Dr. SchonfeldThe vast majority of children experience the death of a close family member or friend during childhood, and approximately one in 20 experiences the death of a parent.
The death of someone close often has a profound and lifelong impact that may result in both short- and long-term consequences for the child’s psychological functioning, emotional adjustment, health and developmental trajectory. Yet, many pediatricians have received little training in this area and feel uncomfortable talking with and supporting grieving children; many families in turn do not view pediatricians as a resource for advice and assistance in this area.
The AAP clinical report Supporting the Grieving Child and Family, from the Committee on Psychosocial Aspects of Child and Family Health and the Disaster Preparedness Advisory Council, updates a prior report that introduced some of the key issues. Available at http://dx.doi.org/10.1542/peds.2016-2147 and published in the September issue of Pediatrics, the updated report provides practical suggestions and resources to help pediatricians fulfill many of these important tasks within their practice and provide much-needed and valued support to grieving children and their families.
Ways to assist
Pediatricians, within a patient-centered medical home, are in an excellent position to provide support to children and anticipatory guidance to caregivers before, during and after a loss. Assistance and support can include the following:
- helping ensure children understand what has occurred and its implications;
- identifying reactions such as guilt, fear, worry or depressive symptoms that suggest the need for further discussion or services;
- providing reassurance to children who become concerned about their own health or that of family members;
- offering support to grieving children and their families to minimize their distress and support their resiliency;
- providing advice on how to support children’s attendance at funerals and other memorial events; and
- referring families to local resources that can provide additional/ongoing assistance.
Parents and other caregivers may be dealing with their own grief and may be unaware of or reluctant to recognize their children’s grief. Children may withhold their questions and concerns so as not to further burden their parents and other adults in the family who are visibly distressed. As a result, children may postpone their grief or grieve alone and unsupported. Children and their families may wish to seek advice and assistance, but not realize that their pediatrician may be interested in helping and able to assist them.
Ask about major changes
Pediatricians can increase the likelihood that children and families will bring significant losses to their attention by directly informing families, often during the initial visit and periodically thereafter, that they are interested in hearing about major changes in the lives of patients and their families, such as deaths of family members or friends, financial or marital concerns of the family, planned or recent moves, traumatic events in the local community or neighborhood, or problems or concerns at school or with peer relationships. At subsequent visits, pediatricians can ask whether any major changes or potential stressors at home, at school or within the community have occurred or are anticipated.
The relatively modest effort to provide compassion and support to grieving families can have a meaningful and lasting impact.
Dr. Schonfeld, a lead author of the clinical report, is a member of the AAP Disaster Preparedness Advisory Council.
