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Virtually all children experience the death of a family member
or friend.1 Approximately 1 of every 20 children
experiences the death of a parent by 16 years of age. Although a
normative and universal experience, bereavement can cause significant
adjustment difficulties for children and adolescents, at least temporarily
impact their ability to learn, and result in feelings and behaviors
that may concern parents and other adults as well as the children
themselves. Pediatricians and other pediatric health care providers
can play a vital role by building on their preexisting relationship
with the child and family to ensure that the child understands accurately
what has occurred, provide advice to families on how to help promote
adjustment and coping, identify misconceptions and reactions (eg,
unwarranted fears, guilt, somatization, depression) that would benefit
from clarification or additional services, and assist the child
and family in identifying supportive resources within the community.
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Children and adolescents who are actively grieving may be reluctant
to disclose their feelings and concerns with parents and other adults and
give the false impression that they are disinterested, unaffected,
or fully adjusted to the loss. Some young children may not understand
what has occurred or the implications of the death, while other
children and adolescents may sense accurately that the topic is
uncomfortable for adults, worry that their reactions are somehow abnormal,
and/or be reluctant to burden further their parents who
appear already overwhelmed with their own grief. Indeed, the egocentrism
of children may lead them to conclude that they are personally hurting
their parents if they initiate a conversation that seems to prompt
signs of distress, such as crying in their parents (ie, that they are
upsetting their parents by talking about the death rather than simply
prompting their parents’ expression of the distress caused
by the death; in a similar manner, many health care providers are
reluctant to initiate conversations with children out of concern
that such discussions may upset them). For this reason, it is helpful
to offer to speak with children and adolescents alone so that they
can talk freely and share their reactions without concern about
upsetting their parents. Parents, in turn, who are grieving themselves,
may wish to believe that their children are spared the pain they
are experiencing and/or be less attentive to their children’s
reactions and needs. Since children have difficulty sustaining strong
emotions for extended periods of time, they may conduct the work of
mourning in “spurts,” employ denial or other means
to delay or limit their engagement in the process, or use play or
behavior to communicate and process their feelings. Therefore, for
many reasons, adults, including pediatric health care providers
and parents, may underestimate the impact of a death on children
and adolescents and miss important opportunities to offer support
and assistance.
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Pediatricians can begin by creating an environment where children
and adolescents feel it is safe and welcome to discuss their thoughts and
feelings related to the death. ...