Managing traumatic stress in children anticipating parental death

QUALITATIVE EVIDENCE drawn from a community study of 58 parentally bereaved school-age children and their surviving parents provides a descriptive exploration of one of the most difficult challenges faced by families in anticipated deaths: managing the stress of a child's exposure to the graphic physical, emotional, and mental deterioration of the dying parent. The concept of traumatic stress is broadly defined to include exposure to the "fact" of impending death itself, that is, the anxiety that comes from knowing that one may lose a close other. Included, as well, is an exploration of secondary traumatic stress, defined here to cover the notion of the stress of watching other loved ones in the family succumb to terror and anxiety about the impending death. Emphasis is placed on a child's unique vulnerability to traumatic stressors and on the role of parenting in mediating child exposure to parental decline. In contrast to the anticipatory grief literature which emphasizes the advantages of forewarning in cushioning postmortem adjustment, this study documents the adverse impact of a child's exposure to graphic stimuli. These findings underscore the need for clinicians to attend to the traumatic stress of "ordinary" anticipated deaths, rather than maintaining an exclusive grief orientation.