A death in the family: the pediatrician's role

The loss of a parent or sibling can have a profound effect on the psychosocial development of the surviving child. The pediatrician, by virtue of his or her longitudinal involvement with children, is in a unique position to provide anticipatory guidance for the family in which such a loss has taken place. This article reviews children's cognitive understanding of death, the distinction between normal and pathologic grief, and the impact of the loss of a parent or sibling on the course of family relations and the development of the children involved. Some of the common problems that may be manifest in children subsequent to such a loss, together with appropriate interventions, are outlined. Most situations can be best handled by the pediatrician, but criteria for seeking psychiatric consultation are provided.