, which can be reversed spontaneously or by using various means or actions (Speece & Brent, 1984). By the of age 6 to 7 years, they start understanding irreversibility, although fantasies of a dead person returning may continue till middle childhood (Kenyon, 2001; Poltorak & Glazer, 2006; Slaughter, 2005).

Universality (or inevitability) of death

It means that all living things die; including loved ones as well as the reality that oneself too will die, that is, personal mortality (Speece & Brent, 1984). There are no exceptions to death. Before children understand that death is universal and inevitable, they often believe that there are certain actions that can be taken to avoid death, such as being clever or lucky (Nagy, 1959). Most young children also think that certain people do not die—such as immediate family, teachers, other children, or themselves (Hornblum, 1978). Also, many children who apparently understand the inevitability of their own deaths do not understand the possibility of it occurring at any time but only in the remote future when they get old (Kane, 1979).

Nonfunctionality (or cessation) of death

It refers to the understanding that all life defining functions, that is—external/behavioral (e.g., eating, breathing, moving, etc.) and internal/cognitive–emotional (e.g., feeling, thinking, dreaming, etc.) cease at death. Before understanding this, some young children perceive death as only a diminished capability for specific functions or like a state with similar functions as in living beings (Speece & Brent, 1984). Studies have reported that children first understand the cessation of the most visible aspects of nonfunctioning, such as eating or speaking and only later recognize that more subtle, cognitive aspects such as dreaming and knowing also ends with death (Smilansky, 1981).

Causality and belief in an afterlife

Two other related subconcepts, which are described differently in literature, are causality and a belief in an afterlife. A mature understanding of causality involves an abstract or generalizable and realistic understanding of both internal and external events that may bring death, such as serious illness or injury (Poltorak & Glazer, 2006; Speece & Brent, 1992). Sometimes old age has also been considered as a related idea (Brent & Speece, 1993).

In addition, research has shown that belief in some type of continued afterlife is a characteristic of many a child’s and even adult’s concept of death (Sperber, 1985). However, this idea is still under debate among researchers in the field. One needs to keep in mind that death is a complex subject and defining a universal and uniform “adult like” or “mature concept of death has its limitations”. At times even adults’ concept of irreversibility has been found to be less mature than children’s concept (Sperber, 1985). It seems as children grow, the clear demarcations between life and death, between heaven and hell, often fade as more complex issues such as reincarnation, spiritual understanding, and energy continuation or even scientific questions about body are entertained (Kastenbaum & Costa, 1977).

Hence, death poses the ultimate challenge to the formation of identity, in that, it defines and delimits human life. In this respect, it has been suggested that the mastery of the concept of death is related to the mastery of the concept of life itself for children (Conrad, 1991; Kenyon, 2001).

Factors Which May Influence the Understanding of Death

Exposure to death

A child’s exposure to death of a close person or even of an animal is one of the most important variables affecting her/his understanding of death. It has been found that in bereaved children, this understanding goes beyond clear and distinct age-specific categories. For them, this understanding is not simply a cognitive exercise in what they think about death, but it is at a personal, emotional, and social level. Thus, their cognitive understanding of death may not be consistent with their level of maturity and may be different from the understanding of children who have not experienced death in their close circles (Bates & Kearney, 2015; Poltorak & Glazer, 2006).

Gender and socioeconomic status

Only a few studies have reported the effect of gender and socioeconomic status on concept of death. The type of explanations that boys and girls provide for causes of death seems to differ. Boys tend to depict more violent causes of death than do girls, who tend to cite accident or illness (Jenkins & Cavanaugh, 1986; Wenestram & Wass, 1987). Another study on effects of socioeconomic status had suggested that poor, urban children have “less mature” concepts of death than do middle-class, suburban children (Tallmer, Formanek, & Tallmer, 1974).

