Bereavement Case Summary
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​Bereavement Case Summary

Case Summary:

  • Doug is an 11-year-old boy and an only child of a married couple living in suburban New Jersey.

  • Doug had alw​ays been he​althy, had many interests, and had been doing well in school.

  • In March 2002, Doug and his mother attend his annual check-up with the pediatrician who has seen Doug since the age of five.

  • During this visit, the pediatrician learns that Doug's grades have dropped due in part to more time being devoted to helping his mother with household chores.

  • Upon further questioning by the pediatrician, Doug's mother discloses that her husband was killed in the attack on the World Trade Center.

  • Neither mother nor son initially volunteered information about the death of Doug's father on September 11th.

  • The pediatrician continues the interview by asking how Doug and his mother first learned about his father's death, their reactions to date and how they have started to adjust.

  • To rule out signs of PTSD, depression, or anxiety Doug is interviewed privately by his doctor who asks Doug to describe the events of the day.

  • Doug tells him that his father left a message on their phone machine on the morning of September 11th to say that he was all right; but then he never came home.

  • Doug wondered if his father might still be alive if he had not gone to school that day and had been home to speak to him.

  • To better assess what is going on at home, the pediatrician also speaks to Doug's mother alone.

  • She tells him that although she is close to falling apart and feels very sad and alone, she is getting great support from Doug.

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Key Teaching Points
  1. Eliciting what might have changed in a child's/family's life since the last primary care visit is critical step. Even with major life events, parents may ultimately be able to seek help or raise the issue with their physician, but many are reluctant or hesitant to do so. Openness to discussion can be communicated to families through active listening and open-ended questions that invite dialogue.

  2. Loss of a parent is unfortunately experienced by about 5% of children by the age of 16. Primary care physicians should be prepared to counsel and support families through this difficult time. Concrete steps that can aid in this area are drawing upon the established relationship with the family, active listening, and providing guidance about the normal reactions to grief.

  3. Grief and mourning are normative reactions to loss and by themselves do not require medication or traditional mental health services. However, a supportive environment in the primary care setting and availability of community resources can be exceedingly helpful for families struggling with a loss. Detecting more serious depression can be assisted by the use of a screening tool such as the PSC.

View additional information on the prevalence, risk factors, and how pediatricians can provide assistance. 

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