Advise the Father to Have the Child Attend the Funeral
The pediatrician should recommend that the 5-year-old child attend her mother's funeral, as participation in memorial services helps children understand the finality of death and provides an important opportunity for grieving and saying goodbye. 1
Why Funeral Attendance is Recommended
The American Academy of Pediatrics explicitly advises pediatricians to offer guidance on supporting children's participation in funerals and other memorial services. 1 This recommendation is based on the understanding that:
- Children benefit from concrete experiences that help them comprehend what has occurred and understand the permanence of death. 1
- Participation reduces confusion and isolation that grieving children often experience when excluded from family rituals. 1
- Memorial services provide closure and allow children to process their grief alongside family members in a supportive environment. 1
Why the Other Options Are Inappropriate
Discussing the Father's Own Grief (Option 1)
This shifts focus away from the child's needs to the pediatrician's curiosity about the father's past, which is not therapeutically appropriate in this acute situation. 1 The pediatrician's role is to support the grieving child and provide guidance to the father, not to explore the father's personal history. 1
Reassuring the Child Will Feel Better Soon (Option 3)
This is explicitly contraindicated and represents a common pitfall. 1 The AAP guidelines emphasize that pediatricians should not try to make children feel "better" in the immediate aftermath, as freely expressing sorrow is part of healthy adjustment. 1 Normal grief is not time-limited in a predictable way—many individuals find the second year more difficult than the first, and people spend the rest of their lives accommodating the absence rather than achieving complete resolution. 2
Immediate Psychiatric Referral (Option 4)
Referral to psychiatry is premature at this stage. 1 The AAP guidelines state that in the immediate aftermath of death, reactions can be quite extreme and varied, and it is best to avoid categorizing such acute reactions as "normal" or "abnormal." 1 More immediate or urgent referral is indicated only if children show deep or sustained sadness or depression, especially if perceived to be at risk of suicidal behavior, or engage in risky behaviors such as substance use. 1 This otherwise healthy 5-year-old does not meet criteria for immediate psychiatric referral.
Telling the Child Mommy Has Gone to Deep Sleep (Option 5)
Using euphemisms like "deep sleep" is harmful and creates dangerous misconceptions. 1 The pediatrician's role includes helping children understand what has occurred and addressing misinformation, misinterpretations, or misconceptions. 1 Equating death with sleep can cause:
- Fear of going to sleep themselves
- Confusion about the permanence of death
- Difficulty processing grief appropriately
- Expectation that mother will "wake up"
Additional Guidance for the Pediatrician
Beyond recommending funeral attendance, the pediatrician should:
- Prepare the father to support his daughter by explaining what to expect at the funeral and allowing the child to ask questions beforehand. 1
- Anticipate common grief reactions including guilt (even when illogical), fear, worry, and concerns about the child's own health or that of remaining family members. 1, 2
- Plan follow-up contact a few weeks or months after the loss to assess coping and answer questions. 3
- Provide resources for community bereavement support services and grief support groups. 3
- Educate about the grieving process, emphasizing that it fluctuates over time and that anniversary reactions and grief triggers are normal. 2
The pediatrician's modest effort to provide compassion and support can have a dramatic effect, helping reduce the time grieving children feel confused, isolated, and overwhelmed. 1