Religious–cultural background

Answers to questions such as what is death?, what happens beyond death?, what ends with death and what continues to survive beyond death? are also influenced by religio-cultural beliefs, folk concepts, oral narratives, and institutions prevalent in a specific culture or society (Candy-Gibbs, Sharp, & Petrun, 1985). Growing up children may learn about these from various sources such as stories, movies, hearing adults talk, grown-ups’ answers to their questions, talking to their friends, or sometimes direct experience of witnessing death and death-related practices in their families (Kongsuwan, Chaipetch, & Matchim, 2012; Yang & Chen, 2006). Majority of Indians practice Hinduism as a religion, which has a long tradition of philosophical contemplation about life and death. It emphasizes a non-material part within living beings, the atman which is immortal, and continues from one birth to another (i.e., concept of reincarnation or rebirth). It differs from both the ideas of nonreversibility and reversibility (or finality). Like nonreversibility, belief in reincarnation considers death of physical body as permanent, on the other hand, it believes that the same soul/atman may take another birth, although in another body, depending upon its past actions and growth needs.

Context of living

Furthermore, traditionally India has been a predominantly agrarian society, with multigeneration families living together and therefore in earlier times family members including children (especially those in rural areas) might have been around when death happened to a person (or to a farm animal). However, this is increasingly becoming less frequent in modern times, especially in growing urban areas. Now, more and more people die either through accident out on the streets or in an alien atmosphere of a hospital where children are kept away. Also, space constraints in most Indian cities do not permit them to have pets in their homes. Thus, for young children, the major source of learning about death becomes their exposure to characters dying in movies, animated or otherwise, computer games, or media news of violent deaths in explosions and wars (Bonoti, Leondari, & Mastora, 2013; Renaud, Engarhos, Schleifer, & Talwar, 2015).

Communication with the parents

In general, what children are told about death, especially by parents, is crucial to their understanding of death (Speece & Brent, 1984). Regardless of their age, children with the healthiest outlook about death often achieve it with adult support (Mahon, Goldberg, & Washington, 1999). When adults hesitate to discuss death with children, it might leave them to their own imaginations and associated anxieties and fears (Poltorak & Glazer, 2006; Renaud et al., 2015). Despite death being a reality of life, conversations around death is avoided as it is considered to be a traumatic topic even for adults, especially when it is associated with the permanent loss of an attachment object or reminds one of the personal mortality. When it comes to children, people find themselves at a loss how to handle the questions about death with children. Although children are exposed to death while growing up (Ellis & Stump, 2000), parents and even professionals are unsure whether children understand death, whether one should talk to children about death, and if yes, who should do so and how to go about it (McGovern & Barry, 2000). One reason why adults are reluctant to talk about death with children is because they are unaware at what age children start understanding the concept of death. Although as mentioned earlier, between 5 and 7 years, children start gaining clarity about this concept, fewer studies have been conducted with children below age 5 years and it is usually assumed that preschool children do not have cognitive capabilities to understand death. Also, no published study was found in the Indian context.

Therefore, given the sparse literature in this field from a non-Western culture, a study was planned to explore the concept of death in urban Indian preschoolers with respect to ideas of universality, irreversibility, and nonfunctionality. Results of such a study will add to the cultural understanding as well as be of use while discussing death with children when required.

Study Methodology and Tools Used

Study design

This study was a cross-sectional, mixed-method, exploratory study, conducted using a purposive sampling in the city of Bangalore in India.

Study sample and their selection process

The study samples consisted of verbal, preschool children from the age-group of 3 to 5 years, from either of the gender. They were recruited from schools (two preschools and one play school) after taking permission from the principal and then meeting the class teachers who introduced the researcher to the parents of potential study participants. A few children were also recruited directly from the general community using snowball method. For all children, written parental consent was taken before conducting the study, after which children were screened using Children’s Behavior Questionnaire (Rutter, 1967) and with interviews with the mothers to rule out the presence of any psychiatric problem, cognitive disabilities, or any behavioral/emotional problems in the child.

