Abstract
Childhood bereavement is a significant issue globally, affecting millions of children each year, with incidence rates significantly increasing following the COVID-19 pandemic. The loss of an important adult, particularly in the ICU environment, can lead to lasting psychological and behavioural challenges for children. While family-centred practices in the ICU have advanced, the unique bereavement needs of grieving children in the family remain insufficiently addressed. Both families and healthcare professionals (HCPs) often feel unprepared and uncomfortable engaging in honest, supportive conversations with children about bereavement, further complicating children’s grief processing. This narrative review examines the pivotal role ICU HCPs can play in facilitating child-centred bereavement support, focusing on promoting honest communication, supportive visitation practices, creating a child-friendly and humanised ICU environment, and encouraging child involvement during end-of-life care. It recommends prioritising research on the lived experiences of bereaved children, caregivers, and ICU HCPs to inform targeted interventions addressing children’s developmental and psychological needs during ICU bereavement. The review also advocates for specialised training to equip ICU staff with the necessary skills to support grieving children and families. Developing comprehensive, child-centred ICU bereavement guidelines will provide evidence-based frameworks that recognise children as integral family members during end-of-life care while advocating for the participation of children in meaningful rituals will empower families to make informed decisions about their involvement. Together, these recommendations aim to create a more compassionate, inclusive, and supportive bereavement experience in ICU settings, prioritising the unique needs of children and promoting healthy emotional adjustment after losing an important adult.
Key Points
- Impact of ICU Bereavement on Children: The sudden and unpredictable nature of ICU deaths increases the psychological burden on families, with bereaved children facing long-term risks, including depression, post-traumatic stress disorder, and academic challenges.
- Barriers to Effective Bereavement Support in ICUs: Many ICU family-centered care practices overlook children’s unique needs. Clinical guidelines primarily address family grief as a whole, leaving HCPs without specific training or protocols for supporting grieving children.
- Importance of Honest Communication: Transparent conversations about death with children improve their emotional adjustment and mental health outcomes. However, many adults avoid direct discussions, using vague language that can confuse and distress children.
- Child Presence and Participation in ICU Bereavement: Allowing children to visit critically ill loved ones reduces anxiety, strengthens their understanding of the situation, and fosters healthy grieving. Despite this, ICU visitation policies are often inconsistent, with many HCPs and caregivers hesitant to involve children.
- Planning Child-Centered ICU Visits: Advance planning, collaboration with caregivers, and adjusting the ICU environment to be more welcoming can help make visits less distressing for children. Personalizing the space and reducing intimidating medical visuals are effective strategies.
- Humanizing the ICU for Children: Efforts to humanize ICU environments—such as reducing noise, allowing personal items, and creating child-friendly spaces—can alleviate children’s fear and improve their experience when visiting loved ones.
- Encouraging Bedside Involvement: Children benefit from active participation in the farewell process, such as holding their loved one’s hand, sharing memories, or leaving personal items. Allowing children to make choices about their involvement enhances their emotional processing.
- Challenges for Healthcare Professionals: Many ICU staff feel underprepared to support grieving children due to a lack of specialized training. Investing in bereavement education for HCPs can improve their confidence and ability to guide families through difficult conversations.
- Developing ICU-Specific Bereavement Guidelines: Establishing standardized, child-centered guidelines will help HCPs navigate bereavement care, ensuring children are recognized as integral family members and receive the support they need.
- Future Research Priorities: Further research is needed to understand the experiences of bereaved children, assess the effectiveness of different support interventions, and develop evidence-based recommendations for ICU bereavement care.
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