Further Reading for Health Professionals - Children’s Grief

1. Bolton, J. M., Au, W., Chateau, D., Walld, R., Leslie, W. D., Enns, J., ... & Sareen, J. (2016). Bereavement after Sibling Death: A Population‐based Longitudinal Case‐control Study. World Psychiatry, 15(1), 59-66. doi: 10.1002/wps.20293 [full text].

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada

The objective of this study was to examine mental disorders and treatment use among bereaved siblings in the general population. Siblings (N=7243) of all deceased children in the population of Manitoba, Canada who died between 1984 and 2009 were matched 1:3 to control siblings (N=21,729) who did not have a sibling die in the study period. Generalized estimating equations were used to compare the two sibling groups in the two years before and after the index child’s death on physician-diagnosed mental disorders and treatment utilization, with adjustment for confounding factors including pre-existing mental illness. Analyses were stratified by age of the bereaved (<13 vs. 13+). Results revealed that, in the two years after the death of the child, bereaved siblings had significantly higher rates of mental disorders than control siblings, even after adjusting for pre-existing mental illness. When comparing the effect of a child’s death on younger versus older siblings, the rise in depression rates from pre-death to post-death was significantly higher for siblings aged under 13 (p<0.0001), increasing more than 7-fold (adjusted relative rate, ARR=7.25, 95% CI: 3.65-14.43). Bereaved siblings aged 13+ had substantial morbidity in the two years after the death: 25% were diagnosed with a mental disorder (vs. 17% of controls), and they had higher rates of almost all mental disorder outcomes compared to controls, including twice the rate of suicide attempts (ARR=2.01, 95% CI: 1.29-3.12). Siblings in the bereaved cohort had higher rates of alcohol and drug use disorders already before the death of their sibling. In conclusion, the death of a child is associated with considerable mental disorder burden among surviving siblings. Pre-existing health problems and social disadvantage do not fully account for the increase in mental disorder rates.

2. Stikkelbroek, Y., Bodden, D., Reitz, E., Vollebergh, W., & Baar, A. (2016). Mental Health of Adolescents before and After the Death of a Parent or Sibling. European Child & Adolescent Psychiatry, 25(1), 49-59. doi:10.1007/s00787-015-0695-3

Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands

The death of a parent or sibling (family bereavement) is associated with mental health problems in approximately, 25 % of the affected children. However, it is still unknown whether mental health problems of family-bereaved adolescents are predicted by pre- existing mental health problems, pre-loss family functioning, or multiple bereavements. In this study, a prospective longitudinal assessment of change in mental health following bereavement was done in a large representative sample from the ‘Tracking Adolescents Individual Lives Survey’ (TRAILS). This is a four-wave prospective cohort study of Dutch adolescents ( n = 2230) of whom 131 (5.9 %) had experienced family bereavement at the last wave (T4). Family-bereaved adolescents reported more internalizing problems, within 2 years after family bereavement, compared to the non-bereaved peers, while taking into account the level of internalizing problems before the bereavement. A clinically relevant finding was that 22 % new cases were found in family-bereaved, in comparison to 5.5 % new cases in non-bereaved. Low SES predicted more internalizing problems in family-bereaved but not in non-bereaved adolescents. Family functioning, reported by the adolescent, did not predict mental health problems within 2 years.

Multiple family bereavements predicted fewer externalizing problems. In conclusion, internalizing problems increase in adolescents after family bereavement in comparison to non-bereaved and these can be predicted by pre-loss factors. Awareness among professionals regarding the risks for aggravation of mental health problems after family loss is needed.

3. Jonas-Simpson, C., Steele, R., Granek, L., Davies, B., & O’Leary, J. (2015). Always with Me: Understanding Experiences of Bereaved Children whose Baby Sibling Died. Death Studies, 39(4), 242-251. doi: 10.1080/07481187.2014.991954

School of Nursing, Faculty of Health , York University , Toronto , Ontario , Canada

An arts-based qualitative method was used to explore the experiences of children’s bereavement after a baby sibling’s death, in the context of their family and school life. Data were collected during in-depth interviews with 9 bereaved children and 5 parents from 4 Canadian families and analyzed. A central process, evolving sibling relationship over the years, and a pattern of vulnerability/resilience, ran through all four themes, which reflected ideas of connection, impact of parental grief, disenfranchisement and growth. Findings indicated that home and school are critical to children in creating safe spaces for expressing the evolving nature of infant sibling bereavement.