Study tools

(a) A basic information data sheet was prepared for the study. This included basic sociodemographic details of the subjects, such as age, sex, school, parent’s age, education, occupation, family income, and so on. In addition, some pertinent information required for the study, such as current family type (e.g., nuclear or joint), number of family members staying together, and presence of a pet, was collected from the mothers. (b) Interview schedule for interview with the mother: Mothers were asked questions regarding birth and developmental history of the child to rule out presence of cognitive disabilities or any other psychiatric problem in the child. Few questions were also asked to enquire about children’s exposure to various life events, especially of death (e.g., of a pet, a known person or in the media), whether the child had shown any curiosity toward death and whether anyone had discussed the topic with the child in the past. (c) Children’s Behavior Questionnaire (Rutter, 1967) for the purpose of screening of any behavioral issues in the child. (d) Interview schedule for interview with the child: This was prepared along with the story for this study and had around 20 questions related to birth, illness, injury, old age, and death along with general questions about future, in the context of the story (more details in the Study Procedure section and Supplementary Material).

Study procedure

Review of literature shows that it is difficult to directly assess young children’s understanding of abstract concepts such as death. The age-group selected for this study (i.e., 3–5 years) demanded that the method of the interview should be more visual and interesting. Play method helps children to be freer and express their feelings or ideas which they find difficult putting into words. Children also identify themselves well with stories, and story-telling method has been frequently used with young children for research purpose. Hence to elicit the understanding of death from the children in a nonthreatening manner, a single session was conducted with the child, which had a combination of storytelling (i.e., joint story construction method), play, and semistructured interview. To facilitate this, a toys kit was assembled to bring in a family setting. It included a father and a mother with two children—a boy and a girl (depending upon the gender of the child being interviewed) and two pets—a dog and a cat. Furthermore, a relevant story was developed, which consisted of a child living with her/his parents and sibling, who also had two pets. During the interview session, the place and pace were selected to make the child most comfortable. These research interviews were conducted by the author herself, who was trained in working with young children as part of her post-PG degree level training (MPhil) in Clinical Psychology. A parent, usually the mother, was around while the researcher (author) was interviewing the child either in school or their home. Rapport with the child was built initially with friendly talk and showing them the play material from the toy kit. Later, family setup was brought in and simultaneously the predeveloped story was introduced. Initially, the names of the characters (i.e., the child, sibling and their pets) in the story were given by the examiner, but the child was given the freedom to change the names according to her/his choice, which would also give her/him a chance to get involved in the story. This story included various events such as death of a plant, death of a beloved pet, and so on. The semistructured interview schedule developed for this study was used to ask questions related to the events happening with the characters of the story and were about plant, animal, and human death (such as what happens when someone dies, whether everyone has to die, etc.). Thus, the story was used to facilitate the responses from the child instead of asking abstract questions, and the interview was done while the child was engrossed in the play, building the story, and simultaneously answering the questions pertinent to different concepts. The child was encouraged to build the story by asking, “… then what happened …/… what do you think happened then …” and in the process the interview questions were also asked. This interview indirectly assessed the children’s concept of universality, finality, and nonfunctionality along with understanding of birth, injury, illness, and old age. The answers were noted down immediately, taking care not to break the rhythm of the story. Some necessary prompts in the form of repeating the questions or the mother reframing the question in easier language were also given as per the child’s comprehension and level of comfort. In the end, debriefing was done by encouraging the child do some neutral drawing and talk about it. If child was not interested in drawing, then she/he was encouraged to tell any story or a rhyme or was involved in some other game as per her/his interest.

Data analysis

Basic statistical analysis was done in terms of frequency and percentage for the quantitative data and thematic analysis was conducted for the qualitative data using a deductive approach. A priori themes were developed based on literature review, the theoretical model in the field, and research question. These themes included the subconcepts of death, that is, universality, irreversibility/finality, nonfunctionality, and also causality.

