Loss or Grief
Grief is a universal experience and is part of life. However, in childhood the death of someone close, especially a primary caregiver, or other significant losses can have profound impact on the child’s life. There are many factors that influence how a child experiences loss and death (e.g., meaning of loss, closeness to the deceased, coping capacity, pre-existing mental illness, life stressors, and support). Having a supportive primary caregiver(s) and a support network that allows open communication about the loss and provides comfort is crucial for helping children grieve. In fact, with support, the vast majority of bereaved children do not need clinical intervention. However, for some children clinical intervention may be indicated.
Below are some grief reactions that may occur. These are expected to be temporary and not cause severe impairment.
- Change in sleep and/or eating habits
- Separation fears
- Anger outburst
- Feeling different and/or wanting to be alone
- Decrease in academic performance or mild temporary impairment in developmental milestones
- Physical complaints (stomach aches and headaches)
- Longing and searching to be with the deceased
- Preoccupation with death and/or constant thinking about the loss/person
When to refer/seek help?
Research has shown that typical grieving processes can take an average of two years. However, if distressing symptoms and impairment have lasted for more than one month after the loss, a referral for further evaluation is indicated.
Other symptoms that indicate the need for treatment include:
- Intense and persistent feelings of guilt, anger and/or sadness
- Depression (e.g., persistently depressed mood, inability to experience happiness or pleasure, low self-esteem, suicidal thoughts)
- Change in behavior resulting in behavior problems, anxiety, and/or substance abuse
In the DSM-5 there is a proposed disorder for further study in the appendix called “Persistent Complex Bereavement Disorder” which was based on the current body of bereavement research. While there is much debate about a proposed disorder for bereavement, it is hoped that the proposed disorder will lead to research to help distinguish between “normal, typical or adaptive grief” and “complicated, maladaptive, prolonged or traumatic grief.”
Psychoeducation. Psychoeducation about grief may be helpful to children and families. Pediatricians and other health and mental health professionals are in the position to provide education about grief and loss, promote open discussion about thoughts and feelings related to the loss, and to encourage support within the family.
Support groups. For children who are experiencing some of the typical grief reactions listed above after a loss and/or death, a referral to a loss and grief support group may be helpful.
Referral for a mental health assessment. However, for children who are having persistent grief reactions, symptoms of posttraumatic stress, depression and/or are experiencing impairment in functioning in one or many areas of their life, a referral for an assessment by a mental health specialist is indicated.
Empirically-supported psychotherapy. Empirically-supported psychotherapy that addresses grief, anxiety, or depressive symptoms can be helpful.
Additional Resources and Handouts
On the Find A Provider page of the Kid Catch Directory, you can use the Issues filter box to search for local experts on loss or grief. Clicking on this filter selection will return results of clinicians who advertise themselves as working with this problem. Kid Catch cannot guarantee that clinicians who advertise themselves this way are truly expert.
Information about childhood grief as well as handouts that can be used for psychoeducation can be found at the following websites:
National Alliance for Grieving Children: http://childrengrieve.org/
National Child Traumatic Stress Network: http://www.nctsnet.org/trauma-types/traumatic-grief
- Updated November 27, 2019