Supporting the bereaved child in the adult ICU: a narrative review

Childhood bereavement is a significant issue globally, affecting millions of children each year, with incidence rates significantly increasing following the COVID-19 pandemic. The loss of an important adult, particularly in the ICU environment, can lead to lasting psychological and behavioural challenges for children. While family-centred practices in the ICU have advanced, the unique bereavement needs of grieving children in the family remain insufficiently addressed. Both families and healthcare professionals (HCPs) often feel unprepared and uncomfortable engaging in honest, supportive conversations with children about bereavement, further complicating children's grief processing. This narrative review examines the pivotal role ICU HCPs can play in facilitating child-centred bereavement support, focusing on promoting honest communication, supportive visitation practices, creating a child-friendly and humanised ICU environment, and encouraging child involvement during end-of-life care. It recommends prioritising research on the lived experiences of bereaved children, caregivers, and ICU HCPs to inform targeted interventions addressing children's developmental and psychological needs during ICU bereavement. The review also advocates for specialised training to equip ICU staff with the necessary skills to support grieving children and families. Developing comprehensive, child-centred ICU bereavement guidelines will provide evidence-based frameworks that recognise children as integral family members during end-of-life care while advocating for the participation of children in meaningful rituals will empower families to make informed decisions about their involvement. Together, these recommendations aim to create a more compassionate, inclusive, and supportive bereavement experience in ICU settings, prioritising the unique needs of children and promoting healthy emotional adjustment after losing an important adult.