Pediatrician guidance on supporting a family after a child or adolescent death

Takeaways

• The report reveals leading causes of child deaths and emphasizes the need for emotional and practical assistance for grieving families.
• COVID-19 has disproportionately affected certain racial and ethnic groups among children.
• Compassionate care, active listening, and cultural understanding are essential for pediatricians supporting grieving families.
• Surviving siblings require follow-up support, considering their unique grief processes and providing information on available resources.

The American Academy of Pediatrics (AAP) has issued guidance for pediatricians working with families following a child or adolescent death. Whether an unexpected loss or from an illness, a child death is traumatic and stressful for all family members involved.

Pediatricians play a critical role when it comes to helping families who are unfortunately going through the loss of a child. The AAP report, published November 27, 2023, highlights recent evidence on grief, mourning, and bereavement to help support families.

According to the AAP, there were 19,582 infant deaths in 2020, with a mortality rate of 541.9 deaths per 100,000 live births. Leading causes include congenital and chromosomal disorders, related to short gestation and low birth weight, and sudden infant death syndrome (SIDS).

In 2020, 3529 children aged 1 to 4 years died (22.7 per 100,000 live births), with injuries, congenital and chromosomal disorders, and assault (homicide) serving as the leading causes.

The same year, there were 5623 deaths among children aged 5 to 14 years, with injuries, cancer, and congenital and chromosomal disorders being the leading causes among those aged 5 to 9 years.

Children aged 10 to 14 years had injuries, suicide, and cancer as leading causes of death.

There were 12,278 teenager (15 to 19 years) deaths in 2020, creating a mortality rate of 58.6 deaths per 100,000 live births, with injuries, homicide, and suicide being the leading causes of death.

The COVID-19 pandemic revealed pediatric vulnerability. By March 2022, approximately 335 children aged 4 years or younger died as a result of a COVID-19 infection, as did 737 children and teenagers aged 5 to 18 years.

American Indian/Alaska Native, Black, and Hispanic children make up 41% of the United States population under age 20 years. However, this group accounted for 78% of COVID-19-related deaths in this age group, according to the report.

The AAP states families are often in need of emotional and practical support throughout the grief journey. The pediatrician and the practice can provide this important support and link the family to additional community resources.

In part, the AAP recommends that pediatricians understand compassion is a “universal language of care and can be expressed through taking the time to listen and provide emotional support to a family.”

Understanding the knowledge about the structure of the family and its respective support system can play a role in determining and recognizing each family’s needs. The pediatrician should also consult with the family to learn religious or cultural traditions.

In the event a child is “seriously ill or dying,” pediatricians should consider visiting their patients in the emergency department or pediatric intensive care units. They should consider setting up a phone call or in-person meeting with the child’s caregiver.

Guidance should be provided along with follow-ups to surviving siblings who are still patients.

“A pediatrician can provide comfort, compassion and a listening ear, and also offer practical information, like where to find a community bereavement program or grief counseling,” said Meaghann S. Weaver, MD, PhD, MPH, FAAP, lead author of the report, in a press release from the AAP.

“If there are siblings, each child may process grief in their own way, based on their age and maturity level. There are no easy paths through the grieving process, but having support from a variety of places, including the medical provider, is critical.”

For more on the recent guidance from the AAP, click here.

Reference:

Weaver MS, Nasir A, Lord BT, Starin A, Linebarger JS. COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, SECTION ON HOSPICE AND PALLIATIVE MEDICINE; Supporting the Family After the Death of a Child or Adolescent. Pediatrics 2023; e2023064426. 10.1542/peds.2023-064426

Join us, as fellow seekers of change, on a transformative journey at https://sdgtalks.ai/welcome, where you can become a member and actively contribute to shaping a brighter future.