Results

Background Details

The study sample consisted of 25 children in the age range of 3 to 5 years, with 28% between 3 and 4 years and 72% between 4 and 5 years of age. The mean age of the study sample was 4 years 2 months, with 56% of the sample being female children and 44% male children. The sample was from an urban background and predominantly from an upper/upper-middle socioeconomic status (60%), nuclear family setup (60%), belonged to Hindu religion (76%), and only a few had any pet at home (32%).

Concept of Death With Respect to Humans

Regarding human death, results indicated that a large number of children understood the universality of death, that is, they responded that everyone has to die (64%). For some children, it included the idea of personal mortality (32%) and death of even significant people like parents (72%), which signifies a developed idea of universality of death. The concept of irreversibility or finality of death, whereby after dying nobody returns back to life, was also found in more than one-third number of children (36%). However, the concept of nonfunctionality indicating the end of functioning (such as thinking, eating, etc.) was rarer in this group with very few children understanding this concept (8%).

Concept of Causality

Concepts of old age and causality are also considered to be associated with concept of death. Thus, a few extra questions related to injury, illness, and old age were also explored and some children seemed to understand universality of old age (20%), changes related to old age (60%), and reasonable causes of illness (52%), injury (72%), and their cure.

Concept of Death of Animals and Plants

Results also indicated that fewer children understood irreversibility of an animal’s death (16%) as compared with human death (64%), or plant death (52%), which was also reported by Kenyon (2001) in his review of literature in this area. Many children expressed ideas indicating reversibility of animal death, where after death the dog may again get up and eat, walk, go to the market, and so on.

To understand these results, it is important to note that many children have had exposure to animal death in real life, either of a pet (16%) or some other animal (44%). As reported by mothers, some children (36%) had also seen people/animals dying in the TV serials/movies. A quarter of the sample (24%) had also witnessed death of a person (e.g., of a relative/family friend) and resulting events and discussions.

Majority of the children (88%) had shown curiosity toward death and discussed it with their parents, who usually provided some religious/spiritual explanation, similar to what has been found in earlier studies (Renaud, Engarhos, Schleifer, & Talwar, 2013). Although, some of these mothers were found to be having anxiety in discussing the topic of death with their children and thus tried to avoid such questions by diverting their child’s attention or dismissing their queries. Such parent–child communication too has been reported by same researchers in another article (Renaud et al., 2015). On the other hand, a small number of mothers (12%) sometimes used possibility of one’s own death or child’s death as a threat to discipline their children. This was not always effective as the child would subsequently cry, cling or even hit the mother. With respect to causality, children who had seen human beings dying violently in the movies or TV serials sometimes believed that death occurs only by violent means, such as shooting or by being stabbed.

An Illustrative Example

Child N. was a 3 years 3-month-old boy, belonging to a Muslim family, whose maternal grandmother died in last 1 year. He would ask many questions about her as whether she suffered from pain or she bled to death. He had seen death of his pets (e.g., of a chick and a fish) and later had told his mother, “don’t bring any more pets, they die.” He had also seen dead animals on the road and would keep asking about them and his mother told they have gone to God. One day during a normal interaction with mother, N told his mother spontaneously, “I have become very naughty, what to do, maybe I’ll die.” When mother asked him what will happen next, he said, “I’ll go up.”

During the interview, his answers to the questions about death of characters in the story are given below (Sunny is the little boy in the story and Bobo is the dog):

Q: When mother told that Bobo is dead what would Sunny do?

A: Don’t know

Q: What did Sunny think where Bobo has gone, when he died?

A: He has gone up

Q: What happens when someone dies?

A: They go up and then they come down. Then they die again and then go up and again come down

Q: How will you know that someone is dead?

A: They sleep (showed action)

Q: Like Bobo who else will die?

A: You also (indicating mother, researcher)

Q: Do you think everyone has to die?

A: Everyone will die and then they will go up. They won’t come back.

Q: Will Sunny’s parents also die?

A: Yes. Parents won’t come back, but dog will come back again

Q: What will Sunny do when her/his parents die?

A: Don’t know. (When he grows up he will go to office, work with computers and get married).

