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Center for Traumatic Stress in Children and Adolescents

Childhood Traumatic Grief


Depressed TeenWhen children experience a death under sudden, horrifying, frightening circumstances they may have difficulty with typical grieving and develop complicated or traumatic grief.  Children whose loved ones die under expected medical conditions such as cancer can also develop traumatic grief if the children's perceptions of the death were that it was shocking, unexpected or terrifying.


In the usual course of grieving the loss of someone they love, children typically have to accomplish several steps. These include the following tasks:

  1. Experiencing the deep and intense pain of the loss of the person who died.
  2. Accepting the permanence of the loss (this will vary according to the child's developmental level -- very young children will not be able to understand this in the same way that older children will).
  3. Reminiscing about and accepting the totality of the person who died (not just the bad parts, not just the good parts, but all of these parts together).
  4. Preserving positive memories of the person who died and integrating some of these into the child's own concept of herself or himself.
  5. Converting the relationship from one of interaction to one of memory.
  6. Reinvesting in new relationships.

Children going through these steps after the death of a loved one, and especially those experiencing the ongoing pain and loneliness associated with losing someone you love so deeply, are experiencing typical childhood grief. This is also called "uncomplicated childhood bereavement."



Children with traumatic grief get "stuck" on the traumatic way their loved one died, such that whenever they try to remember happy times with their loved one, their memories veer off into thoughts about the terrible way the person died. Since these thoughts are not happy or comforting but instead frightening and upsetting, these children may avoid thinking about the person who died. Alternatively, they cannot stop thinking about the person who died, but instead of these thoughts becoming comforting and healing, the thoughts continue to be hurtful, upsetting and even terrifying. 

As a result of being "stuck" on the traumatic aspects of their loved one's death, these children are not able to remember their loved ones in comforting, healing ways. Children with traumatic grief may develop sleep problems, difficulties with school, irritability, ongoing anger, sadness, or avoidance of friends, family and memories of the loved one. If these difficulties do not get better over time, they may interfere with important things that children need to do like school work, extracurricular activities, making and keeping friends, and spending time with family members. These children may also develop a psychiatric condition related to childhood traumatic grief called Posttraumatic Stress Disorder, which can be associated with more serious problems if left untreated. 


Smiling Teen

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can help children who are struggling with traumatic grief. We have used TF-CBT for children with traumatic grief in three studies and have documented positive outcomes. Two of these studies were in Pittsburgh; one was in New York City after the terrorist attacks of 9/11.

What makes our treatment different from typical bereavement programs that children receive in community settings?

  • Children and parents are both included in treatment.
  • Children and parents are seen individually at first, and then seen together, in family sessions so that children can share what they have done in treatment with their parents.
  • Treatment includes several distinct components, with both trauma- and grief-focused phases of treatment.
  • Treatment is both structured to provide all of the treatment components but also flexible to respond to individual family needs.
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