作者: 陈明 翻译 / 8480次阅读 时间: 2017年4月28日
标签: 哀伤

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 They may be angry and irritable, or they may become withdrawn and isolate themselves from family and friends.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:

  • Reliving aspects of the person’s death or having intrusive thoughts, for  example, experiencing nightmares about the death, not being able to stop  thinking about how the person died, imagining how much the person suffered,  or imagining rescuing the person and reversing the outcome.
  • Avoiding reminders of the death or of the person who died, for example,  by avoiding pictures of the deceased person or by not visiting the cemetery,  by not wanting to remember or talk about the person, or by feeling  emotionally numb.
  • Increased arousal, being nervous and jumpy or having trouble sleeping,  having poor concentration, being irritable or angry, being “on alert,” being  easily startled, and developing new fears.

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

  • Do not understand that death is final.
  • May think that they will see the person again or that the person can  come back to life.
  • May think it was their fault that the person died.

Common grief reactions通常的悲痛反应

  • May become upset when their routines change.
  • May get worried or fussy when apart from their usual caregivers and  may be clingy and want extra attention.
  • May express fears, sadness, and confusion by having nightmares or  tantrums, being withdrawn, or regressing to earlier behaviors.

Traumatic grief reactions 创伤性悲痛反应

  • May repetitively engage in play about the death or the person who  died.
  • May have problems getting back on schedule or meeting developmental  milestones.
  • May have difficulty being comforted.

School-age children学龄儿童

Understanding of death对死亡的理解

  • Gradually gain a more mature understanding of death.
  • Begin to realize that death is final and that people do not come back to life.
  • May have scary beliefs about death, like believing in the “boogey man” who comes for the person.
  • May ask lots of questions about how the person died and about what death means.

Common grief reactions通常的悲痛反应

  • May display distress and sadness in ways that are not always clear, like being irritable and easily angered.
  • May avoid spending time with others.
  • May have physical complaints (headaches, stomachaches).
  • May have trouble sleeping.
  • May have problems at school.
  • May have no reaction at all.
  • May dream of events related to the death or war.
  • May want to call home during the school day.
  • May reject old friends and seek new friends who have experienced a similar loss.

Traumatic grief reactions 创伤性悲痛反应

  • May repeatedly talk or play about the death.
  • May have nightmares about the death.
  • May become withdrawn, hide feelings (especially guilt), avoid talking about the person, or about places and/or things related to the death.
    可能变得退缩,隐藏感情(特别是内疚),避免谈论 逝者,或与死亡有关的地方和/或事物。
  • May avoid reminders of the person (for example, may avoid watching TV news, may refuse to attend the funeral or visit the cemetery).
    可能避免提及逝者(例如,可能避免看电视新闻,可能拒绝参加葬礼或 扫墓)。
  • May become jumpy, extra-alert, or nervous.
  • May have difficulty concentrating on homework or class work, or may suffer a decline in grades.
  • May worry excessively about their health, their parents’ health, or the health and safety of other people.
  • May act out and become the “class clown” or “bully.”


Understanding of death对死亡的理解

  • Have a full adult understanding of death.

Common grief reactions通常的悲痛反应

  • May have similar grief reactions to those of school-age children when at home, with friends, and at school.
  • May withdraw, become sad, or lose interest in activities.
    可能 会退缩,变得悲伤,或失去对活动的兴趣。
  • May act out, have trouble in school, or engage in risky behavior.
    可能 会付诸行动,在学校有麻烦,或从事危险行为。
  • May feel guilt and shame related to the death.
  • May worry about the future.
  • May hide their true feelings.

Traumatic grief reactions 创伤性悲痛反应

  • May have similar traumatic grief reactions to those of school-age children when at home, with friends, and at school.
  • May avoid interpersonal and social situations such as dating.
    可 能避免人际交往和社交场合,如约会。
  • May use drugs or alcohol to deal with negative feelings related to the death.
    可 能使用药物或酒精来应对与死亡有关的负面情绪。
  • May talk of wanting to harm themselves and express thoughts of revenge or worries about the future.
  • May have low self-esteem because they feel that their family is now “different” or because they feel different from their peers.
    可能会低自卑,因为他们觉得他们的家庭现在是“不同的”,或因为他们觉得 自己和同龄人不同。

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.

