---
title: "Grief and Bereavement Care in Pediatric Palliative Care: Gaps, Disparities, and an Integrated Fram"
id: "pubmed-42844897"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42844897"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42844897/"
doi: "10.1017/S1478951526103824"
published_at: "2026-10-08T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Grief and Bereavement Care in Pediatric Palliative Care: Gaps, Disparities, and an Integrated Fram
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42844897
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42844897/)
- **DOI:** [10.1017/S1478951526103824](https://doi.org/10.1017%2FS1478951526103824)
- **Published At:** 2026-10-08T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This perspective review examines the underrecognized role of **grief and bereavement care** (GBC) within **pediatric palliative care** (PPC) and identifies persistent gaps and global disparities affecting patients, families, and healthcare professionals (HCPs). - The authors conducted a narrative review using PubMed and Google Scholar, prioritizing publications from 2020 onward and including earlier seminal studies when relevant. Search terms included grief, bereavement, pediatric palliative care, caregivers, siblings, HCPs, anticipatory grief, complicated grief, and prolonged grief disorder. - GBC in pediatrics differs from adult models because of developmental considerations, prolonged illness trajectories, and family-centered decision-making; multiple grief types are relevant to PPC, including **anticipatory grief**, **disenfranchised grief**, **complicated grief**, and **prolonged grief**. - Effective interventions described include early integration of palliative care, legacy-making activities, structured communication strategies, and interdisciplinary psychosocial support tailored to children and families. - The review documents that HCPs frequently report inadequate training and institutional support for delivering GBC, and that wide global disparities remain in access to and provision of bereavement services. - The authors propose viewing GBC as a longitudinal, culturally sensitive, system-level responsibility that extends from diagnosis through bereavement, and recommend integrated frameworks emphasizing early communication, patient- and family-centered care, and formal grief training for HCPs. - The review highlights the need for strengthened bereavement support to reduce unmet psychosocial needs across the pediatric illness trajectory and underscores the distinct considerations required in pediatric settings.
## Clinical Analysis & Structured Key Points
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Grief and bereavement care in pediatric palliative care: Gaps, global disparities, and a proposed integrated framework [Karina Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Castillo+K&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Maria Clara Landivar](https://pubmed.ncbi.nlm.nih.gov/?term=Landivar+MC&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Kevin Zambrano](https://pubmed.ncbi.nlm.nih.gov/?term=Zambrano+K&cauthor_id=42844897)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-2 "Department of Anesthesiology, Lehigh Valley Hospital-Cedar Crest, Allentown, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-3 "School for Mental Health and Neuroscience \(MHeNs\), Maastricht University, Maastricht, The Netherlands."), [Michella Dirani](https://pubmed.ncbi.nlm.nih.gov/?term=Dirani+M&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Diego Montenegro](https://pubmed.ncbi.nlm.nih.gov/?term=Montenegro+D&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Giselle Maldonado](https://pubmed.ncbi.nlm.nih.gov/?term=Maldonado+G&cauthor_id=42844897)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-4 "School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador."), [Valeria Macias](https://pubmed.ncbi.nlm.nih.gov/?term=Macias+V&cauthor_id=42844897)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-5 "School of Medicine, Universidad de Especialidades Espiritu Santo, Guayaquil, Ecuador."), [Luis Noboa](https://pubmed.ncbi.nlm.nih.gov/?term=Noboa+L&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Emilia Valdivieso](https://pubmed.ncbi.nlm.nih.gov/?term=Valdivieso+E&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Jose Maria Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Castillo+JM&cauthor_id=42844897)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-6 "School of Medicine, Universidad de Las Americas, Quito, Ecuador."), [Victoria Cortez](https://pubmed.ncbi.nlm.nih.gov/?term=Cortez+V&cauthor_id=42844897)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-6 "School of Medicine, Universidad de Las Americas, Quito, Ecuador."), [Sabine Dueñas](https://pubmed.ncbi.nlm.nih.gov/?term=Due%C3%B1as+S&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Pablo Salas](https://pubmed.ncbi.nlm.nih.gov/?term=Salas+P&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Sebastian Garzon](https://pubmed.ncbi.nlm.nih.gov/?term=Garzon+S&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Michelle Grunauer](https://pubmed.ncbi.nlm.nih.gov/?term=Grunauer+M&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#full-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.") Affiliations Expand ### Affiliations * 1 School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador. * 2 Department of Anesthesiology, Lehigh Valley Hospital-Cedar Crest, Allentown, USA. * 3 School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands. * 4 School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador. * 5 School of Medicine, Universidad de Especialidades Espiritu Santo, Guayaquil, Ecuador. * 6 School of Medicine, Universidad de Las Americas, Quito, Ecuador. * PMID: **42844897** * DOI: [ 10.1017/S1478951526103824 ](https://doi.org/10.1017/s1478951526103824) Item in Clipboard Review # Grief and bereavement care in pediatric palliative care: Gaps, global disparities, and a proposed integrated framework Karina Castillo et al. Palliat Support Care. 2026. Show details Display options Display options Format Abstract PubMed PMID Palliat Support Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Palliat+Support+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Palliat+Support+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42844897/) . 