来源：美国国家儿童创伤压力网
Sleep and his Half-brother Death (John William Waterhouse 1874)
Information for Families
为家庭提供的信息
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.
当一个与他们有关的人死亡时，儿童和青少年可能也会像成年人一样感到强烈的悲伤，失落或悲痛。儿童和青少年也会像成年人一样通过他们的行为，他们的想法，他们说的话，以及他们的情绪感觉和身体来表达他们的悲伤。每个孩子的悲痛都是不同的，而且悲痛的方式与长短是没有正确与否的。
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 They may be angry and irritable, or they may become withdrawn and isolate themselves from family and friends.
有些悲痛反应跨越了所有年龄组和发展水平，儿童可能以很多不同的方式表达他们的悲痛。例如，任何年龄段的悲痛的孩子或青少年可能比平时睡的更多或更容易哭泣。他们可能会退行，回到早期的行为，或者，他们可能会在学校出现新的恐惧与问题。他们可能会抱怨头痛和身体疼痛。他们可能会变得愤怒或易怒，或者会变得社会退缩和孤僻，将自己与家人和朋友相隔绝。
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.
失去亲人的孩子所采取方式可能不会被他们周围的人识别为悲痛反应。例如，一个非常安静的幼童可能会更多的突然发怒，一个活跃的孩子可能会对以前他感兴趣或一直做的事情失去兴趣，或者，一个勤奋好学的孩子可能会从事危险的行为。无论孩子多大，他或她都可能会对已经导致的死亡感到不切实际的罪疚。有时，丧亲的孩子承担了成人的责任，并且担心幸存的家庭成员，担心如果他们的照顾者发生了什么事，谁会照顾他们。
Childhood Traumatic Grief
童年的创伤性悲痛
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).
一些重要的人死后，一些儿童和青少年可能会体验到比平常更大的悲痛和沮丧，并且有更强烈的反应，这些被称为童年创伤性悲痛。在儿童创伤性悲痛中，儿童出现了与创伤后应激障碍（PTSD）相关的症状。如果死亡是突然的或创伤性的，如果发生在可怕的情况下，或者孩子目睹或了解了死亡的可怕细节，孩子们可能更容易经历创伤性悲痛。此外，虽然创伤后应激反应可能在有人突然死亡后发生，他们也可能发生在可预期死亡（如久病或致残）之后。
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:
并不是所有在创伤性情况下经历特殊死亡的儿童都会产生创伤性悲痛。然而，在某些情况下，儿童可能会出现一些症状，这些症状干扰了他们的哀伤能力，干扰了他们对死去之人有安抚作用的记忆。创伤性悲痛也可能干扰日常活动，例如和朋友一起做功课。创伤后悲痛儿童的PTSD症状包括：
- 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.
在想象中重温人的死亡或有侵入性想法的部分，例如，体验有关死亡的噩梦，无法停止这个人是怎样死的思维，想象这个人有多苦，或想象抢救这个人和逆转结果。
- 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.
避免提及死亡或死去的人，例如，回避亡故之人的照片或不去扫墓，不想回忆或谈论逝者，或者情感上的麻木。
- 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.
唤起反应的增加，神经质和提心吊胆或者有失眠，注意力不集中，急躁或愤怒，“警觉”，易惊，并形成新的恐惧。
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.)
一般来说，如果你的孩子或青少年看上去有非常不安的记忆，回避运动或情绪感觉，或体验身体、情绪或学习问题，他或她可能已经有了创伤性的悲痛反应。（见表1，不同年龄的儿童常见的和创伤性的悲伤反应的例子。）
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.
你可以为你的孩子或青少年寻求帮助或咨询：如果悲痛的反应似乎持续而没有得到减轻，如果他们在初始期的第一阶段后出现相对平静的，如果他们变得更糟，或者如果他们干扰你的孩子和朋友朋友相处、去学校、或享受的活动。
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.
不明白死亡是终了。- May think that they will see the person again or that the person can come back to life.
可能会认为他们会再次看到逝者或者逝者可以死而复生。- May think it was their fault that the person died.
可能认为逝者的去世是他们的错。Common grief reactions通常的悲痛反应
- May become upset when their routines change.
当他们的日常生活发生变化后可能会变得不安。- May get worried or fussy when apart from their usual caregivers and may be clingy and want extra attention.
