a child dies, siblings are often referred to as the “forgotten mourners.” They are
left to grieve their sibling while also experiencing what feels like the loss
of their parents as they mourn. Siblings may experience a wide range of
emotions, varying from sadness to anger and even seeming indifference.
children age and pass through different developmental phases, they may
reprocess their grief and it may appear as if they are re-living their loss. We
have experienced this first hand with Tessa. As a 3-year-old, she was most
preoccupied with where Conor had gone and why we couldn’t bring him back. Now,
as a 5-year-old, her questions are more abstract and detailed. Did he want to
leave us? Will her younger sister Isabelle die? If we didn’t know Conor was
going to die, how can we be sure she and Isabelle will not?
this path of grief is important for pediatricians to ensure that surviving and
subsequent siblings are receiving adequate support--not just in the immediate
aftermath of their sibling’s death, but also in the months and years that
follow. It also is important to recognize that children born after their
sibling died can still experience grief, as their family dynamics have been
are in a unique position to help support these children and ensure they receive
adequate intervention. Placing a flag in the siblings’ chart can serve as a
reminder to check in at annual physicals. Pediatricians can make referrals for
age appropriate books, discuss strategies for parents to explain death and
grieving in developmentally appropriate ways with the child, facilitate
referrals for age appropriate grief support groups or camps, and when
necessary, make referrals to mental health professionals. It is important for
pediatricians to be aware of and educate parents on normal grief responses in
children at different developmental stages and to screen for any red flags that
may call for further intervention.
"In addition to our own mourning, we have had to manage the grief and questions of Tessa, who suddenly and unexpectedly lost her younger brother, her best friend, her constant companion. How could we answer her questions when no one could answer ours?”
of the best ways for us to handle Tessa’s questions was to connect with other
parents who had navigated this path. At a retreat
for families affected by SUDC, we saw the power of connecting siblings who had
a shared experience of loss. We soon discovered that there were no “right”
answers, but there was comfort in talking with other families.
SUDC Foundation funded a grant for a collaboration between the AAP and the
National Association of Medical Examiners to create consensus guidelines for
the investigation of sudden deaths in pediatrics, including recommendations for
the care of families affected by these deaths. These guidelines are anticipated
to be published within the next year and will be a valuable resource for
remember someone telling us that Tessa would be too young to remember her loss.
This felt like a stab through the heart. Our worst fear was that she would
forget Conor. While we wish we could erase her pain, we would never want her to
forget her brother and their special bond. The intense heartbreak of losing
your child and being left without answers is compounded as you watch your
surviving children grieve.
in watching Tessa grieve, we also see great love. Shortly after Conor died, we
saw the most beautiful sunset and Tessa told us Conor had painted the sky pink
for us. Sunsets have now become a special manifestation of their everlasting
we see grief as a manifestation of love, we destigmatize it. In order for
children to talk more openly about grief, we need to provide a forum for these
discussions. Pediatricians should not steer away from the difficult questions
of asking about sibling loss, but rather provide an opportunity for children to
share their feelings and memories.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Bowen, MD, FAAP, is a
member of the American Academy of Pediatrics Section on Child Death Review and
Prevention. She also serves as a member
of the Board of Directors of the SUDC Foundation. Dr. Bowen practices in