The Pediatrician and Childhood Bereavement

The death of an important person in a child's life is among the most stressful events that a youngster can experience.^1–3 Adults in the midst of their own grief often are confused and uncertain about how to respond supportively to a child.^3,,4 When the death involves a parent or a sibling, the potential for an adverse response by the child is compounded.⁵ During such a crisis, the pediatrician can be an important source of education and support for a child and family.¹

By already knowing something of the family interactions and individual coping skills, the pediatrician is in a position to help evaluate and understand a child's reactions and to advise and assist the family in responding to the child's needs.^1–3 Awareness of the child's temperament and typical responses to stress can help the pediatrician counsel the child and family.² Cultural and religious background are important considerations in dealing with the bereaved family.^2,,6,7 Knowledge of previous significant losses and parent and child responses to them are helpful in understanding and predicting how a death may affect the child and family.² Circumstances (eg, prolonged illness, sudden unexpected death, or violent death) are important additional considerations.^6–8 In instances of disasters with multiple deaths, the pediatrician is likely to be called on as a resource by rescue teams, school personnel, and others. The pediatrician should describe to families and personnel the normal childhood emotional reactions to such an abnormal incident and offer support and counsel to the children and to the adults caring for them.⁹

The funeral services can provide even a young child with an important way to grieve a loved one if such involvement is supportive, appropriately explained, and compatible with the family's values and approach.^2,,8 Children need to be prepared if they are to participate in the funeral process.¹² The participation should be tailored according to the developmental level of the child. For instance, the younger child may have the process broken down into shorter, more manageable, intervals. A trusted person should be with a child to explain what is happening and to offer support.³Older children and adolescents may want to participate by speaking at the funeral or memorial service. Encouraging a child to commemorate loss through some form of participation, such as drawing pictures, planting a tree, or giving a favorite object, will promote inclusion in the process and provide a meaningful ritual.⁵

Recognition of one's own attitudes and reactions to death is essential for objectively and supportively counseling the family.¹Pediatricians must realize that grief counseling is an emotionally demanding, time-consuming, and potentially frustrating endeavor.³The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version¹⁴ identifies diagnoses and conditions and may help the pediatrician evaluate the degree of severity of the child's behavior. Use of DSM-PC coding also may help the pediatrician deal with third-party payers. Referral to a mental health specialist or clergy (pastoral counselor) should be considered when the pediatrician believes that progress is not being made or would feel more comfortable having someone else work with the family.

• Copyright © 2000 American Academy of Pediatrics