Support for Grieving Siblings
When a child’s brother or a sister dies, they not only feel deep grief, they often feel lost and alone. They may wonder why this happened to their family or even worry it is their fault. To navigate the confusing time before and after a sibling’s death, grieving kids need guidance and support. With information and understanding, they’ll be better able to cope with a loss that will impact the rest of their life.
When a child’s brother or a sister dies, they not only feel deep grief, they often feel lost and alone. They may wonder why this happened to their family or even worry it is their fault. To navigate the confusing time before and after a sibling’s death, grieving kids need guidance and support. With information and understanding, they’ll be better able to cope with a loss that will impact the rest of their life.
The death of a sibling is a tremendous loss for a child. They don’t only lose a family member; they lose a partner and a friend. Siblings of deceased children may even feel they’ve lost their parents, who are busy grieving, and worry their sister/brother was more important than them. All this is painful and overwhelming, and bereaved siblings need both guidance and support. However, despite the lifelong impact of the loss, most children are resilient and able to go on to live full lives.
Caregivers, friends, extended family and school staff all play an important role in helping children grieve and cope with the death of a sibling. But many do not know where to start. Below is a brief guide to supporting children who are grieving or whose sibling’s life is nearing its end.
Anticipatory Grief in Siblings
Many siblings of children with cancer and other life-changing illnesses or injuries begin grieving well before their sibling is gone. In fact, they may have begun grieving as soon as their brother or sister was diagnosed. This is called anticipatory grief, which is the process that occurs before, or in anticipation of, a death or a loss.
Your well child may mourn the things they can no longer do with their sibling, their old lifestyle, and even how they viewed themselves. They may also feel they’ve lost their relationship with their parents who are busy grieving and the future they had planned. And of course, most siblings worry about their brother or sister’s death and their own life after their sibling is gone.
Finally, it is important to note that watching their sibling decline and the uncertain timeline of death can be very difficult for children (and adults). Should their sibling die suddenly, this can be a shock. And if they live longer than expected, this can be unsettling. Children crave certainty and stability. Never knowing when the end will come and constantly adjusting expectations is therefore incredibly hard. Acknowledging and talking about the uncertainty can help. You may also want to brainstorm or share ideas for how to cope.
Anticipatory grief can be very painful and confusing for a sibling. However, the time before their brother/sister’s death can also offer an opportunity to spend extra time together, say goodbye and take the first steps towards finding closure. Including siblings of dying children in memory-making, care-taking and end of life decisions can be helpful. And it’s never too early to seek professional support. If your child’s anticipatory grief is overwhelming or affecting their ability to function, speak to their doctor or your other child’s medical team about therapy and other forms of emotional support.
Signs of Anticipatory Grief in Siblings
Anticipatory grief looks different for everyone, and it’s important to remind siblings that there is no right or wrong way to grieve a loss. Even children within the same family will react differently to news of their brother or sister’s impending death. Some may have very strong reactions and grieve openly, while others may appear not to understand at all. Both reactions are equally valid, and most often, children will process the news in their own way and time.
It is also normal for children to bounce between feelings, for example going from sad to happy or relieved in short periods of time. Children, especially young ones, have fleeting feelings and this can be very confusing for them and adults. It does not mean they are not mourning their sibling or that something is wrong.
Despite the uniqueness of grief, there are some common responses many siblings of dying children have. Your child may show some or many of the signs of anticipatory grief in the table below.
Emotional | Behavioral |
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Mental | Physical |
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A child’s reaction to learning their sibling is dying is influenced by their age and ability to grasp the concept of death. Below is some additional information on anticipatory grief by age to help you better understand how they may respond.
Young Children
Younger children, including infants and toddlers, are often unable to fully understand death. Many believe death is either temporary or reversable. However, even infants grieve. They often pick up on the emotional reactions of those around them and mirror those feelings back.
They may also react strongly to other changes in their routines or environment. Typical reactions include behavior changes or regressions in eating, sleeping, or toileting.
School Age Children
School age children can better understand that their sibling’s illness will cause them to die and recognize that it is permanent. However, death is still a relatively new concept. They may have many questions about death or dying, and even ask them repeatedly, as a result.
Due to their greater understanding, children ages 6-12 often experience more fear, sadness, and anger than a younger child. Some may express these feelings openly, while others will keep them inside. It is common to see more significant changes in their behavior as well.
