• Filipa Martins Silva, Ana Filipa Lopes, Vânia Carneiro, and Álvaro Campelo.
• Departamento de Pedopsiquiatria e Saúde Mental da Infância e Adolescência. Centro Hospitalar Universitário do Porto. Porto. Portugal.
• Acta Medica Port. 2020 Oct 1; 33 (10): 649-656.

IntroductionScientific 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 MethodsWe 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).ResultsOf 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.DiscussionEven 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.ConclusionThis study provides valuable information to health professionals and other interested adults about the way preschoolers position themselves in relation to death.

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