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Pediatricians get guidance on helping children through grief
(CNN) -- The American Academy of Pediatrics is recommending that doctors take a more active role in easing the suffering and assessing the reactions of children who have lost loved ones.
The academy issued revised guidelines Monday calling on pediatricians to help determine whether a child's grief is normal or something more serious that requires mental health services. The academy states that doctors are also "in a position to encourage open discussion (of death) in the family, thereby increasing their sense of mutual support."
The goal is to help children cope with one of the most stressful events they can encounter.
"If you're going to put it on a scale of one to ten, it's probably some place between a nine and one-half and above," says Dr. George Cohen, a pediatrician.
Crying, feelings of guilt and a brief lack of interest in school are all normal responses to a loss. But there may be cause for concern if these responses linger for many weeks or months -- or intensify.
The academy says signs of serious problems include long-term denial of feelings, repeated crying, disabling depression and suicidal ideas, persistent anger or unhappiness, social withdrawal, separation anxiety, serious conduct problems, decline in school performance, persistent sleep problems, physical symptoms of the deceased, eating disorders and continued belief that the deceased is still alive.
Much of a doctor's evaluation depends upon the age of the child. The academy lists the following overview of children's concepts of death:
Children need to be assured that they will be cared for and loved by an adult. They also must be assured that they did not cause a death, could not have prevented it and can't bring back the deceased, the academy stated. It also stated that parents should continue family routines and disciplines.
John and Mary Raterman know too well how children respond to loss. Three of the family's seven children have died from a rare genetic disorder.
"My sisters and brother are in heaven," says one of the surviving children.
The best approach has been an open discussion, John Raterman says.
"Talk to them," he says. "They're going to ask tough questions. Don't dodge them. Don't sugarcoat them. Answer them forthright to the best of your ability."
Mary Raterman says the deaths have left the family with an important lesson.
"You appreciate each day so much, and you live each day to the fullest," she says.
CNN Health Correspondent Pat Etheridge contributed to this report.RELATED SITES:
The American Academy of Pediatrics
The Compassionate Friends grief support
Hygeia, an online journal for pregnancy and neonatal loss
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