School age siblings can feel as though they are being neglected or missing out on things while their caregivers care for their dying brother or sister. This sometimes leads to attention-seeking behaviors, jealousy, guilt, frustration, and sadness. Additionally, they may wonder if their sibling’s illness is their fault or fear that they could get sick themselves. Worry about who will care for them and about being without their loved ones are also common.
Teenagers
Teenagers are more able to understand that their sibling’s illness is terminal and the permanency of death. They might experience more intense feelings of sadness, worry, anger, and isolation or engage in risky behaviors as a result. Your teen may mourn the future they had imagined with their sibling, or struggle with regrets about arguments in the past. Teen siblings of dying children may also question the purpose or meaning of life. Additionally, teens can worry about whether their family will be okay after their sibling’s death, experience survivor guilt or be concerned that something will happen to themselves or another important person in their life.
As they go through the anticipatory grief process, many teens turn to their friends for support. This is normal as they seek more independence from their parents. They may also recognize that their caregivers are handling a lot and don’t want to increase their burden. However, despite their seeming maturity and independence, teenagers still need parental support as they go through the grieving process.
How to Talk to Siblings About Their Brother/Sister’s Death
However, children of all ages require direct, accurate and age-appropriate information to understand what is occurring. No matter their age, children usually pick up on changes in the emotions and behaviors of others and can sense something is wrong. Spoken or unspoken, they will have questions.
You can help by starting these conversations yourself. This will reassure your child it’s okay to talk about their sibling’s death and share their feelings, worries and concerns. These talks can also reduce feelings of jealousy, confusion, or abandonment, and show your child they are not facing this alone. Finally, talking about death with your child provides them the opportunity to be involved in end of life care, if they want to, and grieve appropriately. They will have a chance to participate in often important memory making activities and say goodbye.
While talking about a child dying can be difficult, the silence is often worse. Everyone reacts differently, but for many just starting the conversation brings a sense of relief. And if your child shares what they’re thinking and feeling, you will be better able to support them through this painful time.
Talking to Siblings About Death
- It can be hard to know when and how to talk to your child about their sibling’s death. Try to pick a time when they feel safe and ask for permission to talk. Then begin by clarifying what they already know and understand about what is happening to their sister or brother.
- When sharing, be open and honest. It’s okay to say, “I don’t know.” You can also ask your child what they think and share your own beliefs about death. And for medical questions, your other child’s doctor, child life specialist or social worker are great resources.
- The way information is shared, and the questions siblings ask will vary based on their age and developmental stage. If you have multiple children of varying ages, be prepared to talk to them differently about their brother/sister’s death.
- Use concrete language, especially with younger siblings. Avoid phrases, such as going to sleep, passing away, or resting, as these phrases can be confusing or scary to a child. Instead, simple and accurate words (i.e. death / dying) are best. Child life specialists can help with explaining medical conditions and are available at most hospitals and clinics.
- Try providing short pieces of information then give siblings time to process and decide if they want to know more.
- Follow your child’s lead. Listen and be aware of their reactions. Don’t pressure them to share their feelings but create space so they know they can ask questions now and later on.
- Remind your child (and yourself) that there is no one right or wrong way to feel. Everyone reacts differently and grief does not have to follow a certain pattern or timeline.
- Think of these conversations as ongoing. Some siblings might want to talk right away, while others may want time to process on their own. It is okay to pause if you or your child needs a break and come back to it at another time.
- Caregivers can encourage sharing and expressing feelings by doing it themselves. It is okay to cry in front of your child and explain why you are sad. This shows children they can do the same and models healthy coping. You can also share other things that help you cope, such as journaling or talking with a friend. If you have very strong emotional reactions (for example, need to sob uncontrollably), find some support for yourself away from your child.
- Make clear it’s okay to ask questions, especially if your child has been hesitant to do so. Many kids need an invitation to bring up tough topics like death with adults.
- Remind siblings that you love them and are there to support them, no matter what.
- Consider sharing that you have other adults to help you with feelings and that they are not responsible for your emotions.
- While difficult, it is important to acknowledge the changes in your child’s condition as they near end of life. Siblings of all ages notice these changes and their impact on those around them. Not talking about it can increase anxiety and the fear of the unknown. And without accurate information, most children will fill in the blanks which can be worse.