  • Survivor’s guilt about being alive. This can stem from a sibling questioning why he or she was spared because they feel no better than—or even inferior to—the sibling who died.

    Tip: Acknowledge that many siblings feel guilty, but correct inaccurate thoughts and information. Reassure the child that all children are different and unique, and that he or she is just as important and loved as the child who died. You should also pay attention to friends or family members’ comments comparing a surviving sibling to the child who died. You should comfort your child and help others understand that this can be hurtful.
    提示:承认许多兄弟姐妹感到内疚,但 要纠正错误的想法和信息。让孩子放心,所有的孩子都是不同的、独一无二的,而且,和爱死去的孩子一样,他或她是同等重要和值得爱的。在比较幸存的兄弟姐妹和失去的孩子的时候,你也应该注意朋友或家人的意见。你应该安慰你的孩子,帮助别人理解这会伤害你的孩子。
  • Regrets and guilt about previous “bad” behavior. Surviving siblings may express regrets or remorse about things they did or said to the sibling who died. For example, they may think that they should have been nicer to or more patient with the sibling while he or she was still alive. Surviving children who fought with the deceased sibling or at times “wished” that he or she would disappear or die may believe that their own thoughts and feelings caused the death.

    Tip: “Normalize” children’s feelings by reassuring them that all brothers and sisters fight or disagree at times—that this is a natural part of sibling relationships. It may be helpful to explain what actually caused the sibling’s death. Also, it is important to acknowledge surviving siblings’ thoughts that they could have prevented the death, while also letting them know that they were not responsible. Explain that all children feel angry or have unkind thoughts about family members from time to time, but that feelings or wishes cannot cause a death to happen.
  • Ongoing connections with the deceased sibling. The sibling who has died may remain an influence in the surviving children’s lives. Although this can be comforting—for example, through pleasant memories of shared experiences and goals—it can also have a negative impact if surviving children idealize the deceased sibling, feel inadequate when they compare themselves to the deceased sibling, or try to “replace” the sibling by being just like him or her.
    持续与死去的兄弟姐妹 连接。幸存的孩子们的生活可能仍然会受到死去的兄弟姐妹的影响。虽然这可以被安慰——例如,通过愉快的回忆,共同的经历和共同的目标——如果幸存的孩子理想化死去的兄弟姐妹 ,这可能有负面的影响,当他们将自己和死去的兄弟姐妹比较时,他们可能会感到不够格,或者会成为他或她的样子来试图“取代”手足(的死亡)。

    Tip: Focus on comforting connections with the sibling who died, perhaps by talking with surviving children about happy memories or special life lessons they shared. At the same time, help surviving children to see and appreciate their own unique strengths and abilities and their special place within the family.
    小贴士:关注于抚慰和死去的兄弟姐妹之间的连接,也许是通过与幸存的孩子谈论幸福的回忆或他们分享的特殊生活经验。同时,帮助幸存的孩子看到和欣赏自己独特的优势 与能力,以及他们在家庭中的特殊地位。
  • Questions related to their beliefs and faith. Surviving children’s perceptions of—and reactions to—the death of a sibling are often influenced by the cultural and religious background of their family and community. Although the rituals conducted after a death can be comforting, very young children do not fully understand the abstract concept of death, and some older children may question such explanations (for example, questioning a faith that could let their brother or sister die). When talking to children about their sibling’s death, try to incorporate not only your cultural and religious understanding of the death, but also a concrete, age-appropriate explanation of what happened.

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.

  • Don’t be afraid to talk about the child who died. It can be difficult to talk about a child who has died, especially if you feel that the surviving children are too young to understand and should be protected. Some family members may want to keep the death a secret—particularly when a child dies at birth or if one of a set of twins dies—or to remove all reminders of the child who has died. However, learning of the death by accident, by overhearing a conversation, or by finding a reminder such as a photo, can leave children shocked or overwhelmed. Sometimes parents believe that limiting conversations about the deceased child will help the other children to “get back to normal” or to move on with their lives. Children may misinterpret these actions to mean that it is not okay to talk about their own feelings about the death, or that the grownups can’t handle seeing how sad they are. These children may try to hide their feelings, develop physical symptoms, or even develop traumatic grief symptoms. They may believe that this secrecy means that there was something shameful or bad about the child who died, about the survivors, or about the death itself. This may make children distrust their caregivers and other information they may be given.