4. Morris, A. T., Gabert-Quillen, C., Friebert, S., Carst, N., & Delahanty, D. L. (2016). The Indirect Effect of Positive Parenting on the Relationship between Parent and Sibling Bereavement Outcomes after the Death of a Child. Journal of Pain and Symptom Management, (1), 60. doi:10.1016/j.jpainsymman.2015.08.011

Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs.

5. Buckle, J. (2015). Parenting after the Death of a Child: A Practitioner’s Guide. Routledge, London. Find in an Australian library

The death of a child has a tremendous and overwhelming impact on parents and siblings, completely altering the psychological landscape of the family. In the aftermath of such a tragedy, parents face the challenge of not only dealing with their own grief, but also that of their surviving children. How can someone attempt to cease parenting a deceased child while maintaining this role with his/her other children? Is it possible for a mother or father to effectively deal with feelings of grief and loss while simultaneously helping their surviving children? “Parenting After the Death of a Child: A Practitioner’s Guide” addresses this complex and daunting dilemma. Following on the heels of a qualitative research study that involved interviewing bereaved parents, both fathers and mothers, Buckle and Fleming have put together several different stories of loss and recovery to create an invaluable resource for clinicians, students, and grieving parents. The authors present the experience of losing a child and its subsequent impact on a family in a novel and effective way, demonstrating the strength and importance of their book for the counseling field.

6. Donnelly, K.F. (2015). Surviving Brothers and Sisters. In Recovering from the Loss of a Child. New York: Open Road Media. Find in an Australian library

The pain and shock when a child dies can seem unbearable. But expert-on-grief Katherine Fair Donnelly, who has suffered many personal losses, has gained wisdom and strategies for emotional recovery. By sharing, understanding, and accepting this tragic loss, bereaved parents, siblings, and others can cope with this intense grief. Intimate, telling interviews with survivors present practical ways in which surviving family members can take the necessary steps toward recovering from their devastating loss. [Publisher’s blurb]

7. Grassetti, S. N., Herres, J., Williamson, A. A., Yarger, H. A., Layne, C. M., & Kobak, R. (2015). Narrative Focus Predicts Symptom Change Trajectories in Group Treatment for Traumatized and Bereaved Adolescents. Journal of Clinical Child & Adolescent Psychology, 44(6), 933-941. doi:10.1080/15374416.2014.913249

Department of Psychological and Brain Sciences, University of Delaware, USA

Growing evidence supports the effectiveness of Trauma and Grief Component Therapy for Adolescents (TGCT-A) in reducing posttraumatic stress disorder (PTSD) symptoms and maladaptive grief (MG) reactions. This pilot study explored whether the specific focus of students’ narratives (i.e., focus on trauma vs. focus on loss) as shared by TGCT-A group members would predict initial pretreatment levels, as well as pre- to posttreatment change trajectories, of PTSD symptoms and MG reactions. Thirty-three adolescents from three middle schools completed a 17-week course of group-based TGCT-A. PTSD and MG symptoms were assessed at pretreatment, twice during treatment, and at posttreatment. The focus (trauma vs. loss) of each student’s narrative was coded using transcripts of members’ narratives as shared within the groups. The reliable change index showed that 61% of students reported reliable pre–post improvement in either PTSD symptoms or MG reactions. Students whose narratives focused on loss both reported higher starting levels and showed steeper rates of decline in MG reactions than students whose narratives focused on trauma. In contrast, students whose narratives focused on trauma reported higher starting levels of PTSD than students who narrated loss experiences. However, narrative focus was not significantly linked to the rate at which PTSD symptoms declined over the course of treatment. This study provides preliminary evidence that TGCT-A treatment components are associated with reduced PTSD symptoms and MG reactions. Loss-focused narratives, in particular, appear to be associated with greater decreases in MG reactions.

8. Naumann, E. E. (2015). A Retrospective Examination of Sibling Bereavement Counseling for Children Ages 6-18 (Doctoral dissertation, Ohio University). [full text]

- ... often believe that their sibling’s health will improve and are therefore less able to engage in anticipatory grief work, thus potentially complicating the bereavement process (Pearson, 2009). Child life specialists are often in a position to provide immediate ...

