A 9-year-old boy and his 5-year-old sister are brought to the office by their mother. The boy has been sad and has cried frequently since the family dog was hit by a car and died 10 days ago. His mother says, "The other day he had a severe stomachache and did not want to go to school. I later learned from his teacher that he was very embarrassed after crying in front of his classmates. I am also worried that he has been asking to sleep in my bed. He hasn't done that in years." In contrast, his sister is cheerful and acts as though nothing has happened. The mother says, "She doesn't seem sad at all. She's excited about her upcoming birthday party this weekend and plans to set a place for the dog at the table." Neither child has a history of medical or psychiatric problems or takes any medications. Their developmental and growth milestones are normal. Which of the following is the most appropriate response to the mother's concerns?

Question

A 9-year-old boy and his 5-year-old sister are brought to the office by their mother.  The boy has been sad and has cried frequently since the family dog was hit by a car and died 10 days ago.  His mother says, "The other day he had a severe stomachache and did not want to go to school.  I later learned from his teacher that he was very embarrassed after crying in front of his classmates.  I am also worried that he has been asking to sleep in my bed.  He hasn't done that in years."  In contrast, his sister is cheerful and acts as though nothing has happened.  The mother says, "She doesn't seem sad at all.  She's excited about her upcoming birthday party this weekend and plans to set a place for the dog at the table."  Neither child has a history of medical or psychiatric problems or takes any medications.  Their developmental and growth milestones are normal.  Which of the following is the most appropriate response to the mother's concerns?

Quizplus · Accepted Answer

Explanation: Bereavement in children can present in different ways, depending on the child's age. The type of death, nature of the relationship to the deceased, personality and temperament of the child, pre-existing risk factors such as mental illness, quality of family support, and concurrent life stressors may also contribute to the varieties of response. Preschool children usually react to the loss of a loved person or pet with disbelief and may think that death is temporary or reversible. For example, they may think that the dead person or animal is only sleeping and will later wake up or come back to life. The 5-year-old girl acting as though the dog is still alive and her magical thinking that it can reappear are not pathological. It would not be helpful to explain the finality of death to a 5-year-old (Choice B). (Choices C and D) Older children (age >7), in contrast, are aware that death is final. They may react with sadness, crying, self-blame, inability to concentrate, anger, nightmares, regression to earlier behaviors, social isolation, and school problems such as avoidance or academic difficulty. The 9-year-old boy's sadness, crying, school avoidance, and regressive behavior are normal reactions in the weeks following the unexpected death of a beloved pet. Support from the parents, including encouragement to express feelings at the child's own pace and reassurance that the child is not to blame, is usually sufficient to help him or her through the bereavement period. Psychiatric/psychology referral should be pursued if there are signs of persistent mood disturbance or academic or social impairment does not improve. (Choice E) Regression to earlier behaviors is common during periods of stress and is typically self-limiting. Recommending that the 9-year-old boy return to his bed may further embarrass him or invalidate his appropriate distress at losing his pet. Educational objective: Bereavement in children can present in different ways, depending on the child's age. Preschool children tend to react with disbelief and may have magical thoughts that death is temporary or reversible. Older children understand the finality of death and may experience a range of emotional and behavioral reactions, including sadness, anxiety, anger, self-blame, regression, and avoidance.

A 9-Year-Old Boy and His 5-Year-Old Sister Are Brought to the Office