    Tip: Open communication will help you to understand your surviving children’s feelings, fears, and understanding about their sibling’s death. Although difficult, it is important to give children honest, age-appropriate information about their deceased sibling so that they can feel comfortable coming to you with their questions, concerns, and feelings. You can also look for and use opportunities to talk about the deceased child, sharing stories and memories about the child who died at special times as well as in everyday conversation.
  • Manage reminders: After the death of a child, it is common to go through the child’s belongings deciding what to store, remove, give to others, or keep. When parents or caregivers put away all physical reminders of the child who died, surviving children who have memories of their deceased sibling may be confused and upset by the disappearance of their brother’s or sister’s belongings. They may feel guilty for wanting the things in sight or for remembering the sibling. On the other hand, if parents or caregivers find it difficult to change anything and keep things exactly as they were, surviving siblings may feel afraid to touch any of the things or feel an ongoing sadness throughout the home.

    Tip: Consider the impact of where and how many of your deceased child’s things are kept visible in the home. Try to include the siblings in some of the decision making in ways that are appropriate to their age. Physical reminders such as pictures, toys, and clothing can be comforting for surviving children and let them know that the person who died was a valued member of the family. If you yourself find these reminders too upsetting, look for ways that the surviving children can keep some reminders.

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:

  • Feeling helpless or hopeless. After losing a cherished brother or sister, surviving children may feel adrift and lonely. They may give up, not enjoy life or, in extreme cases, feel they want to join the sibling and think about their own death. Sometimes they may feel suicidal or even talk about suicide.
    感到无助或绝望。 在失去了一个珍惜的兄弟或姐妹后,幸存的孩子可能会感到飘零和孤独。他们可能会放弃,不再享受生活,或者在极端的情况下,觉得他们想要和兄弟姐妹一起去,想到自己的死亡。有时他们可能会 觉得要自杀甚至谈论自杀。
    Tip: Acknowledge surviving children’s sadness and tell them that it’s an understandable response to the family’s loss. Encourage children to return to their regular, life affirming activities. Playing and socializing with friends can increase children’s sense of accomplishment and give them vital social support. However, be especially alert if children become extremely withdrawn or isolated, and seek professional help immediately if they express thoughts about suicide.
    提示:承认幸存的孩子的悲痛,并告诉他们,对于家庭的丧失而言,这是一个可以理解的回应。鼓励孩子们回到他们的正常活动,肯定生活的活动。与朋友玩耍和社交可以增加孩子的成就感, 并且给予他们重要的社会支持。但是,如果孩子变得非常退缩或孤僻,如果他们表达了关于自杀的想法,要特别警觉,立即寻求专业的帮助。
  • Wanting to change the past. Surviving siblings may become preoccupied with thoughts that they could have or should have prevented the death. They may keep imagining or thinking of ways they could have saved their brother or sister if only they had called for help sooner or pushed the sibling out of the way of the speeding car. These thoughts can interfere with everyday activities, especially with schoolwork.
    想改变过去。幸存的兄弟姐妹可能变得心事重重,认为他们本可以或本应该阻止死亡。他们可能会继续想象或想办法拯救他们的兄弟姐妹 ,如果他们早就寻求帮助,或者把兄弟姐妹从高速行驶的车上推出去。这些想法会干扰日常活动,尤其是家庭作业。
    Tip: If children show recurring feelings of responsibility and guilt, reassure them that the death was not their fault. Explain that things often look different when we look back and think about “what might have been,” but that there was nothing they could have done at the time. Let children know that you don’t blame them for their sibling’s death.
    提示:如果孩子表现出反复的责任感和内疚感,向他们保证死亡不是他们的错。解释一下,当我们回顾过去,思考“可能 会如何”的时候,事情往往会有所不同,但是在当时他们不可能做任何事情。让孩子知道你不会因为兄弟姐妹的死亡而责怪他们。
