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AAP: Pediatricians can do more to help grieving children, adolescents

The American Academy of Pediatrics has released guidelines for supporting children, adolescents and their families who are grieving the death of a loved one, stating that pediatricians in the patient-centered medical home are “in an excellent position” to offer assistance and help.

The clinical report, “Supporting the Grieving Child and Family,” published in Pediatrics, includes practical advice on initiating conversations with young children in mourning, cumulative losses, grief triggers, funeral attendance, and working with schools. The report was drafted by the AAP Committee on Psychosocial Aspects of Child and Family Health, Disaster Preparedness Advisory Council.

“At some point in their childhood, the vast majority of children will experience the death of a close family member of friend; approximately one in 20 children in the United States experiences the death of a parent by the age of 16,” David J. Schonfeld, MD, FAAP, director of the National Center for School Crisis and Bereavement at the University of Southern California School of Social Work, and colleagues wrote. “Despite the high prevalence of bereavement among children, many pediatricians are uncomfortable talking with and supporting grieving children.”

According to the report, pediatricians should encourage patients’ families to bring up and discuss major changes in their lives, including deaths. In addition, physicians should not balk at discussing the death of a loved one with young patients, even if they show few outward signs of grief.

Ways pediatricians can initiate conversations about death include:

• Be genuine. For example, rather than tell the child you will miss their grandfather, despite never having met the man, instead say you appreciate that he was important to the child, and that you are sorry they had to experience this loss;
• Talk less, listen and observe more. Simply being present while the child is experiencing grief can often be helpful;
• Ask opened-ended questions, such as “How are you doing since your mother died?” or “How is your family coping?”
• Refrain from bringing up one’s personal experiences and comparing them to the child’s loss. Keep the focus on the child’s feelings and loss;
• Avoid attempts to “cheer up” the child, as they are often neither effective nor appreciated;
• Do not instruct the child to hide their emotions, and do not tell them how they ought to feel; and
• Do not claim to know how they feel, but instead encourage them to share their feelings.

“To minimize misinterpretations, it is best to avoid euphemisms; especially with younger children, it is important to use the word ‘dead’ or ‘died,” Schonfeld and colleagues wrote. “For example, a young child told that a family member is in eternal sleep may become afraid of going to sleep himself.”

When it comes to funeral attendance, the report states that it is best to encourage children to participate in wakes and other memorial services only to the extent they feel comfortable. In addition, they should be told, in simple terms, the basic information regarding what they can expect from the experience, including whether there will be an open casket.

If an adolescent who had a very close relationship with the deceased indicates they do not want to attend the funeral, it may be helpful to explore their reasons, and to ask them what accommodations might be made in the plans to meet their needs.

“Pediatricians who do provide support to grieving children and families often have a meaningful and lasting impact,” Schonfeld and colleagues wrote. “A relatively modest effort to provide compassion and support can have a dramatic effect. It can help reduce the amount of time grieving children feel confused, isolated and overwhelmed. Pediatricians will not be able to take away the pain and sorrow (and should not see that as their goal), but they can significantly reduce the suffering and minimize the negative effects of loss on the children’s lives and developmental courses.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.