9. Salloum, A. (2015). Grief and Trauma in Children: An Evidence-Based Treatment Manual. Hoboken : Taylor and Francis. Find in an Australian library

University of South Florida, FL, USA

Grief and Trauma in Children provides easy-to-implement, ready-to-use therapy materials to help busy practitioners use grief and trauma interventions in real-world settings. All interventions in the book have been developed and researched with clinicians who faced challenging environments, including devastating natural disasters, and in communities where ongoing violence victimized children directly. Even in these stressful environments, clinicians found the interventions easy to implement, effective in helping children acquire coping skills, and effective in decreasing traumatic symptoms in order to proceed with grieving without impaired functioning. Grief and Trauma in Children blends cognitive-behavioral therapy methods and narrative practices to present an integrated grief and trauma model that can be delivered individually, to a group of children, or to a family. The book uses the Draw, Discuss, Write, Witness (DDWW) method to help children explore narratives of resilience and build coping capacity, engage in restorative stories about what happened, and reconnect and reengage in meaningful ways that allow the child to enjoy life again and get back on-track developmentally. Grief and Trauma in Children also provides up-to-date research on childhood bereavement and trauma, a brief description of the theoretical framework of the Grief and Trauma Intervention (GTI) model, a description of session-by-session goals and activities, case examples with ways to address common challenges, and photocopiable tools for clinicians to easily implement the model, such as session agendas, fidelity checklists, handouts for parents, and activity sheets for children.

10. Schonfeld, D., Quackenbush, M., & Demaria, T. (2015). Grief across Cultures: Awareness for Schools. NASN School Nurse, 30(6), 350. doi: 10.1177/1942602X15610321

National Center for School Crisis and Bereavement, University of Southern California School of Social Work and Children’s Hospital Los Angeles, CA, USA

Extract: School personnel may not be familiar with the rituals and expectations of every culture represented among their students. Rather than reaching out to a family after the death of a loved one, some hold back, concerned they might say something inappropriate or unintentionally offend the family…Although there are real differences in traditions between cultures, the fundamental experience of grief is universal. Rather than trying to gain knowledge about every culture, it’s best to first aim to become competent in supporting a grieving individual in at least one culture. Probably your own would be a good start. If someone is able to be thoughtful, empathic, sensitive, and supportive to a grieving child of one culture, chances are quite good that this person will be able to help a child of another culture…

11. Machajewski, V., & Kronk, R. (2013). Childhood Grief Related to the Death of a Sibling. Journal for Nurse Practitioners, 9(7), 443-448 6p. doi:10.1016/j.nurpra.2013.03.020

Gateway Health of Pittsburgh, PA, USA

Unfortunately, children die each day, many leaving a childhood sibling survivor. Events such as those at Sandy Hook Elementary School or inner city violence bring the plight of the childhood sibling survivor more to the forefront. Although previous literature and research have focused on the grief process of adults or teenagers, an urgent need remains to understand the grief process of the younger sibling survivor. This article examines the grief process of a sibling survivor within the framework of childhood developmental stages to assist the family nurse practitioner in caring for the sibling survivor on the grief journey.

12. Chadwick, A. (2012). Talking About Death and Bereavement at School: How to Help Children Aged 4 to 11 to Feel Supported and Understood. London, England: Jessica Kingsley Publishers.

13. Malone, P. A. (2012). The Impact of Peer Death on Adolescent Girls: An Efficacy Study of the Adolescent Grief and Loss Group. Social Work With Groups, 35(1), 35-49. doi:10.1080/01609513.2011.561423

This study examines the efficacy of the Adolescent Grief and Loss (AGL) group, a 6-week group designed to address the needs of adolescent girls who have experienced the death of a peer within the past 2 years. The goal of the AGL group was to reduce or lessen physical, emotional, social, and cognitive responses to grief. The results indicate that adolescent girls benefited from participation in the AGL group as evidenced by significantly reduced scores on the Loss Response List for all domains of physical, emotional, social, and cognitive grief responses.

14. Wender, E. (2012). Supporting the Family after the Death of a Child. Pediatrics, 130(6), 1164-1169. doi:10.1542/peds.2012-2772 [full text]

The Committee on Psychosocial Aspects of Child and Family Health

The death of a child can have a devastating effect on the family. The pediatrician has an important role to play in supporting the parents and any siblings still in his or her practice after such a death. Pediatricians may be poorly prepared to provide this support. Also, because of the pain of confronting the grief of family members, they may be reluctant to become involved. This statement gives guidelines to help the pediatrician provide such support. It describes the grief reactions that can be expected in family members after the death of a child. Ways of supporting family members are suggested, and other helpful resources in the community are described. The goal of this guidance is to prevent outcomes that may impair the health and development of affected parents and children.

