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The death of a loved and important person in a child's life is perhaps one of the most stressful events that one can experience. The emotions of a bereaved child are varied and unique, and not as neatly characterized as what occurs in adults. The child will also be surrounded by adults in the midst of their own grief; the surviving parent may be uncertain and confused as to how to respond in a supportive manner to their children.
Approximately 8% of children in the United States will have one parent die before the child is 18 years; 25% to 33% of adult cancer patients undergoing treatment have at least one child younger than 18 years in the home. In childhood, nearly all children will experience the death of a loved one, whether it is a pet, grandparent, sibling, close friend, or parent.
Medical specialists, in adult oncology and hospice care, as well as pediatricians, need to be aware and ask about children and how they are coping in the face of a parent's terminal illness. During this crisis, pediatric care providers can become an important source of support and education to the child and their family.1--3
The stages of grief were described by Dr. Elisabeth Kübler-Ross in 1969, and include denial and isolation, anger, bargaining, depression, and acceptance. 4 A child's response may not appear to fit neatly into one of these five stages, yet children grieve. Myths surround children and their capacity to grieve and are important to dispel (see Table 1, page 278). Even a child with a terminal illness will go through grief stages; a dying child will grieve their own loss of function, interaction, and participation in developmentally appropriate activities of daily living, such as play and school.1--3 Grief of children is dependent upon their age and is influenced by factors, such as culture, closeness of the lost family member or friend, and socioeconomic conditions.
Accepting Loss
Understanding the influence of a child's developmental stage, as it relates to death concepts, is important in guiding a child through the loss of a loved one.1,5--9 Preschool children often see death as reversible, a concept reinforced by cartoon characters who die and come back to life.1,3,5,7,8,10 However,...