In this example, it seems that the child has developed a mature concept of universality. The concept of nonfunctionality is not clearly reflected in his answers, as the answer “they sleep” might mean either a permanent sleep like state, or sleep-awake cycle. He has not consistently suggested that death is nonreversible. Although he mentions nobody comes back after death and parents too won’t come back, but the dog will come back. The idea that after death, people “go up and then they come down, then they die again …” in a child from a Hindu family this response may have be considered as reflecting reincarnation beliefs; however, as this child was from a Muslim family, his response may be interpreted as reflecting reversibility (or nonfinality) of death.

Discussion

This is one of the few studies conducted in a non-Western culture, and probably first in India to explore concept of death in preschool children. This becomes significant in the context of different kinds of prevalent folk/religious beliefs (such as reincarnation) and also different life styles in India, than in a Western country like the United States. The results indicate that preschool urban Indian children in the age-group of 3 to 5 years of age do not have a fully mature understanding of death, except in few cases (8%). Higher percentage of children understood universality of death than irreversibility associated with death. Only few children understood the concept of nonfunctionality. A few children had also started understanding other associated concepts, such as old age and death. Fewer children understood animal death, as much as that of plant and human death. Thus, whereas a mature concept of death in terms of universality, irreversibility, and nonfunctionality varies for children in this age-group, yet a few are definitely capable of such an understanding. This might be explained by the fact that majority of children had exposure to death in real life and had also discussed death with an adult. These two factors are very important in helping a child develop a mature understanding of death.

Furthermore, the study also suggested that it is possible to elicit preschool children’s understanding of death in a nonthreatening manner. Thus, instead of avoiding discussing the inevitable concept of death with a child, parents and other adults can and should be able to talk about it and help the child understand death (McGuire, McCarthy, & Modrcin, 2013).

Limitations of the Study

Study sample predominantly comprised of healthy children from upper and upper middle socioeconomic status and urban background, limiting the generalizability of the study results. Furthermore, given the mixed method nature of study, sample was kept small; however, due to this reason, we could not compare the responses of children who had not lost any close relatives, with that of children who had. In future, research may be conducted with children from a different socioeconomic background and also with children having terminal illness which will help us to understand their concept of death and evolve a line of management for them and their care givers. Future research may also examine whether children with better conceptual understanding of death have better adjustment to a loss, especially when openly communicated about death.

Implications

The results derived from the data makes a beginning toward understanding young children’s concept of death in India. Presence of a mature concept of death varied in this age-group (3–5 years). Although small in number, some children (8%) have shown a mature concept of death in terms of universality, irreversibility, and nonfunctionality. Such knowledge has implications not only for future research but also in deciding whether or not to discuss natural death and traumatic events with preschool children. In the light of this study results, it may be useful to first ascertain whether or not a child in this age-group understands these concepts and accordingly decide whether to talk about death. For those children who do understand such concepts, an open communication about death may be appropriate, in their benefit. On the other hand, children who do not have such conceptual understanding may be better served by other ways to discuss a death without invoking concepts which they do not yet understand.

Supplemental Material

Supplemental material for What Do Preschool Children in India Understand About Death?: An Exploratory Study

Supplemental Material for What Do Preschool Children in India Understand About Death?: An Exploratory Study by Jyotsna Agrawal in OMEGA—Journal of Death and Dying

Footnotes

Acknowledgments

The author gratefully acknowledges the contributions of Prof. S. Pasricha for this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by National Institute of Mental Health and Neuro Sciences MPhil Fellowship.

Supplemental Material

Supplemental material is available for this article online.

Author Biography

Jyotsna Agrawal, PhD is currently working as an assistant professor of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore. She completed her MPhil and PhD in Clinical Psychology from the same institute, and went on to do her postdoc training as a Fogarty Fellow at Washington University School of Medicine at St. Louis. Her research interests are in the area of psychotherapy and preventive- promotive approaches to well-being along with yoga, meditation and contemplative practices.

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