2026 Oct 8:24:e256. doi: 10.1017/S1478951526103824. ### Authors [Karina Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Castillo+K&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Maria Clara Landivar](https://pubmed.ncbi.nlm.nih.gov/?term=Landivar+MC&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Kevin Zambrano](https://pubmed.ncbi.nlm.nih.gov/?term=Zambrano+K&cauthor_id=42844897)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-2 "Department of Anesthesiology, Lehigh Valley Hospital-Cedar Crest, Allentown, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-3 "School for Mental Health and Neuroscience \(MHeNs\), Maastricht University, Maastricht, The Netherlands."), [Michella Dirani](https://pubmed.ncbi.nlm.nih.gov/?term=Dirani+M&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Diego Montenegro](https://pubmed.ncbi.nlm.nih.gov/?term=Montenegro+D&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Giselle Maldonado](https://pubmed.ncbi.nlm.nih.gov/?term=Maldonado+G&cauthor_id=42844897)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-4 "School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador."), [Valeria Macias](https://pubmed.ncbi.nlm.nih.gov/?term=Macias+V&cauthor_id=42844897)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-5 "School of Medicine, Universidad de Especialidades Espiritu Santo, Guayaquil, Ecuador."), [Luis Noboa](https://pubmed.ncbi.nlm.nih.gov/?term=Noboa+L&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Emilia Valdivieso](https://pubmed.ncbi.nlm.nih.gov/?term=Valdivieso+E&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Jose Maria Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Castillo+JM&cauthor_id=42844897)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-6 "School of Medicine, Universidad de Las Americas, Quito, Ecuador."), [Victoria Cortez](https://pubmed.ncbi.nlm.nih.gov/?term=Cortez+V&cauthor_id=42844897)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-6 "School of Medicine, Universidad de Las Americas, Quito, Ecuador."), [Sabine Dueñas](https://pubmed.ncbi.nlm.nih.gov/?term=Due%C3%B1as+S&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Pablo Salas](https://pubmed.ncbi.nlm.nih.gov/?term=Salas+P&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Sebastian Garzon](https://pubmed.ncbi.nlm.nih.gov/?term=Garzon+S&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador."), [Michelle Grunauer](https://pubmed.ncbi.nlm.nih.gov/?term=Grunauer+M&cauthor_id=42844897)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42844897/#short-view-affiliation-1 "School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.") ### Affiliations * 1 School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador. * 2 Department of Anesthesiology, Lehigh Valley Hospital-Cedar Crest, Allentown, USA. * 3 School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands. * 4 School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador. * 5 School of Medicine, Universidad de Especialidades Espiritu Santo, Guayaquil, Ecuador. * 6 School of Medicine, Universidad de Las Americas, Quito, Ecuador. * PMID: **42844897** * DOI: [ 10.1017/S1478951526103824 ](https://doi.org/10.1017/s1478951526103824) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Objectives:** Grief and bereavement care (GBC) remains an underrecognized component of pediatric palliative care (PPC), contributing to the emotional and psychological burden experienced by patients, families, and healthcare professionals (HCPs). This perspective review examines gaps in GBC, defines key types of grief in pediatric settings, and proposes a framework to improve patient- and family-centered grief support. **Methods:** We conducted a narrative perspective review using PubMed and Google Scholar to identify literature on GBC in PPC. Search terms included combinations of "grief," "bereavement," "pediatric palliative care," "children," "caregivers," "siblings," "healthcare professionals," "anticipatory grief," "complicated grief," and "prolonged grief disorder." Publications from 2020 onward were prioritized, with seminal earlier studies included when clinically or conceptually relevant. **Results:** GBC in PPC differs from adult models because of developmental considerations, prolonged illness trajectories, and family-centered decision-making. Relevant forms of grief include anticipatory, disenfranchised, complicated, and prolonged grief, affecting patients, families, and HCPs. Effective approaches include early palliative care integration, legacy-making activities, structured communication, and interdisciplinary psychosocial support. However, global disparities persist, and HCPs frequently report inadequate training and institutional support. **Significance of results:** GBC should be viewed as a longitudinal, culturally sensitive, system-wide responsibility extending from diagnosis through bereavement. Integrated frameworks emphasizing early communication, patient- and family-centered care, and formal grief training for HCPs may strengthen bereavement support and reduce unmet psychosocial needs across the pediatric illness trajectory. **Keywords:** bereavement; death; grief; pain; pediatric palliative care; pediatrics. 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