Intended for healthcare professionals

Education And Debate

Coping with loss: Bereavement in childhood

BMJ 1998; 316 doi: (Published 21 March 1998) Cite this as: BMJ 1998;316:931
  1. Dora Black, honorary consultant child and adolescent psychiatrist
  1. Traumatic Stress Clinic, London W1P 1LB

    This is the second in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice

    Infants do not come into the world as “empty slates” but bring with them complex behavioural systems. One system that has been well studied protects the child from danger during the long period of extra-uterine immaturity. It involves the development of mutual attachment behaviour (box), which ensures that the child does not stray far from a caretaker. Infants are active partners in the development of this behaviour, using instinctive behaviours to engage caretakers in protecting them. These include smiling, vocalising, crying, and, later, returning frequently to the secure base of the adult after exploratory forays.1 Infant attachment is at its height at about 3 years of age and then becomes increasingly diffused by the development of other relationships, but it remains important throughout life, with later relationships qualitatively echoing the earlier ones.

    For optimal emotional, social, and psychosexual development to occur, children need a warm, secure, affectionate, individualised, and continuous experience of care from a few caretakers who interact with them in a sensitive way and who can live in harmony with each other.

    Summary points

    The pattern of attachment between infant and parent is rooted in instinct but modified by experience. It is an important source of security throughout life

    The articles in this series are adapted from Coping with Loss, edited by Colin Murray Parkes and Andrew Markus, which will be published in May.

    Separation from a parent in early childhood is followed, in succession, by protest, despair, and detachment; feeding difficulties, bedwetting, constipation, and sleeping difficulties may arise

    In later childhood the loss of a parent commonly gives rise to emotional and behaviour problems

    Children bereaved in childhood may be vulnerable to psychiatric …

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