- Sometimes difficult conversations are easier while doing an activity. Ideas include making art, going for a walk or bike ride, doing a puzzle, baking or playing with fidget toys. Reading a book or watching a show that addresses dying can also help you start. Check out the Bereavement Resource section (link) for a few options.
- Recognize your own emotions and limits. If you feel you might need or want some support in having these conversations, you can ask a professional from your medical team, child life specialists, a psychologist or social worker for guidance. Some caregivers also find it helpful to have a close family member or friend there to support them. Finally, try to set aside some alone time before and/or after difficult conversations to process your emotions.
- Some children wish to speak with an adult in addition to, or in place of, a parent or caregiver. Siblings often fear their emotions will create an even greater burden or are ashamed of them. Friends and family, medical professionals, coaches, counselors, and religious figures are all great options.
- Help prepare siblings to talk with others, as friends, extended family, teachers, and community members have questions of their own. Depending on their age, you may need to be present to explain things to their friends. It is also a good idea to reach out to adults in their lives, like teachers and coaches, to share what’s going on. For more information on preparing children to answer questions, see our How to Help Your Child Answer Question article.
Useful Phrases for Talking to Siblings About Death
You are the expert on your child and know the best way to speak with them. However, the tone and language you use are important. Below are some phrases that may help.
- Getting started: “Some things can be hard to talk about, but we want you to know you can always talk to us about anything, like what you are thinking and feeling. We will always be honest with you.”
- Assessing understanding and knowledge: “What do you know about [sibling’s illness/injury]?” “What worries do you have?” “What do you think happens after you die?”
- Explaining: “The doctors don’t think treatments are working and they don’t have any other medicines to treat [sibling’s name]’s illness.” Or, “The doctors don’t think [siblings name]’s body will be able to get better.”
For younger children, it can be helpful to discuss death from a biological standpoint. For example, “When someone dies, their body no longer works. They stop breathing and can’t feel any pain.” You may also need to explain more about what death is like. “When someone dies, they cannot eat, walk, talk or be with you as a person.”
Some families find stories can be helpful for explaining death to their child, followed by a discussion, asking “What did you think about the story?”
Finally, you may need to explain that their brother/sister’s death is no one’s fault. “Sometimes there are machines or medicines to help a person to get better. Sometimes though there are no medicines or machines that can be used, and the doctors cannot help to make the person better. This is the case with [sibling’s name]. There is nothing that anyone can do to help [name] get better. No one knows exactly why this happens, but she/he is not going to die because of something that someone said or did.”
- Religious/ spiritual beliefs: Including your cultural, religious or spiritual beliefs about death can be helpful when having these conversations. Religious leaders can also be useful in having these conversations and/or offer direct support to your child. Even if you do not have your own specific beliefs, you might want to include comforting statements that help them feel safe, such as, “Your sibling won’t be in pain anymore.”
- Inviting questions: “What questions do you have?” “What are your worries?” “Do you have any other questions right now?” “If you ever have any questions, we are here to support you. If you’d like to talk to someone else, that’s okay too.”
- Modeling and expressing emotions: “We know this might be difficult, scary, and emotional to hear. It’s okay to feel whatever you are feeling. We want you to know you can talk to us. We love you and we feel upset, sad, and scared too.”
- Supporting & reassuring: “We are here to support you.” “This is not your fault. You didn’t do anything to cause this.” “We love you and will be here for you.” “This will be difficult for our entire family, but we will get through it together.”
How to Include Siblings in End of Life Care
However, it is important that siblings are involved in end of life care only at a level that is comfortable for everyone. Forcing or pushing children past their comfort level could be traumatic and hinder the grief process. The best approach is to have an open discussion with each of your children about their wishes and offer several different options. Their desires may also change, so remember to remain flexible and open. Because it cannot be said enough, there is no right or wrong way to grieve and everyone has different needs throughout the process.
Below are a few ways siblings can be included in end of life care to get you started.
Care-taking
Some siblings wish to help care for their dying brother or sister. Providing a choice and small ways children can help can provide them with a sense of control and inclusion. Depending on their age, they may wish to be involved in simple tasks such as food preparation, fetching things, entertaining their sibling, or giving them company and just being present. Older siblings may also wish to help with more advanced care-taking tasks, such as minor medical care, ensuring their sister/brother’s comfort and running errands.
