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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.

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.

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. ...

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