可能会担心或易烦恼，当他们和日常照顾者分离的时候可能过于依赖别人并且需要额外的关注。- May express fears, sadness, and confusion by having nightmares or tantrums, being withdrawn, or regressing to earlier behaviors.
可能通过噩梦或发脾气表达恐惧，悲伤，和混乱，变得退行，或退回到早期的行为之中。Traumatic grief reactions 创伤性悲痛反应
- May repetitively engage in play about the death or the person who died.
可能重复地从事于死亡或逝去的人的游戏。- May have problems getting back on schedule or meeting developmental milestones.
重新回到日程或接触发育标志可能会有问题。- May have difficulty being comforted.
可能难以安抚。
School-age children学龄儿童
Understanding of death对死亡的理解
- Gradually gain a more mature understanding of death.
逐渐获得更成熟的死亡认识。- Begin to realize that death is final and that people do not come back to life.
开始意识到死亡是终了，人们不会回死而复生。- May have scary beliefs about death, like believing in the “boogey man” who comes for the person.
对于死亡可能会有可怕的信仰，就像相信由人变成的“狼人”。- May ask lots of questions about how the person died and about what death means.
对于人是如何死去的，以及死亡意味着什么，可能会问很多问题。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.
表现出痛苦和悲伤的方式可能并非一直很清晰，例如易激惹和容易激怒。- May avoid spending time with others.
可能避免与他人共度时光。- May have physical complaints (headaches, stomachaches).
可能会有身体不适（头痛、胃痛）。- May have trouble sleeping.
可能有睡眠问题。- May have problems at school.
在学校可能有问题。- May have no reaction at all.
可能根本没有反应。- May dream of events related to the death or war.
可能梦见与死亡或战争有关的事件。- May want to call home during the school day.
在校期间可能会想打电话回家。- May reject old friends and seek new friends who have experienced a similar loss.
可能会拒绝老朋友，并寻找有相同丧失经历的新朋友。Traumatic grief reactions 创伤性悲痛反应
- May repeatedly talk or play about the death.
可能反复谈论死亡或玩死亡游戏。- May have nightmares about the death.
可能有关于死亡的噩梦。- 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.
可能会变得神经兮兮的，额外的警惕，或紧张。- May have difficulty concentrating on homework or class work, or may suffer a decline in grades.
可能很难专注于家庭作业或课堂作业，或可能会在成绩下降。- May worry excessively about their health, their parents’ health, or the health and safety of other people.
可能过分担心他们的健康，他们的父母的健康，或其他人的健康和安全。- May act out and become the “class clown” or “bully.”
可以扮演并成为“班上的小丑”或“以强凌弱”。
Teens青少年
Understanding of death对死亡的理解
- Have a full adult understanding of death.
对死亡有充分的成人理解。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.
在家里，与朋友在一起，或者在学校可能有类似于学龄儿童的悲痛反应。- 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.
对于死亡可能感到内疚和羞愧。- May worry about the future.
可能担心未来。- May hide their true feelings.
可能隐藏他们真实的感情。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.
在家里，与朋友在一起，或者在学校可能有类似于学龄儿童的创伤性悲痛反应。- 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.
可能会提及想要伤害自己，并且表达报复的想法或担心未来。- 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
悲痛与手足之死
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.
一个特殊的人的死亡对于一个孩子或十几岁的孩子来说是非常困难和悲伤的，但是当一个兄弟姐妹死后，这个家庭面临着一系列独特的挑战。兄弟姐妹往往有非常复杂的关系。姐妹和兄弟彼此之间体验了一系列相互冲突的感情——他们彼此相爱，彼此照顾，年长的兄弟姐妹可能会觉得要为他们的弟弟妹妹们负责，乐于和/或怨恨照顾他们，或者他们之间可能嫉妒/斗争——他们的关系会随着时间而改变。
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.
当一个兄弟姐妹去世，这些过去的关系和感情会影响幸存孩子的悲痛和家庭的丧亲过程。悲痛中的兄弟姐妹可能会表现出以下一些或所有共同的反应，在此之中父母和照顾者可以有许多方法帮助他们应付。
- 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.
幸存者因为自己的幸存而内疚。这可能源于兄弟姐妹质疑他或她为什么会幸免，因为他们感觉不比——甚至不如——死去的兄弟姐妹。
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.
