tially since the 1950s childhood homicide rates have tripled and suicide rates have quadrupled [9]. Recent findings suggest that parents of children who die from any cause are more likely to suffer symptoms of traumatic stress and experience more severe problems with emotional dysregulation than occurs with the death of a spouse [10].

Integrating the loss of a child into the life narrative, making sense and new meanings of such a wrenching event, presents a challenge to parents and family [11]. Although once common, deaths of children between the ages of 1 and 14 now account for less than 5 percent of all deaths in the United States; about 57,428 infants, children, and adolescents died in 1996. In contrast to the past when families might have had several children die, death in childhood is now rare. Children are expected to live to adulthood. Conflicting with current life-cycle expectations, the death of a child may be experienced as the death of the parents’ future dreams as well as creating a profound change in their present roles and functioning. Increases in the incidence of suicide and homicide in adolescents and random acts of violence in our society have increased the risk of traumatic stress responses for bereaved family members.

Medical advances have prolonged the dying process for children as well as adults, making terminal illness in children longer and more complex, often requiring parents to make difficult decisions about end-of-life care. Preliminary research evidence suggests that family bereavement may be adversely affected by the inability to reduce suffering during the child’s dying process [12].

This appendix reviews the unique features of the parent role; the importance of the parents’ continuing memory of the child; the impact of variations in atypical, unresolved, and catastrophic deaths; and the special features of parents’ loss of an infant, a school age child, and an adolescent, and the impact of a child’s death on siblings and other family members. Also reviewed are interventions and research directions.

BEREAVEMENT, MOURNING, GRIEF, AND COMPLICATED GRIEF

Bereavement is a broad term that encompasses the entire experience of family members and friends in the anticipation, death, and subsequent adjustment to living following the death of a loved one [13]. It is widely recognized as a complex and dynamic process that does not necessarily proceed in an orderly, linear fashion [14, 15]. Rather, individuals have concurrent and overlapping reactions that may recur at any time during the family’s bereavement process. Bereavement includes the internal adaptation of individual family members; their mourning processes, expressions, and experiences of grief; and changes in their external living arrangements, relationships, and circumstances.



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