By: David J. Schonfeld, MD, FAAP & Arwa Nasir, MBBS, MSc, MPH, FAAP
Death creates a deep, lifelong impact for kids in every part of the world. Here in the U.S., around 1 in 20 children will lose a parent by age 16—and countless others will grieve for a grandparent, sibling or someone else they love.
Doctors who treat children and teens know the impact that serious losses like these can have on their health and
development. In a busy practice, pediatricians see at least one child per week who may be grieving the death of a relative or friend. Here’s what to know when your child is mourning someone close to them—and how your pediatrician can help.
How can grief affect children?
Grief is the pain we experience after losing something or someone we love. Although people grieve many kinds of loss or separation, grief is often linked with the pain that follows the death of someone close to them.
Children of all ages may mourn the loss of someone whether they were family or not. Neighbors, friends, teachers, coaches, caregivers and others they loved or cared about may touch off a time of mourning.
Beyond sadness, grief can cause disbelief, denial, confusion, anger, anxiety and deep longing for a loved one to come back. These emotions can affect a child’s physical health, since they can interfere with healthy sleep, regular meals and more. Losses that feel overwhelming can also fuel
anxiety,
depression,
self-harm and
thoughts of suicide in children and teens.
Other kinds of loss that can trigger a child’s grief
It’s helpful to realize that other forms of loss can also create grief. For example, kids who desperately miss a divorced parent they no longer live with, or whose close family members are in prison, may feel the loss very deeply. Others whose parents have been deported or moved away for work opportunities may suffer, too.
How long will my child grieve?
No two children (or adults) respond to loss in the same way. What happened before, during and after a loved one’s death will color a child’s feelings.
Kids who live in areas plagued by
violence or armed conflict may have mourned many other deaths before this one without adequate emotional support to develop coping strategies and
resilience to future loss. This can leave them more vulnerable to
complicated grief—more severe and prolonged than expected—rather than better prepared. Those who
survived a shooting, car crash or natural
disaster that killed others might feel intense grief when another death happens.
Whatever your child’s history or circumstances, keep in mind they won’t simply "get over" a loved one’s death within a few months or even a year. They will spend the rest of their lives dealing with the loss. Future milestones such as graduating from high school or college, moving to a new home, falling in love or becoming parents themselves can throw "adult children" who lost someone dear to them temporarily off-course, even decades later.
Good news: healthy support now can make a lasting difference
Though you can’t erase the pain your child feels, there are many ways to help them deal with their grief. The steps you take now will protect their health and enable them to navigate grief and loss better as adults.
6 ways to support a grieving child
- Be clear and honest. As adults, we might assume that the less we talk about death with children the better. But kids of all ages can benefit when caring adults take time to offer a framework for
understanding death, using words that match the child’s age and level of development. It is helpful to discuss how the person who died is not in pain or suffering, for example.
- Don’t assume that older children are fine, even if they seem calm and accepting. You might open a conversation by saying, "I’m wondering which part of this is the hardest for you." If kids can’t or won’t talk, let them know you love them and try again later. Children may hide their own grief because they believe sharing their difficult feelings will make others—especially parents—feel worse.
- Allow feelings to flow. Let them know that it’s healthy to cry or talk about how we
feel when we’re sad. Open the door by saying something like, "I’m glad you’re brave enough to show how you feel, because I’m sad too, and being with you makes me feel less alone."
- Address harmful beliefs like blame and guilt—your child’s and your own. You could ask, "Sometimes when bad things happen, people feel like they must have done something bad. I know it wasn’t your fault that your mother died, but a lot of kids still think they are to blame after someone they love dies. Have you ever felt that way?" An open conversation can address a child’s feelings of guilt or shame while reminding you to go easy on yourself, too.
- Try to keep routines in place. Regular
meals,
bedtimes and attention to little things like tooth-brushing and laying out clothes for the next day can help kids feel secure and loved, even in times of loss. Adapt and support your child as needed. You don’t need to go back to all routines right away, but it’s good to have some predictability. Even small steps that keep home life stable will benefit all of you.
- Accept help from friends and community. This shows your child that in difficult times, the people around us can make a difference. Welcoming help in the form of meals, chores or rides to work or school also lightens your load, giving you more time and energy to spend with your child.
Are some kids at increased risk for complicated grief?
Your child’s age, overall health and past experiences may also make a difference in their ability to cope with the death of a loved one. Be aware of particular reactions and needs, especially for:
Preschoolers. With children under 5 years old highly dependent on others for support and basic needs, the death of a primary caregiver during this time period is particularly difficult.
Adolescents. Many ‘tweens and adolescents will try to hide any sign of weakness, which may mean they’re mourning all alone. Kids this age may challenge parents and other loved ones more as they naturally strive for independence, and may feel guilt over past arguments.
Teens and young adults preparing to leave home for college, the military, to start careers or other young-adult experiences. They may fear "abandoning" their families or doubt their ability to cope on their own.
Children who are adopted, in foster care or kinship care. While certainly not true in every case, kids separated from their birth parents usually already feel a sense of loss. This can multiply the grief or fear they endure when someone close to them dies.
Kids with special needs. Children with intellectual, neurodevelopmental, or physical disabilities may need individualized care that helps them tap their inner strengths, offering the idea that mourning is natural and the pain will ease over time.
Kids with mental health concerns. If your child or teen has a history of depression, anxiety, eating disorders, substance use or any other mental health condition, grief may trigger or intensify their symptoms.
When your child may need more support to cope with grief
Many children and teens need focused support in processing grief. Watch for signs of major changes in your child’s approach to everyday life.
For example, you might be concerned if:
A child who loves to tell stories becomes unusually quiet, responding to questions with one- or two-word answers.
A teen who’s known for being a "take-charge" person struggles to make choices or
manage time effectively.
A once-gentle preschooler begins to hit, push or shout at classmates or teachers.
What to do if your child is struggling with grief
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Call their doctor. Pediatricians and family physicians care about the well-being of your child’s body and mind. They can screen for specific health concerns and talk privately with kids who feel reluctant to speak in front of others. They can also refer you to health care specialists for grief counseling and community programs such as support groups and
camps for kids grieving a serious loss.
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Talk with teachers, school mental health professionals, coaches and other support people. Grief can interfere with
school,
sports, youth groups and other mainstays of your child’s life.
While you want to respect your child’s privacy and ask older kids for permission, it is helpful to let teachers, counselors, coaches and youth group guides know what’s happening. This lets them see your child with compassion, provide learning supports and accommodations, develop plans to address
grief triggers in class or other groups settings and share programs and resources that can help your family.
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Explore online resources. Because death and grief are universal experiences, many tools and insights are readily available for families. Helpful organizations include:
More information on HealthyChildren.org
About Dr. Schonfeld
 David Schonfeld, MD, FAAP, is an Executive Committee member of the AAP Council on Children and Disasters and a member of the Section on Developmental and Behavioral Pediatrics. He also serves as Director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles, and Professor of Clinical Pediatrics, Keck School of Medicine of USC.
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About Dr. Nasir
 Arwa Nasir, MBBS, MSc, MPH. FAAP, is a Professor of Pediatrics at the University of Nebraska Medical Center and Chair of the AAP Committee on the Psychosocial Aspects of Child and Family Health.
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