对以前的“坏”行为的遗憾和内疚。幸存的兄弟姐妹可能会对死去的兄弟姐妹做的和说的事情表达遗憾或悔恨。例如，他们可能认为，当他或她还活着的时候，他们应该对兄弟姐妹更好一些或更多的耐心。与失去的兄弟姐妹打架，或者有时候希望他们消失或失去的幸存孩子可能会认为自己的思想和情绪导致了死亡。
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.
提示：通过让他们放心以“正常化”孩子的感情，所有的兄弟姐妹之间都会争吵或有不同意的意见，这是兄弟姐妹关系的天经地义的部分。这可能有助于解释究竟是什么原因导致了兄弟姐妹的死亡。此外，重要的是要承认幸存的兄弟姐妹的想法，他们可以防止死亡的发生，同时也让他们知道，他们对此本没有责任。解释所有的孩子都会不时地对家庭成员感到愤怒或不友善的想法，但这种情绪或愿望不会导致死亡的发生。
- 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.
询问与他们的信念与宗教信仰有关的问题。幸存孩子对兄弟姐妹的死亡的看法——和反应往往受到他们的家庭和社区的文化和宗教背景的影响。虽然在死亡后进行的仪式可以让人感到安慰，但年幼的孩子并不完全理解死亡的抽象概念，一些年纪较大的孩子可能会质疑这样的解释（例如，质疑一种可以让兄弟姐妹死去的宗教信仰）。当和孩子们谈论他们兄弟姐妹的死亡的时候，不仅要试着具体的谈论你对死亡的文化和宗教理解，同时要具体的适合年龄的解释所发生的事情。
Caregiver and Family Grief
照顾者与家庭悲痛
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.
如果你失去了一个孩子，你处理悲痛的方式会影响你的孩子的丧亲过程。在一些父母和照顾者中，对失去孩子的悲痛会导致他们拉远与孩子的距离，或者在情绪上缺席于幸存的孩子。当这种情况发生时，幸存的兄弟姐妹可能为他们自己的开心或需要父母的支持而感到内疚。他们可能担心父母永远不会从丧失中恢复过来，觉得有必要照顾他们的父母或尽善尽美的避免进一步让他们心烦意乱。孩子们可能会认为父母向责怪他们的兄弟姐妹的死亡，甚至采取行动是因为他们觉得他们需要受到惩罚，或试图做的一切努力，以“弥补”他们所做的事情。
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.
如果你正在处理一个孩子的损失，重要的是有一个积极的支持网络，以及安全的地方来表达你的悲伤。当你有效地管理自己的悲伤时，它为幸存的孩子减轻了负担，为他们提供了一个积极的应对模式，为他们表达自己的悲痛创造了一个更为有利的环境。以下是另外一些帮助你的孩子——和你自己——管理悲伤的技巧。
- 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.
不要害怕谈论死去的孩子。很难谈论一个已经死去的孩子，尤其是如果你觉得幸存的孩子太小而无法理解同时应该得到保护的时候。有些家庭成员可能想守住死亡的秘密——尤其是当一个孩子在出生时就死去或者如果一对组双胞胎中的一个死去——或删除能够回忆起已经死去的孩子的信息是。然而，经由意外事故，偶尔听到的谈话，或者发现像照片这样的一个提醒而得知死亡，可以让孩子们感到震惊和不知所措。有时父母认为限制谈论已故孩子的谈话会帮助另一个孩子“恢复正常”或继续他们的生活。孩子们可能会误解这些行动，意味着谈论他们自己关于死亡自己情绪是不对的，或者说，大人们在看到他们是多么的伤心时是无法处理的。这些孩子可能试图隐藏他们的感情，发展身体症状，甚至发展创伤性悲痛症状。他们可能相信这种秘密意味着对死去的孩子，对于幸存者，或者关于死亡本身是一些可耻的和不好的事情。这可能会让孩子不信任他们的照顾者和其他被可能会给予他们的信息。
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.
提示：开放的交流将帮助你了解你的幸存的孩子的感受、恐惧，并了解他们的兄弟的死亡。虽然困难，重要的是要将他们已故的兄弟姐妹的信息诚实，适合年龄的告诉孩子，以便让他们能够感到舒适的带着他们的问题，关注和感情与你交流。你也可以寻找并利用机会谈论死去的孩子，分享故事以及的死去的孩子特殊时候的记忆，就像在日常的交谈一样。
- 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.