15. Burns, Donna M (2010). When Kids are Grieving: Addressing Grief and Loss in School. Corwin, Thousand Oaks, Calif. [Find in an Australian library]

This primer on loss and grief helps educators and counsellors understand and respond to the extraordinary challenges that children and adolescents may face when dealing with loss and grief. The book explains how children and adolescents are affected by various forms of loss.

16. Monroe, Barbara & Kraus, Frances (2010). Brief Interventions with Bereaved Children (2nd ed). Oxford University Press, Oxford. Find in an Australian library

“Recent years have seen increasing interest in the needs of children facing bereavement, and a corresponding increase in services to support them. This book addresses and explains the theoretical concepts and practical implications behind the idea of brief work with bereaved children and families. Flexible and accessible short term services delivered at the right time underpin the strengths of bereaved children, supporting their recovery rather than pathologizing the grief process. In this way, the book also speaks to the current interest in the concept of resilience and working with families’ strengths and possibilities, rather than merely identifying their problems. This second edition continues to be a unique book within the growing field of childhood bereavement, and the new chapters added to this edition discuss managing situations with learning disabilities, supporting very young children and emotional literacy. The book also presents cases from the service user’s perspective. It looks at different approaches to intervention, such as the importance of assessment and the value of groupwork, and also covers work with children and families before a death. Brief Interventions with Bereaved Children will appeal to practitioners, educators, and service providers managing scarce resources. The editors have more than twenty-five years experience as practitioners within the field, as service providers and educators. The book features chapters from distinguished contributors with backgrounds in healthcare, education, social work, and the police, alongside theoretical and practice-based chapters from workers in the field of bereavement care for children”—Provided by publisher.

17. Pearlman, Michelle Y & Schwalbe, Karen D’Angelo & Cloitre, Marylène (2010). Grief in Childhood: Fundamentals of Treatment in Clinical Practice. American Psychological Association, Washington, DC. Find in an Australian library

This book presents Integrated Grief Therapy for Children, an evidence-based model for treating bereaved children that draws extensively on cognitive behavioral, family systems, and narrative approaches to therapy. The model shows clinicians how to assess the needs of bereaved children, treat common distressing symptoms (depression, posttraumatic stress disorder, anxiety, and behavioral problems), and address the grief itself while fostering resilience.

18. Webb, N. B. (2010). Helping Bereaved Children: A Handbook for Practitioners (3rd edn.). New York : Guilford Press. Find in an Australian library

Contents include: The grief of siblings / Betty Davies & Rana Limbo—The Disenfarnchised Grief of Children / David Crenshaw & Jennifer Lee—Suicide in the Family: Helping Child and Adolescent Survivors / Cynthia McCormack & Nancy Boyd Webb—Storytelling with bereaved children / Donna O’Toole.

19. Hindmarch, C. (2009). Guidelines for talking with children. In On the Death of a Child (3rd ed). Radcliffe Publishing, Abingdon, Oxon [England]. Find in an Australian library

“The death of a child - whether during or following birth, through illness, through accident, or through suicide - is one of the greatest challenges families, carers, friends, and the health and social care professionals who support them can face. This book provides professionals with practical advice, resources for further support and reading, and much-needed reassurance that whatever contact they have with the bereaved, and however inadequate they may feel to the task, they can make a difference.”—BOOK JACKET.

20. Dyregrov, A. (2008). Grief in Children: A Handbook for Adults (2nd ed). London Jessica Kingsley Publishers. Find in an Australian library

21. Markell, Kathryn A & Markell, Marc A (2008). The Children Who Lived: Using Harry Potter and other Fictional Characters to Help Grieving Children and Adolescents. Routledge, New York. Find in an Australian library

“Like many of the best children’s stories, the books in J. K. Rowling’s Harry Potter series are filled with loss and grief. These real-life issues are experienced in a world filled with fantastic creatures and magic, but not even wizards and witches can easily explain them or take away the pain they cause. Literature, however, like magic, can open up new worlds for people, showing them myriad ways to survive losses and challenges, and even to flourish beyond them. Markell and Markell use examples from Harry Potter and other classic children’s books to show that these stories can be used to help children and adolescents deal with their own grief and loss-issues. After thoroughly examining these instances, they provide dozens of original activities, games, and discussion questions that can be used to help struggling children and adolescents, all of which are easily adaptable for use with other stories and characters. Highly original and filled with an unparalleled creativity, The Children Who Lived Is sure to be an invaluable resource for educators, counselors, and parents for some time to come.”—BOOK JACKET.

