Death creates a deep, lifelong impact for kids in every part of the world. In the United States, around 1 in 20 children will lose a parent by age 16—and countless others will grieve for a grandparent, sibling or someone else they love.

Doctors who treat children and teens know the health impact that serious losses like these can have on their health and development. In a busy practice, pediatricians see at least one child per week who may be grieving the death of a relative or friend. Here’s what to know when your child is mourning a loved one—and how your pediatrician can help.

Grief is the pain we experience after losing something or someone we love. Although people grieve many kinds of loss or separation, grief is often linked with the pain that follows the death of someone close to them.

Children of all ages may mourn the loss of someone whether they were family or not. Neighbors, friends, teachers, coaches, caregivers and others they loved or cared about may touch off a time of mourning.

Grief can cause disbelief, denial, confusion, anger, anxiety and deep longing for a loved one to come back. These emotions can affect a child’s physical health, since they can interfere with healthy sleep, regular meals and more. Losses that feel overwhelming can also fuel anxiety, depression, self-harm and thoughts of suicide in children and teens.

It’s helpful to realize that other forms of loss can create grief, too. For example, kids who desperately miss a divorced parent they no longer live with, or whose close family members are in jail or prison, may feel the loss very deeply. Others whose parents have been deported or moved away for work opportunities may suffer, too.

Whatever your child’s history or circumstances, keep in mind they won’t simply "get over" a loved one’s death within a few months or even a year. They will spend the rest of their lives dealing with the loss. Future milestones such as graduating from high school or college, moving to a new home, falling in love or becoming parents themselves can throw "adult children" who lost someone dear to them temporarily off-course, even decades later.

Though you can’t erase the pain your child feels, there are many ways to help them deal with their grief. Here are some steps that you can take now to protect their health and enable them to navigate grief and loss better as adults:

Be clear and honest. As adults, we might assume that the less we talk about death with children the better. But kids of all ages can benefit when caring adults take time to offer a framework for understanding death, using words that match the child’s age and level of development. It is helpful to discuss how the person who died is not in pain or suffering, for example.

Don’t assume that older children are fine, even if they seem calm and accepting. You might open a conversation by saying, "I’m wondering which part of this is the hardest for you." If kids can’t or won’t talk, let them know you love them and try again later. Children may hide their own grief because they believe sharing their feelings will make others—especially parents—feel worse.

Allow feelings to flow. Let them know that it’s healthy to cry or talk about how we feel when we’re sad. Open the door by saying something like, "I’m glad you’re brave enough to show how you feel, because I’m sad too, and being with you makes me feel less alone."

Address harmful beliefs like blame and guilt—your child’s and your own. You could ask, "Sometimes when bad things happen, people feel like they must have done something bad. I know it wasn’t your fault that your mother died, but a lot of kids still think they are to blame after someone they love dies. Have you ever felt that way?" An open conversation can address a child’s feelings of guilt or shame while reminding you to go easy on yourself, too.

Try to keep routines in place. Regular meals, bedtimes and attention to little things like tooth-brushing and laying out clothes for the next day can help kids feel secure and loved, even in times of loss. Adapt and support your child as needed. You don’t need to go back to all routines right away, but it’s good to have some predictability. Even small steps that keep home life stable will benefit all of you.

Accept help from friends and community. This shows your child that in difficult times, the people around us can make a difference. Welcoming help in the form of meals, chores or rides to work or school also lightens your load, giving you more time and energy to spend with your child.

Your child’s age, overall health and past experiences may also make a difference in their ability to cope with the death of a loved one. Pay close attention to the reactions and needs of preschoolers and adolescents; teens and young adults in transition (e.g., leaving home to go to college, the military or to start a career); children who are adopted, in foster care or kinship care; children with neurodevelopmental and other special needs; and children with mental health concerns.

Many children and teens need focused support in processing grief. Watch for signs of major changes in your child’s approach to everyday life. For example, you might be concerned if a child who loves to tell stories becomes unusually quiet, responding to questions with one- or two-word answers. Or if a teen who’s known for being a "take-charge" person struggles to make choices or manage time effectively. Be alert if your once-gentle preschooler begins to hit, push or shout at classmates or teachers.

If you are concerned, call your doctor. Pediatricians and family physicians care about the well-being of your child’s body and mind. They can screen for specific concerns and talk privately with kids who feel reluctant to speak in front of others. They can also refer you for grief counseling and community programs such as support groups and camps for kids grieving a serious loss.

Talk with teachers, school mental health professionals, coaches and other support people. Grief can interfere with school, sports, youth groups and other mainstays of your child’s life.

While you want to respect your child’s privacy, it’s helpful to let teachers, counselors, coaches and youth group leaders know what’s happening. For older kids, ask their permission and explain why sharing this information with these caring adults is helpful; it lets them see your child with compassion, provide learning supports and accommodations, develop plans for addressing grief triggers in class or other groups settings, and share programs and resources that can help your family.

For more information, go to HealthyChildren.org.

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About Dr. Schonfeld

David Schonfeld, MD, FAAPDavid Schonfeld, MD, FAAP, is an Executive Committee member of the AAP Council on Children and Disasters and a member of the Section on Developmental and Behavioral Pediatrics. He also serves as Director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles, and Professor of Clinical Pediatrics, Keck School of Medicine of USC.

About Dr. Nasir

Arwa Nasir, MBBS, MSc, MPH. FAAPArwa Nasir, MBBS, MSc, MPH. FAAP, is a Professor of Pediatrics at the University of Nebraska Medical Center and Chair of the AAP Committee on the Psychosocial Aspects of Child and Family Health.

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