A child's death, whether from illness or sudden loss, is always traumatic and stressful, and those affected may grieve in different ways.
The pediatrician can play a critical role in helping families, caregivers and the child's community navigate the loss of a child, according to an updated clinical report published by the American Academy of Pediatrics.
The report, "Supporting the Family After the Death of a Child or Adolescent," published in the December 2023 Pediatrics, draws on the latest evidence on grief, bereavement and mourning on ways to provide support and practical information.
How pediatricians can help a grieving family
"A pediatrician can provide comfort, compassion and a listening ear. They can also offer practical information, like where to find a community bereavement program or grief counseling," said Meaghann S. Weaver, MD, PhD, MPH, FAAP, lead author of the report.
"If there are siblings, each child may process grief in their own way, based on their age and maturity level. There are no easy paths through the grieving process. But having support from a variety of places, including the medical provider, is critical."
The AAP Committee on Psychosocial Aspects of Child and Family Health and the Section on Hospice and Palliative Medicine wrote the clinical report, which replaces a 2016 report, noting that families cannot be expected to "move on" or "get over" the death of a child.
"The grief process is unpredictable. It does not unfold in a straight line. Emotions may wax or wane from one day to another," said Arwa Nasir, MBBS, MSc, MPH, FAAP.
"After families absorb the inevitable shock of the death, they may move into new phases of their grief," Dr. Nasir said. "We can encourage family members to be gentle with each other as they adjust to their loss and the impact on their lives."
The most common causes of death in children
The report breaks down the most common causes of death in children. It shows how the COVID-19 pandemic revealed the vulnerability of even pediatric patients. By March 2022, approximately 355 children ages 4 and below and 737 ages 5 through 18 died from a COVID infection and related causes in the United States.
Although American Indian/Alaska Native, Black, and Hispanic children represent 41% of the US population under age 20, they accounted for 78% of COVID-19-related deaths in this age cohort, according to research cited.
Sudden and unexpected infant deaths, including SIDS, accidental suffocation deaths, and ill-defined deaths represent 3,400 deaths per year in the United States and are the largest category of sudden and unexpected deaths in childhood.
Motor vehicle crashes were cited as the leading cause of pediatric deaths for over half a century. Beginning in 2017, firearms now represent the number one cause of death among persons ages 1 to 19 years old.
AAP's recommendations for pediatricians include:
Respect that compassion is a universal language of care and can be expressed through taking the time to listen and provide emotional support to a family.
Realize how knowledge about the structure of a family and its support systems may be important in recognizing each family's unique needs.
Consult with sources and family to learn about the cultural and religious traditions surrounding death and bereavement to include culturally appropriate parental roles of grieving.
Pediatricians should consider visiting their seriously ill or dying patients in the emergency department or pediatric intensive care unit, as able. Consider a phone call or face-to-face meeting with the child's caregiver.
Follow-up with and provide guidance to surviving siblings who are still patients.
"It's important to understand that grieving the loss of a child is longer than many expect," Dr. Weaver said. "Families often hold a cherished, forever connection to the child."
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