22. Perkins, J. (2007). How to Help a Child Cope with Grief: A Book for Adults who Live or Work with Bereaved Children. Foulsham, London. Find in an Australian library

23. Price, S. K. (2007). Social Work, Siblings, and SIDS: Conceptual and Case-Based Guidance for Family System Intervention. Journal of Social Work in End-of-life & Palliative Care, 3(3), 81. doi:10.1300/J457v03n03•

Virginia Commonwealth University School of Social Work, Richmond, VA, USA

Sudden Infant Death Syndrome (SIDS) is a tragic loss event within the family, impacting adults as well as children. This article uses three case illustrations to discuss the role of a SIDS event on the family system with a special focus on the emergent challenges for surviving siblings of various ages. Practice application examples are woven throughout the review to illustrate the age-specific grief responses which may occur following a SIDS event. The article also presents a theoretically supported intervention matrix that integrates models of bereavement support and family system responses, taking into account children’s varying developmental needs and tasks based on sibling age.

24. St. Thomas, Bruce & Johnson, Paul (Paul Gordon), 1959- & ebrary, Inc (2007). Empowering Children through Art and Expression: Culturally Sensitive ways of Healing Trauma and Grief. London : Jessica Kingsley Publishers. Find in an Australian library

25. Horsley, H., & Patterson, T. (2006). The Effects of a Parent Guidance Intervention on communication among Adolescents who have Experienced the Sudden Death of a Sibling. American Journal of Family Therapy, 34(2), 119-137.

FDNY/Columbia University Family Assessment and Guidance Program, Adjunct Assistant Professor, Columbia University, School of Social Work, New York, USA

This study examined the effectiveness of an intensive parent guidance intervention with bereaved adolescents relative to communication. Five adolescents participated in the study, all of whom had experienced the sudden death of a sibling 12 to 24 months prior to the research study. Based on a single-case design, the results re- flected a strong pattern of increased communication between the adolescents and their parents during and after the intervention. This study demonstrates that helping bereaved adolescents recognize the importance of communication skills in everyday life allows them to feel understood, acknowledged, and less alone in their grief.

26. Dent, Ann & Stewart, Alison (2004). Family Bereavement: The Experience of Surviving Children. In Sudden Death in Childhood: Support for the Bereaved Family. Butterworth-Heinemann, Edinburgh. Find in an Australian library

27. Foley, T., & Lenehan, G. (2004). Clinical Notebook. Encouraging the Inclusion of Children in Grief after a Sudden Death: Memory Bags. JEN: Journal of Emergency Nursing, 30(4), 341-394. doi:10.1016/j.jen.2004.03.032

Chaplain, Emergency Department, Northwest Community Hospital, Arlington Heights, IL, USA

Extract: The family is here. Those 4 words are dreaded by ED staff when a death has occurred in the emergency department. The words hold special significance for me; when I was 9 years old, I had already experienced death and dying in my own family. One of my brothers suffered severe head trauma, and another brother died at the age of 13 years. He drowned while swimming with friends after school. I remember it all as if it were yesterday. Most of all I remember being pushed away and being told I did not understand, to “leave your mom alone, she’s upset.” This experience only pushed my pain deeper into a place where it would take a long time to access. This experience in part became the foundation for my current career and my strong interest in children’s crises. In times of pain and grief, children learn how to deal with loss by watching adults, through what the psychologist Kohut calls “mirroring.”…

28. Ryan-Mckissock, Di (2004). Kid’s Grief: A Handbook for Group Leaders. Terrigal, NSW National Centre for Childhood Grief.

At the beginning - Ethical and legal issues - Pre-group planning - Kids’ grief - Palling you support program - Sample support groups, including when family members are dying - Group resources - Reading resources and services.

Last reviewed: 25/4/24