Pediatricians and other pediatric health care providers play
an important role in helping adults identify and attend to their
children’s needs around the time of the death and during the
period of readjustment, which often lasts months to years (the duration
depending in large part on the closeness of the child’s
relationship to the deceased and whether or not risk factors for
complicated mourning are present). Referral for additional support
or counseling should be considered, especially when the death involves
a close family member (eg, sibling or parent) or close friend (especially
for older children and adolescents), when risk factors for complicated
mourning are anticipated (eg, death from suicide, parents’ inability
to talk to the child about the death, when child or parent is experiencing guilt
associated with the death), when the initial reactions seem intense
(eg, child appears markedly depressed or suicidal) or unusual (eg,
failure to show any distress after the death of a parent), or intensive
grieving is prolonged and associated with impairments in daily function
(eg, sleep or eating problems or deterioration in school performance).
Children who are grieving should be expected to have at least some
transient difficulties with school work secondary to problems with
attention, sleeping, and sadness; parents should be encouraged to
contact the school to help arrange for support services prior to
academic failure, which can otherwise become an additional stressor
for the grieving child. Pediatricians and other pediatric health
care providers should be aware of local bereavement support groups8 and
counseling services for children and families and offer these resources,
and they should schedule periodic follow-up appointments in order
to answer questions and monitor adjustment rather than simply inviting
the family to call as needed. Contact can be made around the time
of anniversaries of the death or birthday of the deceased or around the
time of special occasions and holidays, which may be particularly
stressful. Adjusting to a significant loss is a lifelong process;
children will reprocess the experience at each new stage in their
life, applying new cognitive and emotional insights to try and reach
a more satisfying explanation or justification for the death. Parents
should be prepared that new developmental stages or significant
milestones (eg, graduation, marriage, birth of first child) may
stimulate new questions and renewed feelings about the death. Siblings
of children who have died too often are overlooked and may require
active outreach.9 It is particularly challenging
for pediatricians to know what role they can play in supporting
families when the individual who has died is the family’s only
child. Ongoing communication and offers to meet for follow-up can
be very helpful to the family in this setting. Adults often underestimate
the significant impact on children of the death of a peer. Pediatricians
can also play an important role in not only providing consultation
to schools related to the needs of their patients but also in advising
on how to provide support to others in the school community.10,11