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陈明 翻译 2017-4-28

Sibling Death and Childhood Traumatic Grief:Introduction to Childhood Grief
陈明 译

Sleep and his Half-brother Death (John William Waterhouse 1874)

Information for Families

Like adults, children and teens may feel intense sadness and loss, or grief, when a person close to them dies. And like adults, children and teens express their grief in how they behave, what they think and say, and how they feel emotionally and physically. Each child grieves differently, and there is no right or wrong way or length of time to grieve.

Some grief reactions cut across all age groups and developmental levels, and children may show their grief in many different ways. For example, grieving children or teens of any age may sleep or cry more than usual. They may regress and return to earlier behaviors, or they may develop new fears or problems in school. They may complain about aches and pains. They may be angry and irritable, or they may become withdrawn and isolate themselves from family and friends.

Bereaved children may also act in ways that those around them may not recognize as grief reactions. For example, a quiet toddler may have more tantrums, an active child may lose interest in things he or she used to do, or a studious teen may engage in risky behavior. Whatever a child’s age, he or she may feel unrealistic guilt about having caused the death. Sometimes bereaved children take on adult responsibilities and worry about surviving family members and who would care for them if something happened to their caregivers.

Childhood Traumatic Grief

After someone important dies, some children and teens may experience greater than usual sadness and upset and have a more intense reaction known as childhood traumatic grief. In childhood traumatic grief, children develop symptoms associated with posttraumatic stress disorder (PTSD). Children may be more likely to experience traumatic grief if the death was sudden or traumatic, if it occurred under terrifying circumstances, or if the child witnessed or learned of horrific details surrounding the death. Also, although posttraumatic stress reactions may occur after someone has been killed suddenly, they may also occur when the death was expected (such as following a long illness or disabling injury).

Not all children who experience the death of someone special under traumatic circumstances develop traumatic grief. However, in some cases, children may develop symptoms that interfere with their ability to grieve and to have comforting memories of the person who died. Traumatic grief may also interfere with everyday activities such as being with friends and doing schoolwork. PTSD symptoms in children with traumatic grief can include:

In general, if it becomes apparent that your child or teen is having very upsetting memories, avoiding activities or feelings, or experiencing physical, emotional, or learning problems, he or she may be having a traumatic grief reaction. (See Table 1 for examples of common and traumatic grief reactions in children at various ages.)

You may wish to seek help or counseling for your child or teen if grief reactions seem to continue without any relief, if they appear for the first time after an initial period of relative calm, if they get worse, or if they interfere with your child’s being with friends, going to school, or enjoying activities.

Table 1. Children’s Understanding of Death and Reactions to Grief
表1 儿童对死亡的理解和悲痛反应

Preschool and young children学龄前儿童和幼儿

Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应

School-age children学龄儿童

Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应


Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应


Grief and Sibling Death

The death of someone special can be very difficult and sad for a child or teen, but when it is a sibling who dies, the family faces a unique set of challenges. Siblings often have very complicated relationships. Sisters and brothers experience a range of sometimes conflicting feelings for each other—they may love and look up to one another, older siblings may feel responsible for, enjoy and/or resent caring for younger ones, or they may be jealous and fight—and their relationships can change over time.

When a sibling dies, these past relationships and feelings can affect the surviving child’s grief and the family’s bereavement process. Grieving siblings may show some or all of the following common reactions, and there are many ways in which parents and caregivers can help them cope.

Caregiver and Family Grief

If you have lost a child, the way in which you handle your grief can affect the bereavement process for your surviving children. In some parents and caregivers, grief over a lost child causes them to pull away or become emotionally absent from their surviving children. When this occurs, the surviving siblings may feel guilty for being happy or for needing their parents’ support. They may fear that their parents will never recover from the loss and feel a need to take care of their parents or be perfect to avoid upsetting them further. Children may believe their parents blame them for the sibling’s death and even act out because they feel they need to be punished, or to try to do everything right in an effort to “make up” for what they did.

If you are dealing with the loss of a child, it is important to have an active support network as well as safe places to express your grief. When you manage your own grief effectively, it eases the burden felt by the surviving children, offers them a positive role model for coping, and creates a more supportive environment for them to express their own grief. Here are a few other tips for helping your child—and yourself—to manage grief.

Traumatic Grief Among Surviving Siblings

In come cases, the death of a sibling can lead to traumatic grief in surviving children, particularly if the sibling’s death was itself traumatic (for example, a traffic accident, community violence, abuse, war, or a natural disaster) or stigmatizing (suicide, HIV/AIDS, drug use).

Since children may not express their feelings directly, it is important to be aware of any changes in surviving children’s play and behavior that may indicate their distress. In addition to the traumatic grief reactions discussed earlier, children who are experiencing a traumatic grief reaction to sibling loss may exhibit or express it in the following ways:

Sibling Identity

Accepting New Siblings

The birth or introduction of a new child into the family following the death of another child can lead to mixed reactions. Surviving children may welcome the new child, but they may also feel that they were “not good enough” on their own to satisfy their parents’ needs. In addition, the surviving children may believe that children who die are easily replaced.

How to help: Be ready for mixed reactions. Talk with the surviving children about their feelings and reassure them about what makes them special. Emphasize that you can love more than one child and talk about what the new child represents to everyone in the family. Whenever possible, set aside special one-on-one time with the surviving siblings.

The death of a child often leads to changes in the structure of the family and in the roles of the surviving siblings. Depending on the number of children and their birth order, for example, a surviving child may now be the oldest or youngest child, the only girl or boy, or perhaps an only child. Parents and caregivers may rely on or change their expectations of the remaining children.

These changes may give surviving siblings a sense of pride in their new found responsibilities, but they may also result in feelings of pressure or even resentment if children are expected to replace or live up to the behavior and goals of the deceased sibling. Surviving siblings may respond by acting out or by rejecting their new place in the family. Caregivers should consider that negative changes in family functioning may be due to such shifting of roles. A family meeting or one-on-one talks with children about different feelings, with a goal of discussing different household jobs, can be a good way for everyone to share feelings and take responsibility for creating new family routines.

The death of a sibling also impacts surviving children in many small and large ways throughout their lives. For example, responding to a casual or typical question such as “Do you have any brothers or sisters?” can be difficult. To help children move on in a life without their sibling, prepare surviving siblings for difficult questions by helping them to develop and practice responses. Explore together what kinds of responses feel most comfortable and also what they mean to the surviving brother or sister. Reassure your child that he or she can choose how and when to talk about the deceased child. For example, in group situations or when dealing with new people, it may be simplest to talk about surviving siblings. In more private conversations, a more direct answer such as “my brother died two years ago” may feel more natural. Be aware that this topic may need to be revisited as children mature and face new situations.


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