Less than five months after the death of Nekrasov, Dostoevsky was crushed by the death of someone much closer to him, his two-year-old son Alyosha. One May morning in 1878, shortly before the family was to leave the capital for their summer retreat at Staraya Russa,Anna noticed that her little Alyosha's oval face began to twitch. She called the children's doctor,who came over, gave her a prescription, and assured her that the twitching would soon cease. But since it continued, she awoke Dostoevsky, and they decided to seek out a specialist in nervous disorders. The specialist promised to come as soon as possible and arrived early in the afternoon. By that time the infant was unconscious, and his little body convulsed sporadically in spasms. The doctor told Dostoevsky, but not Anna, that the boy was near death. Dostoevsky knelt down next to the couch where they had placed Alyosha. Anna knelt beside him, not knowing what the doctor had told her husband. About an hour later, after the convulsions had begun to occur less frequently, the infant stopped breathing. His father kissed him, made the sign of the cross over him three times, and let out his grief in sobs and tears. Anna and the other children, their eight-year-old daughter Lyubov and the six-year-old Fedor, also cried.

A few days later, after a church service, the family stood in the Great Okhta Cemetery on a beautiful May day and watched Alyosha's little white coffin being lowered into the ground.