INTRODUCTION

It is not clear exactly how many young people are affected by the death of an immediate family member. Kliman estimates that 5 percent of children in the United States—1.5 million—lose one or both parents by age 15; others suggest that the proportion is substantially higher in lower socioeconomic groups. This chapter discusses the types of bereavements considered to have the most serious implications for medical, psychiatric, and behavioral sequelae in children—namely, death of a parent or sibling. Because more of the literature in this field deals with parental than with sibling loss and because many of the reactions to both types of bereavement overlap, most of the discussion is based on studies of response to the death of a parent.Bereaved Parents

Individuals continue to grow and develop throughout life, but during no other period beyond childhood and adolescence are specific reactions as likely to be influenced by the level of development. Because the impact of trauma in children depends so heavily on the life stage during which the event occurs, this chapter is informed by a particular emphasis on developmental analysis. This perspective assumes that the repercussions and meanings of major object loss will be colored by the individual child’s level of development. Psychiatrists and others have generally been struck by how often major childhood loss seems to result in psychopathology. Studies of adults with various mental disorders, especially depression, frequently reveal childhood bereavement, suggesting that such loss may precipitate or contribute to the development of a variety of psychiatric disorders and that this experience can render a person emotionally vulnerable for life. This special vulnerability of children is attributed to developmental immaturity and insufficiently developed coping capacities.Bereaved Parents

The tendency to impose adult models on children has generally led to a great deal of confusion and misunderstanding about children’s grieving. Although sharing some similarities with adults and even with monkeys , children’s reactions to loss do not look exactly like adults’ reactions, either in their specific manifestations or in their duration.Bereaved Parents

For example, often what seems glib and unemotional in the small child—such as telling every visitor or stranger on the street, “my sister died”—is the child’s way of seeking support and observing others to gauge how he or she should feel. Children may be observed playing games in which the death or funeral activities are reenacted in an effort to master the loss. A child may ask the same questions about the death over and over again, not so much for the factual value of the information as for reassurance that the story has not changed. A four- or five-year-old might resume playing following a death as if nothing distressing had happened. Such behavior reflects the cognitive and emotional capacity of the child and does not mean that the death had no impact.