  • Feeling vulnerable and afraid. The death of a sibling can change children’s perceptions of themselves and of the world. They may feel more fearful, vulnerable, and aware of their own mortality and the mortality of the people they love. This can lead to their being overly cautious and overly protective of other siblings and of their parents or caregivers because they fear that something will happen to them.
    感觉脆弱和害怕。兄弟姐妹的死亡可以改变孩子对自己和世界的看法。他们可能会更加感到害怕,脆弱,并意识到自己 必死的命运和他们所爱的人必死的命运。这可能会致使他们过于谨慎和过度保护其他兄弟姐妹以及他们的父母或照顾者,因为他们担心有些事情会在他们身上发生。
    Tip: Acknowledge surviving children’s fears and talk about them without dismissing them. Reassure children about their safety, for example, by reviewing safety plans and establishing check-in times. Also, monitor your own fears and maintain a sense of control and calm.
    提示:承认幸存的孩子的恐惧,并谈论他们,而不忽略这些。例如,通过评审安全的计划和建立 登记时间来保证孩子们的安全。同时,监控自己的恐惧,保持控制和平静的感觉。
  • Worry about physical symptoms. If the sibling’s death was related to a particular illness or to physical pain and suffering, symptoms related to those conditions can take on new meaning for surviving siblings. Parents and children alike may associate previously benign physical ailments with death. For example, if a sibling’s death was due to a brain tumor, other family members may feel frightened or panicked when they have a headache. Caregivers should be aware that children can also develop physical symptoms due to anxiety (for example, children who refuse to go to school or frequently get sick at school may be fearful of parents or other siblings dying).
    担心身体症状。如果兄弟姐妹的死亡与特定的疾病或肉体上的疼痛和痛苦有关,与这些病症相关的症状可以为幸存的兄弟姐妹带来新的意义。父母和孩子都会把以前良性的 躯体疾病和死亡联系起来。例如,如果一个兄弟姐妹的死亡是由于脑瘤,其他家庭成员可能会在他们头痛时感到害怕或恐慌。照顾者应该意识到孩子也会因为焦虑而出现身体症状(例如,拒绝上学或经常在学校生病的孩子可能害怕父母或其他兄弟姐妹的死亡)。
    Tip: If surviving children express concerns about physical symptoms, avoid talking about your own fears but don’t ignore their complaints. Show concern and, if need be, make an appointment with a trusted pediatrician who can objectively assess the situation. It may also be helpful to provide realistic reassurance about other family members’ health and point out everyday healthy behaviors.
    提示:如果幸存的孩子对身体的症状表达了担忧,避免谈论自己的恐惧,但不要忽视他们的诉苦。显表现出关注,并且,如果需要的话,预约一个值得信赖的 、可以客观地评估情况的儿科医生。提供其他家庭成员的健康,指出每天的健康行为的现实保证也是有帮助的。
  • Avoiding reminders of the deceased sibling. Surviving children may avoid people, places, or things that remind them of the sibling who died because these things can trigger memories of the death itself. This avoidance may or may not be obviously related to the death. For example, if siblings shared a bedroom, it may be difficult for the grieving sibling to sleep alone. Or a surviving sibling may no longer want to play Little League because he and his deceased brother or sister always played catch after dinner.
    回避提及死去的兄弟姐妹。幸存的孩子可能会避开那些让他们想起死去的兄弟姐妹的人、地方或事物,因为这些东西会触发死亡本身的记忆。这种回避可能 也不可能与死亡有明显的关系。例如,如果兄弟姐妹共用一个卧室,那么,悲痛的兄弟姐妹就很难独自入睡。或幸存的兄弟可能不再想玩小联盟,因为他和他已故兄弟或姐妹总是晚饭后 一起玩。
    Tip: Look for changes in behavior and consider whether these can be linked to memories or reminders of the deceased sibling. Acknowledging the changes and the accompanying sadness is important, but finding alternatives can also be helpful, for example, rearranging the furniture in the bedroom or talking with a sympathetic baseball coach. If siblings are still intensely bothered by painful memories or denying their avoidant behavior, a mental health professional can help them develop positive coping skills and memories.
    提示:寻找行为的变化,并考虑这些是否可以与记忆或 提及死者的兄弟姐妹有关。承认变化以及随之而来的悲痛是很重要的,但寻找替代品也有帮助,例如,重新安排在卧室里的家具或者与富有同情心棒球教练交谈。如果兄弟姐妹仍然 极度地受到痛苦的回忆或否认他们的回避行为的干扰,心理健康专业人士可以帮助他们形成积极的应对技能和记忆。

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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