However, be sure your child is only involved in end of life care at a level that is comfortable and that you check back frequently to be sure they do not feel overwhelmed or burdened. It can be helpful to allow older children to offer suggestions of how they’d like to help and then choose those that are appropriate.
Memory Making for Siblings
Having the opportunity to create and preserve memories can be very helpful to children as they anticipate and grieve their sister/brother’s loss. Memory making activities can also be healing on significant anniversaries and holidays after their sibling is gone.
These types of activities have many benefits for every member of the family. Memory making can reduce kids’ feelings of loneliness, offer siblings a way to be involved in end of life care, and create positive experiences during an incredibly hard time. In some cases, these activities also create keepsakes that can be used to connect with the deceased child in the years to come.
Below is a brief list of memory making activities for siblings. Feel free to adjust them to fit the age, abilities and interests of each child.
- Picking matching stuffed animals, jewelry, toys etc. for themselves and their sibling.
- Making art work together as a family or just with their sibling. Many enjoy including family members’ thumbprints, footprints or handprints using paint, clay or tracing.
- Creating interviews, video/audio recordings, or letters from the child nearing end of life. Younger siblings can help with this process by making up interview questions.
- Making a family photo album or scrapbook together.
- Writing down favorite stories or memories that include the dying child.
- Creating a poem or song about the family or dying child.
- Writing a letter to the dying sibling about their relationship, feelings, or to say goodbye.
- Planting a tree or other plant in memory of their sibling.
- Making a memory box of items or images that remind them of their sibling.
- Creating new traditions or purchasing/making items to help celebrate the loved one’s memory at significant moments or holidays (like a Christmas ornament).
- Watch this video on remembering a deceased loved one and see what ideas your children come up themselves. This video is also great for explaining memory making to younger kids.
Visiting a Dying Sibling
Just like involving siblings in end of life care, deciding whether to have children visit a dying sibling can be tricky. Some families feel they are protecting the well child by keeping them away. Others may want the two siblings to spend as much time together as possible. Like many decisions throughout a child’s life, this is something each family must determine based on their unique personalities, situation, and goals.
However, depending on age, visiting a dying sibling at the hospital or in the home can be a very important part of both children’s grieving process. They may wish to say goodbye and spend time together, and your well child might want to offer their sibling support. They may also wonder what is happening to their brother/sister or if they are being kept away because they or their sibling did something wrong.
Again, providing siblings with a choice (while also respecting the dying child’s preference for visitors) is appropriate. If the sibling decides to visit, a caregiver should prepare them for what to expect. Your child’s healthcare or hospice team can be helpful with this process. And if siblings prefer not to visit, you can still offer the opportunity to say goodbye with a phone call, video call, picture or letter.
Finally, know a sibling’s preferences may change. Be as honest as possible about the time you believe is left and try not to push them. It can also be helpful to be flexible about when and how they can visit, if possible. Obviously, this is an incredibly hard period for everyone. Offering your entire family grace and understanding is generally the best policy.
Sibling Participation in End of Life Ceremonies
End of life ceremonies, such as funerals and memorial services, are another important way in which siblings can be involved in end of life planning. Sometimes caregivers are hesitant to include siblings, especially younger children. And again, there are no rules about how and if siblings are involved. However, for many children, end of life ceremonies help them begin to grieve and feel less alone.
If siblings choose to attend an end of life ceremony, try to prepare them by explaining what they will see, what will occur, and the purpose. Some families also find it helpful to have a designated support person (family member, close friend or babysitter, etc.) to attend to a young child. This allows them to take breaks and/or leave if they want. It also reduces stress on you and other caregivers knowing there is someone else to provide them support. Finally, during the ceremony, allow siblings to grieve in their own way. There are often expectations to act a certain way but trying to control their grief can hinder the process.
If a child will not be attending the end of life ceremony, they can still be involved. They can help choose photos to be displayed, decorations or music. You may also want to record the ceremony and/or preserve keepsakes should they wish to watch it later or have a memento.
