About 53,000 children pass away each year in the United States and nearly 19% of the adult population has experienced such painful loss1. The death of a child is a severely traumatic event for parents and represents a major risk for future emotional, psychological and physical problems.2, 3, 4 The loss of a child challenges parents’ expectations for the natural order of life events and shatters hopes and beliefs for the future.5 Some psychologists suggest that parental grief is more severe that other types of grief and lasts longer, presenting with more serious psychological, physical, behavioral and social issues. 1, 6 This may be explained by the special role that a child plays in a person’s life – the child represents a unique amalgam of feelings for parents, as it is both part of themselves and representation of their feelings for each other.7 In essence, bereaved parents mourn the loss of self, their hopes and dreams.2
The fact that parents think of their child as a “part of, and the same as themselves” 7, p. 234 suggests that the loss of a child is very much the loss of a part of one’s self and represents a unique challenge.
The Shock of Sudden and Unexpected Death
The death of a child has become rare in the Western world, due to improved prenatal and perinatal care, it is considered exceptionally painful and traumatic, with parents not being prepared to face such loss.8, 9 Nowadays, pregnancies continuing after the 20th week are usually wanted and anticipated with joy and commitment. In the case where such joyous event ends up being a tragedy, parents face a major challenge. For many young parents, this may be their first experience with death and loss.8 When the death occurs unexpectedly and suddenly, as opposed to following a long disease or terminal condition, the shock, guilt and bewilderment experienced by the parents are much more severe and long lasting.1, 3 Although a long and debilitating disease is another source of trauma for parents, it provides an opportunity to psychologically prepare for the death and understand the cause of death.3, 10 In fact, sudden and unexpected loss is correlated with higher levels of distress and parents are at much higher risk of experiencing complicated grief.9
In one study1 researchers interviewed and assessed bereaved parents about 20 months after the child’s death. Their results showed that mothers who experienced the sudden death of a child had more prolonged grief than those who anticipated the grief. Results from the same study did not support expectations that mothers experience more severe grief than fathers. A Swedish population-based study5 by demonstrated that fathers’ opportunity to know about the impending death of a child in advance is correlated with better prognoses of grief processing. These results indicate that medical practitioners need to be honest with parents, when the death of a child is concerned, to allow time for accepting and preparing for the imminent death. However, research finds that physicians are aware of a child’s terminal prognosis 3 months before parents are (Wolfe cited in 5).
Findings about the profound negative effects of sudden loss explain why parents who experience Sudden Infant Death Syndrome (SIDS) face especially troublesome complications and adjustment problems. These parents suddenly have to deal with the unexplained and, possibly unpreventable, death, the sudden severing of the the attachment and bonding and the involvement of other agencies in the investigation process.11 Currently, SIDS is identified as “the sudden death of an infant younger than one year that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.” 12, p. 870 It is the leading cause of death among healthy infants and accounts for about 2,200 deaths each year.12
(For additional information about Sudden Infant Death Syndrome, including statistics and risk factors, see here)
References:1. Seecharan, G., A., Andersen, E., M., Norris, K. & Toce, S., S. (2004). Parents’ assessment of quality of care and grief following a child’s death. Archives of Pediatrics & Adolescent Medicine, 158, 515-520. 2. Alexy, W., D. (1982). Dimensions of psychological counseling that facilitate the grieving process of bereaved parents. Journal of Counseling Psychology, 29(5), 498-507. 3. Limerick, L. & Downham, M. (1978). Support for families bereaved by cot death: joint voluntary and professional view. British Medical Journal, 1, 1527-1529. 4. Zisook, S. & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World Psychiatry, 8, 67-74. 5. Kreicbergs, U., Lannen, P., Onelov, E. & Wolfe, J. (2007). Parental grief after losing a child to cancer: Impact of professional and social support on long-term outcomes. Journal of Clinical Oncology, 25(22), 3307-3312. 6. Rando, T., A. (1986). Parental Loss of a Child. Champaign, IL, Research Press Co. 7. Papadatos, C. & Papadatou, D. (1991) Children and Death (Death Education, Aging and Health Care), Chapter 19 by Rando, T. A. Taylor & Francis, 1st Ed. 8. Canadian Pediatric Society, Fetus and Newborn Committee (1983). Support for parents experiencing perinatal loss. Canadian Medical Association Journal, 128, 335-339. 9. Sheldon, F. (1998). ABC of palliative care: Bereavement. British Medical Journal, 316, 456-458. 10. Cook, P., White, D., K. & Ross-Russell, R., I. (2002). Bereavement support following sudden and unexpected death:guidelines for care. Archives of Disease in Childhood, 87, 36-39. 11. Alexy, W., D. (1982). Dimensions of psychological counseling that facilitate the grieving process of bereaved parents. Journal of Counseling Psychology, 29(5), 498-507. 12. Adams, S., M., Good, M., W. & Defranco, G., M. (2009). Sudden Infant Death Syndrome. American Family Physician, 79(10), 870-874.