管理提醒：一个孩子死后，通常可以检查孩子的物品以决定如何存储，拿走，给别人，或保存。当父母或看护人把死去的孩子的所有生理记忆都带走后，幸存下来的孩子对他们死去的兄弟姐妹的记忆可能会因为兄弟姐妹遗物的消失而感到困惑和不安。他们可能因为纪念的兄弟姐妹或者想要眼前的东西而感到内疚。另一方面，如果父母或照顾者发现很难改变任何事情，如实的保持他们在世时的事物，幸存的兄弟姐妹可能会感到害怕触摸任何东西或感到一个持续的悲痛贯穿整个家庭。
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.
小贴士：考虑一下在家的哪儿或保持多少你死去孩子东西的影响。试着用一些适合他们年龄的方法来包括兄弟姐妹的一些决定。图画、玩具和衣服这样的物理提醒可以让幸存的孩子感到安慰，并且让他们知道死去的人是家庭中的重要成员。如果你自己发现这些提醒太让人不安，那么找到一些幸存下来的孩子可以保持一些提醒物的方法。
Traumatic Grief Among Surviving Siblings
幸存兄弟姐妹的创伤性悲痛
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).
在随后的案例中，兄弟姐妹的死亡可以导致幸存儿童的创伤性悲痛，尤其是如果兄弟姐妹的死是自己的创伤（如交通事故、社会暴力、虐待、战争、或自然灾害）或污名（自杀、艾滋病、吸毒）。
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:
由于儿童不能直接表达他们的情感，重要的是要意识到幸存的孩子的游戏与行为的任何变化，可能暗示了他们的不幸。除了先前讨论过的创伤性悲痛反应外，那些经历了对同胞丧失的创伤性悲痛反应的儿童，可以通过以下方式表现或表达：
- 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
兄弟姐妹的认同
Accepting New Siblings
接受新的兄弟姐妹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.
在一个孩子死后，另一个孩子的出生或引入新的家庭成员会导致复杂的反应。幸存的孩子可能会欢迎新来的孩子，但他们也可能觉得自己“不够好”以满足父母的需要。此外，幸存的孩子可能认为死去的孩子很容易被取代。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.
如何帮助：做好复杂的反应准备。与幸存的孩子谈论他们的感受，并让他们相信是他们与众不同的地方。强调你可以爱一个以上的孩子，并且谈论新的孩子代表了家庭中的每一个人。只要有可能，留出与幸存的兄弟姐妹的特殊的一对一的时间。
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.
一个孩子的死亡往往会导致家庭结构以及幸存的兄弟姐妹角色的变化。例如，根据孩子的数量和他们的出生顺序，一个幸存的孩子现在可能是最老的或最小的孩子，唯一的女孩或男孩，或者也许是独生子女。父母和照顾者可能依赖或改变他们对剩下的孩子的期望。
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.
这些变化可能会在他们新发现的责任的时候，给幸存的兄弟姐妹一种自豪感。但是，如果儿童被寄希望于取代或不符合死去的兄弟姐妹的行为和目标时，他们也可能导致压力的感觉，甚至怨恨。幸存的兄弟姐妹可能会采取行动，或拒绝在家庭中的新位置。照顾者应该考虑家庭功能的负面变化可能是源自于角色的转移。一个家庭会议或和孩子一对一的讨论哪些不同的感情，有一个目标的讨论不同的家庭工作，分享每个人的感情并负责创建新的家庭惯例可以是一个很好的方式。
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.
一个兄弟姐妹的死亡也影响了幸存的孩子在许多小和大的方式上的他们的生活。例如，回答一个偶然或典型的问题，如“你有兄弟姐妹吗？”可能是困难的。为了帮助孩子们在没有兄弟姐妹的生活中继续前进，为幸存的兄弟姐妹准备好困难的问题，帮助他们形成并练习相应的反应模式。一起探索什么样的反应感觉最舒服的，以及这对于幸存的兄弟姐妹意味着什么。安抚你的孩子，他或她可以选择以什么样的方式以及何时谈论已故的孩子。例如，在群体情况下，或与新的人打交道时，谈论幸存的兄弟姐妹可能是最简单的。在更私人的对话中，更直接的回答诸如“我的哥哥两年前去世了”可能会更自然。请注意，这个主题可能在儿童成熟和面临新的情况的时候需要重新审视。
