Palliative care and sibling grief
Children and young people often grieve differently than older people which can feel uncomfortable for some adults. Each sibling will have their own unique relationship to the child who has died.
Children and young people can experience intense distress and sadness one minute and then be focused on playing or laughing the next. They may find it difficult to be separated from their family members and they may want to talk about their feelings at unpredictable times such as bedtime.
Supporting grieving siblings is challenging for families. Immediately after the death of their brother or sister, siblings may feel excluded or forgotten due to the number of arrangements that need to be made. It also needs to be recognised that when a sibling dies, children are adjusting to this significant loss but also the impact that the death has had on their parents as well.
A brother or sister’s grief is influenced by their age, their developmental stage, personality and the family, cultural and religious influences in their lives. Understandably, you may have concerns about how your other children will manage their grief.
Worries children have following a death of a sibling
- Did I cause the death?
- Will I or other loved ones die?
- Who will care for me?
Speaking in an honest and age appropriate way with children can help them adjust more easily to their loss. Encouraging siblings to be involved in the funeral service can help children feel included and validates their unique relationship with their sibling and feelings of grief.
Remember that grief is not always visible but it doesn’t mean that your child is not grieving.
Viewing their deceased brother or sister
You may be feeling uncertain about whether you should allow your child to view their brother/sister after their death. Siblings who are old enough to tell you their thoughts should be given the choice as to whether they wish to see their brother or sister.
Experience tells us that if a sibling wishes to view their brother/sister that it is important to try and help them do this as this benefits their understanding of death. It is also an opportunity to spend some extra time with someone that they love and it can help reduce any fear about death, as many families report how peaceful their child looks.
Siblings and funerals
Funerals can help children participate in the family ritual of honouring their sibling who has passed away, however it is important to give them the option to attend or not.
It is important to explain to children what will happen at the funeral, what takes place in a burial or a cremation, what songs will be played and who will speak. If you are not sure how to have this conversation with children please speak to the palliative care team as they may be able to offer some guidance and resources.
If your other children are attending the funeral, it may be helpful to have a trusted adult look after them. It can be hard to feel connected to your child’s funeral whilst also having to support their sibling during the ceremony.
If siblings are not in the room when their brother/sister dies, it is important to prepare them for what they may see and feel when they visit. If you have any concerns or questions about your child viewing their sibling after they have died, it is important to speak to a member of your palliative care team.
Common grief responses in children
Children under 5
- affected by the emotions of those around them
- alternating between displaying grief and playing as if nothing has happened
- ask confronting questions about death
- seek attention or show signs of insecurity
- feel guilty or responsible for their sibling’s death
- act in ways that are younger than they are e.g. bed wetting
- act out their feelings
Children aged 5- 11
- see death as reversible or become more anxious about the possibility of others dying
- curious about death and burial rituals and ask detailed questions
- take time to absorb the reality of what has happened and may not appear immediately affected by the death
- be quick to blame themselves for their sibling’s death
- worry about their parents who are grieving and feel a sense of responsibility for making them happy again
- act out feelings rather than talk about them
- be concerned about what their peers think and have a sense of isolation or separation
Helping children with grief
- Listen and talk with them. Children need time and feel safe in order to express how they are feeling. Be patient, honest and consistent with your response
- Include children in decision making when appropriate, such as funeral plans or which day of the week to return to school or an activity
- Provide safety and security. Try to maintain routines and firm but fair boundaries as much as possible
- Provide creative opportunities for expression, such as drawing, craft activities or storytelling.
It can be difficult to support your grieving child when you are grieving too. Grief can also make you doubt yourself and parenting decisions. It is important to look after yourself as much as possible so you can be there for your children.
Grief responses in teenagers and young adults
- break their grief into bearable amounts, but this can sometimes result in intense outbursts
- experience a multitude of emotions and thoughts that come and go and feel overwhelming
- feel guilty that they were unable to save their sibling
- not want to talk about their grief
- have problems sleeping or oversleeping
- feel isolated or separated from their peers.
Helping teenagers and young adults with grief
- Be available- provide them with an accepting, open environment in which to grieve
- Tell them it is okay to feel the emotions and thoughts they are experiencing, and that you will be there if they want to talk
- Invite teenagers to talk about their loss and their sibling, however if they do not want to talk at that time, you also need to respect this
- Teenagers often look to their peers for support when times are tough. Encourage them to connect with their friends in a safe environment
- Reassure them that it is okay to have a different grieving style than yourself
The more they observe healthy communication and the natural expression of feelings when grieving, the more likely they are to understand and accept the emotions they may be feeling. Remember that even for adults, talking about such feelings is difficult especially at the beginning of grief.
When to seek help
With good information and support, children and young people can learn to understand and adapt to their grief.
However, if you are concerned by their behaviour or feel they need more assistance than you can provide please contact the paediatric bereavement coordinator at your local children's hospital.