American Academy of Pediatrics Offers Guidance on Supporting the Grieving Child and Family

Many children who experience profound losses can benefit from the compassion and care of a pediatrician

ITASCA, IL--An estimated 1 in 20 children experience the death of a parent by age 16, and many others experience the death of a family member or friend at some point in their childhood. The way children grieve and cope with death is not always apparent to the people around them but is often profound and long-lasting.

The American Academy of Pediatrics describes the ways that pediatricians can support children and families navigating the death of a loved one within an updated policy, “Supporting the Grieving Child and Family: Clinical Report.”

The clinical report, published in the July issue of Pediatrics (published online Monday, June 17), was written by the AAP Committee on Psychosocial Aspects of Child and Family Health and the Council on Children and Disasters. Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.

“Caring adults may worry that asking children about the recent death of someone close to them may upset them, but inviting children to express their feelings allows them to express their sadness - it does not cause it,” said David J. Schonfeld, MD, FAAP, a lead author of the clinical report. “If children are able to share their distress, we can help them begin to cope, rather than leave them to grieve in isolation.”

The AAP provides recommendations for pediatricians when counseling families, describing children’s developmental understanding of death and providing ways to help them cope with common feelings like guilt and shame. Guidance also is provided on cultural sensitivity, funeral attendance, working with schools and other practical information for pediatricians and family members.

“Children generally are resilient and able to adjust to the death of someone close to them,” said Arwa Nasir, MBBS, MSc, MPH, FAAP, a co-author of the report. “But they do not ‘get over it’ in six months or a year. They will spend a lifetime adjusting to the loss. Open communication and maintaining support over time is important.”

The AAP recommends that pediatricians:

• Talk with grieving children and advise caregivers on how to help children of all developmental abilities better understand and cope with the loss;
• Approach the situation with an open mind and heart and strive to be culturally sensitive;
• Help identify and address guilt, shame, and other troubling reactions and make referrals when grief becomes complicated;
• Be aware of the unique challenges of children from groups and communities that historically have been marginalized and disadvantaged;
• Offer resources within their practices and communities, including children’s bereavement programs, centers, and camps for peer-to-peer support;
• Provide periodic support and assistance beginning soon after the death and continuing throughout the longer recovery period; and
• Understand and manage their personal reactions to promote professional self-care and decrease compassion fatigue.

The AAP observes that pediatricians may also be personally impacted by supporting grieving children and should practice self-care strategies to minimize compassion fatigue.

“Grieving children and their families greatly appreciate the compassionate care provided to them by their pediatrician at a time of great personal need; a modest amount of effort can have a profound impact and be remembered for a lifetime,” Dr. Schonfeld said. “But because pediatricians care about their patients, they often find it difficult to witness the distress of grieving children. By making sure to monitor and address their own reactions, pediatricians can provide this critical support and will find that it can bring greater meaning to the pediatric care we provide.”

###

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.