Death and Dying in Children

Most often the death of a child happens in the hospital or emergency department. Death can occur after a prolonged illness, such as cancer, or suddenly and unexpectedly, such as after an injury or sudden infant death. The death of a child can be difficult for families to comprehend and accept. For parents, the death of a child means that they must give up their dreams and hopes for their child. The grieving process may also mean that they are unable to attend to the needs of other family members, including other children. Health care practitioners can help in the process by being available to the family for consultation and to provide comfort whenever possible (1, 2). In some circumstances, referral to specialists skilled in working with families who have experienced the death of a child is appropriate.

Some parents respond to the death of a child by quickly planning another pregnancy, perhaps in an attempt to create a "replacement" child. Health care providers who have a supportive relationship with the grieving parents should dissuade such a quick pregnancy. As parents embark on a subsequent pregnancy, anxiety and fear of another loss may make it difficult for them to form an attachment to the new child. A child who is born after another child has died is at risk of replacement child syndrome or vulnerable child syndrome.

In replacement child syndrome, feelings and expectations for the "ideal" child who died are overlaid on feelings for the next child.

In vulnerable child syndrome, because of their previous loss, parents mistakenly perceive the new child to be at risk of behavioral, developmental, or medical problems and think the child needs special care and protection from potential harm.

Parents who are grieving the loss of a dead child and who are also struggling with an inability to attach to a new child need to know their feelings are normal. If their feelings are not acknowledged as normal, the parents and child are at risk of mental health disorders. The next pregnancy, when and if it occurs, should be forward-looking and not backward-looking.

Many children experience the death of a loved one. The way children perceive the event (and hence the best response by parents and health care practitioners) is affected by their developmental level. Preschool children may have limited understanding of death. Relating the event to previous experience with a beloved pet may be helpful. Older children may be able to understand the event more easily. Death should never be equated with going to sleep and never waking up because children may become fearful of sleeping.

Parents should discuss with health care practitioners whether to have children visit severely ill children or adults. Some children may express a specific desire to visit family members or friends who are dying. Children should be adequately prepared for such a visit so they will know what to expect. In the same way, adults often wonder whether to bring children to a funeral. This decision should be made individually, in consultation with the children whenever possible. When children attend a funeral, a close friend or relative should accompany them to provide support throughout, and children should be allowed to leave if necessary.

1. 1. Wender E, The Committee on Psychosocial Aspects of Child and Family Health: Supporting the family after the death of a child. Pediatrics 130(6):1164–1169, 2012. doi: 10.1542/peds.2012-2772

2. 2. Schonfeld DJ, Demaria T, AAP Committee on Psychosocial Aspects of Child and Family Health, Disaster Preparedness Advisory Council: Supporting the grieving child and family. Pediatrics 138(3):e20162147, 2016. doi: 10.1542/peds.2016-2147