This perspective review addresses the underrecognized importance of grief and bereavement care (GBC) within pediatric palliative care (PPC). The authors aim to: identify existing gaps in GBC delivery, define the principal forms of grief encountered in pediatric settings, describe characteristic differences from adult bereavement models, and propose a framework to strengthen patient- and family-centered grief support throughout the pediatric illness trajectory.
The review emphasizes that unmet bereavement needs affect not only patients and families but also healthcare professionals (HCPs), and that system-level responses are required to reduce emotional and psychological burden.
The authors performed a narrative perspective review using PubMed and Google Scholar. Search strategies combined terms such as grief, bereavement, pediatric palliative care, children, caregivers, siblings, healthcare professionals, anticipatory grief, complicated grief, and prolonged grief disorder. Publications from 2020 onward were prioritized while earlier seminal studies were included when they were clinically or conceptually relevant.
As a narrative review and perspective piece, the aim was synthesis and framework development rather than meta-analysis; details on selection criteria, numbers of studies included, and quantitative synthesis were not reported in the abstract.
GBC in pediatric settings cannot be extrapolated directly from adult bereavement models. The review highlights three interrelated reasons:
Developmental considerations: grief reactions vary across childhood and adolescence, requiring developmentally appropriate assessment and interventions.
Prolonged illness trajectories: many pediatric illnesses involve long courses with repeated losses (function, appearance, expected milestones) and periods of anticipatory grief for families and patients.
Family-centered decision-making: pediatric care involves caregivers and siblings as integral participants; bereavement support must attend to the family system rather than only the individual patient.
These differences imply tailored approaches to communication, psychosocial support, and follow-up compared with adult palliative care.
The review defines and emphasizes several grief types that are particularly relevant in PPC:
Anticipatory grief: emotional responses occurring before an expected loss during prolonged illness trajectories.
Disenfranchised grief: grief that is unacknowledged or unsupported by social norms or institutions, which can affect families and HCPs when losses are stigmatized or not publicly recognized.
Complicated grief: intense, prolonged grief reactions that impair functioning; the review notes its relevance among bereaved family members and possibly among surviving pediatric patients.
Prolonged grief disorder: a diagnostic construct reflecting persistent, debilitating grief beyond typical cultural expectations; the review includes this as a relevant consideration in pediatric bereavement.
The authors also note that HCPs themselves may experience grief of these types, and that attention to clinician bereavement and moral distress is necessary.
The review summarizes approaches that have demonstrated conceptual or clinical relevance for pediatric settings:
Early integration of palliative care into the illness trajectory to anticipate and address bereavement needs proactively.
Legacy-making activities that allow children and families to create meaning and preserve memories.
Structured, developmentally appropriate communication strategies between clinicians, patients, and families to prepare for transitions and end-of-life moments.
Interdisciplinary psychosocial support involving mental health, social work, chaplaincy, and community resources to address complex family needs.
The authors stress that interventions should be culturally sensitive and tailored to developmental stage and family context.
The review highlights persistent global disparities in access to and quality of GBC within PPC. These disparities reflect variations in resources, service models, cultural norms, and institutional prioritization of bereavement services.
Healthcare professionals frequently report inadequate training and insufficient institutional support to provide effective GBC. The review identifies workforce education and formal grief training as key deficits that limit consistent, high-quality bereavement care.
Based on the literature synthesis, the authors propose conceptualizing GBC as a longitudinal, system-level responsibility that extends from diagnosis through bereavement. Core elements of the proposed framework include:
Early, routine communication about prognosis and potential losses to facilitate anticipatory grief work.
Patient- and family-centered care plans that integrate legacy activities, psychosocial supports, and follow-up for bereavement needs.
Interdisciplinary team involvement, ensuring mental health and spiritual care inputs are available and coordinated.
Formalized training for HCPs in grief recognition, communication, cultural competence, and referral pathways.
Culturally sensitive implementation that accounts for local practices, resources, and norms.
The abstract does not provide a detailed schematic or stepwise protocol; it frames the framework at a conceptual level emphasizing integration and longitudinal care.
The review concludes that strengthening grief and bereavement care in pediatric settings requires reframing GBC as an integral, longitudinal component of pediatric palliative care rather than an episodic add-on. Recommended priorities include early palliative care integration, developmentally and culturally tailored interventions, interdisciplinary psychosocial support, and formal grief training for healthcare professionals.
Addressing global disparities and institutional training gaps is necessary to reduce unmet psychosocial needs among children with serious illness, their families, and the clinicians who care for them. The abstract underscores the potential for integrated frameworks to improve bereavement outcomes but does not present outcome data or implementation results in the abstract.