Grief guidance: 6 ways pediatricians can support children, families after loss
David J.Schonfeld, M.D., FAAP
AAP Clinical Report
The 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
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
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.