Adding to a child's shock and confusion at the death of a brother, sister, or parent is the unavailability of other family members, who may be so shaken by grief that they are not able to cope with the normal responsibility of child care.

Parents should be aware of normal childhood responses to a death in the family, as well as signs when a child is having difficulty coping with grief. According to child and adolescent psychiatrists, it is normal during the weeks following the death for some children to feel immediate grief or persist in the belief that the family member is still alive. However, long-term denial of the death or avoidance of grief can be emotionally unhealthy and can later lead to more severe problems.

A child who is frightened about attending a funeral should not be forced to go; however, honoring or remembering the person in some way, such as lighting a candle, saying a prayer, making a scrapbook, reviewing photographs, or telling a story may be helpful.

Once children accept the death, they are likely to display their feelings of sadness on and off over a long period of time, and often at unexpected moments. The surviving relatives should spend as much time as possible with the child, making it clear that the child has permission to show his or her feelings openly or freely.

The person who has died was essential to the stability of the child's world, and anger is a natural reaction. The anger may be revealed in boisterous play, nightmares, irritability, or a variety of other behaviors. Often the child will show anger towards the surviving family members.

After a parent dies, many children will act younger than they are. The child may temporarily become more infantile; demand food, attention and cuddling; and talk "baby talk." Younger children frequently believe they are the cause of what happens around them. A young child may believe a parent, grandparent, brother, or sister died because he or she had once "wished" the person dead when they were angry. The child feels guilty or blames him or herself because the wish "came true."

Children who are having serious problems with grief and loss may show one or more of these signs:

• An extended period of depression in which the child loses interest in daily activities and events
• Inability to sleep, loss of appetite, prolonged fear of being alone
• Acting much younger for an extended period
• Excessively imitating the dead person
• Repeated statements of wanting to join the dead person
• Withdrawal from friends, or
• Sharp drop in school performance or refusal to attend school

These warning signs indicate that professional help may be needed. A child and adolescent psychiatrist can help the child accept the death and assist the survivors in helping the child through the mourning process.