Ways to Include Siblings in End of Life Ceremonies:
- Picking out flowers/music/decor for the funeral or gravesite
- Selecting clothes, jewelry, photos or other items for the departed child or to be placed in the casket
- Drawing a picture or writing a letter to leave with their sibling
- Choosing a favorite memory to be shared at the service, or speaking themselves
- Having a role in the end of life ceremony such as handing out memory cards, speaking or being a pallbearer
- Funeral directors, chaplains and other religious figures may have ideas for other ways siblings can be involved.
Grieving the Loss of a Sibling
The loss of a child rocks a family, especially the child’s sibling. Even if there is a lot of time to prepare, the physical loss is a thing all its own. On top of this, many siblings are coping with medical trauma from their brother/sister’s diagnosis and/or treatment. It’s a lot to manage, and most bereaved children struggle to understand and process their emotions following their sibling’s death.
This is all part of grief, and no matter their age, every sibling will go through a form of the grief process. Grief often involves some of the same symptoms of anticipatory grief which occurs before a loss.
However, every child, even within the same family, will grieve differently depending on their personality, age and understanding of death. Some siblings show signs of grief right away. Others wait many years before grieving openly. It is also common for children to bounce between deep grief and feeling happy or normal. Grief is not a clear or straightforward process that follows a specific timeline. This can be very confusing to you and your child. It’s common to wonder if what they are feeling, doing, or thinking is appropriate.
Generally, the answer is yes – your child’s grief for their lost sibling is normal. And while every child is unique, there are certain emotions and reactions that are common. Below you will find some typical grief reactions in siblings by age to help you better understand your grieving child.
Young Siblings |
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School Age Siblings |
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Teenage Siblings |
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Grief is an ongoing and evolving process. While coping with the loss of a sibling typically gets easier, your child might experience grief differently and more intensely at times. Certain events, places, things, or dates can trigger symptoms of grief even years after a loss.
For example, important dates such as birthdays, the anniversary of your child’s death, or holidays can be more difficult. Younger siblings may also experience anxiety as they approach the age of their sibling when they died. If another family member experiences an illness or injury, or the sibling visits the hospital, this can also trigger renewed feelings of anxiety and grief. It can be helpful for families to plan ahead and identify ways to cope should it occur.
Supporting Grieving Siblings
Below are a few important ways to help grieving siblings. You can also view our sibling resources for books, toolkits, websites and other ways to provide support.
- Do your best to support siblings in their own activities during both your child’s end of life care and after death. Siblings can feel neglected or overlooked during these difficult times. While you might not be able to be physically present for everything, make sure siblings know they still matter, are cared for, and their interests are important. If you cannot attend, consider having someone video you in or record their activities. And be sure to make time to discuss them, as well as other parts of their life, with your well child.
- Pay attention to siblings’ needs. Sometimes siblings feel less important than the child that died. Or worry that they will not measure up. You might notice siblings trying to be perfect or setting unrealistic standards for themselves to get your or another caregiver’s attention. They may also take on additional responsibilities and/or simply try not to create additional stress. It is helpful to reassure them that they are loved, no matter what, and that it is not their job to be the adult.
- It can sometimes be helpful to have a trusted family member or another adult take responsibility for the support of a sibling. This ensures they are receiving attention and care while making space for you to grieve. However, do your best to find time to check in and offer support.
- Children look to parents and caregivers for information on what’s going on and how to react. Have open and honest conversations with siblings about what has happened and their own mental and emotional health. Allow them to ask questions and answer as simply and honestly as possible. And encourage your child/ren to recognize and express their feelings and thoughts.
It is also important to discuss and model healthy coping by showing them the positive coping strategies that you use and talking about what might work for themselves. You can learn more about managing difficult emotions and making a coping plan in this article. - Some siblings do not wish to talk about their brother/sister and just want to be “a normal kid”. Give them space and time. However, be sure they know that it is okay to bring their sister/brother up. Some children are afraid to talk about their sibling’s death as they know it’s an upsetting topic.
- Older siblings might not want to further burden you and other caregivers, and prefer to open up to peers, another trusted adult, or a mental health professional. If that is their preference, support them in that choice.
- Journaling, drawing, listening to music and reading books about death and feelings can all help children cope. Other stress reducing activities that have helped throughout their sibling’s medical journey will often continue to be useful now. Child life specialists, social workers and other members of your child’s medical team may have additional ideas to provide.
- Continue to share stories about your deceased child and express what they meant to you. Some families find it helpful to include or acknowledge the child in small ways during significant events (i.e. family photos, holidays). Other memory making activities can also help with this process.
- Maintain routine and rules as much as possible. Children do best with clear expectations and structure. Routines can provide a sense of safety and control. Try to get siblings back to school, encourage them to engage in normal activities and spend time with friends. A sense of normalcy is also important for healing and building resilience.
- Remind your child it’s okay to still feel happy and have fun. They are not betraying their sibling and it does not mean that they are “grieving wrong”.
- After your child passes, it can be helpful to reach out to their sibling’s school and friends’ parents to share the news, so they do not have to do so themselves. You should also help your child prepare for questions and create a short phrase to use when they do not want to talk. Finally, continue to check in and support your living children as they experience other’s reactions. Unfortunately, children and adults can say very thoughtless things. For more on sharing the news of your child’s passing, read the “Sharing the News of Your Child’s Death” section on the Grieving Parents and Caregiver page.
- For more ways to support siblings, visit the siblings page and check out our overview of sibling support.
When to Seek Help for Grieving Siblings
Losing a sibling is a life changing event and it’s normal for bereaved children to struggle for a time. Yet sometimes, despite best efforts, grieving siblings need professional support. There is no reason for anyone to feel guilty or ashamed if this occurs.
Some signs your child may benefit from mental health support as they are coping with the loss of their sibling include:
- Significant changes in mood / behavior
- Withdrawing / isolating or the loss of important friendships
- Your child becomes easily overwhelmed, extremely jumpy or develops fears and phobias that impact their ability to function and cope
- Your child develops problems in school
- You are having difficulty supporting your child due to your own emotions
- Your child threatens or engages in self-harm
- Your child threatens or does harm to others
- Your child simply expresses they are having a difficult time or desire additional support
If your child experiences any of these symptoms, or if distressing emotions go on for weeks or interfere with everyday life, it may be time to reach out for help. Talk to your child’s medical team, another trusted medical provider and/or your insurance company for referrals to a psychologist, psychiatrist, or other mental health provider. Support groups, guidance counselors and religious figures can also offer support to your bereaved child.
Resources for Grieving Siblings
Below are a few suggested books, websites and toolkits to help grieving siblings. You can also find more resources to help them cope at any stage of the treatment process, and beyond, on our Resources page.
Books
- Brother: A Grief Story by Teleah Scott-Moore
- Life Is Like the Wind by Shona Innes, Irisz Agocs
- Something Very Sad Happened: A Toddler’s Guide to Understanding Death by Bonnie Zucker
- When Something Terrible Happens: Children Can Learn to Cope with Grief by Marge Heegard
- Gone But Never Forgotten: A Children’s Book about Grief and Loss
- Scarlet Says Good-Bye: An Activity Book for Kids When a Loved One Enters Hospice Care
- Forever Connected by Jessica Correnti
- You’ll Always Be by Callie Fryt
- The Invisible String by Patrice Karst and Geoff Stevenson
- Invisible String Workbook by Patrice Karst & Dana Wyss
- The Grief Bubble by Kerry Debay
- The Memory Box: A Book About Grief by Joanna Rowland
- Always and Forever by Alan Durant
- Helping Teens Cope with Death by The Dougy Centre
- Fire in My Heart, Ice in My Veins: A Guided Grief Journal for Teenagers and Young Adults by Enid Samuel Traisman
Websites
- JustSibs.org
- The Dougy Center’s Resources for Kids
- Sesame Street– Grief
- MISS Foundation – For Children Who are Grieving
- Child Mind Institute – Helping Children Grieve
- National Alliance for Children’s Grief
- Child Bereavement UK
Toolkits
- NACG Toolkit: Responding to Change & Loss in Support of Children, Teens, & Families
- NACG: Talking to Children & Teens about End of Life Memorials/Rituals
- NACG: Individual Bereavement Support Plan – Returning to School
- NACG: Supporting Children of All Abilities Who are Grieving
- New York Life Foundation: After a Loved One Dies – How Children Grieve and How Parents/Adults Can Support Them
Videos
- Roger Neilson House Sibling Bereavement Video Series
- Child Bereavement UK Video on Remembering a Lost Loved One