Pediatrician and nationally renowned grief expert Dr. David Schonfeld reflects on recent JAMA Pediatrics study on sibling loss

Commentary on Yu et al: Association of mortality with the death of a sibling in childhood. JAMA Pediatrics 2017;171(6):538-545. David J Schonfeld, MD, Director of the National Center for School Crisis and Bereavement (

Note: A recent study published in JAMA Pediatrics explores how children are impacted when the death of a sibling occurs. Below pediatrician and nationally renowned grief expert Dr. David Schonfeld, who also serves as the director of the National Center for School Crisis and Bereavement, shares his perspective on the study and our collective need to provide greater support to grieving children.

“He (she) is like a brother (sister) to me” is a common means of expressing an extremely close relationship that exceeds the strongest of friendships. It is one of the deepest per relationships and one of the longest enduring family relationships. But despite this, there has been relatively little attention given to the impact when this relationship ends prematurely through the death of a sibling. A recent study published in JAMA Pediatrics demonstrates just how much an impact the death of a sibling can have on children: children who experience the death of a sibling are more likely to die at an earlier age.

Yu and associates note that prior research has demonstrated an increased risk of mortality and adverse health outcomes for bereaved spouses, parents, and children. Because siblings have a unique and strong relationship, they wanted to see if there would be similar finding among children who experience the death of a sibling. They took advantage of the comprehensive national registers of citizens of Denmark and Sweden to answer this question. They studied approximately 5 million children in the two countries over a more than 35-year-period. They found that children who experienced the death of a sibling (i.e., a child born of the same mother) when they were between 6 months and 18 years of age were 71% more likely themselves to die during the period studied (which was when the children reached roughly 2- to 35-years-of-age, depending on what year they were born during the study period).

The risk of death was highest during the first year after the sibling died and when both children and their siblings died of similar causes, such as endocrine, nutritional and metabolic diseases or diseases of the nervous or circulatory systems. And the risk of death was much higher when both siblings died of suicide. This would suggest that much of the risk of mortality in siblings was due to shared family environmental exposures and genetic susceptibility. But there was still an increased risk of mortality if the siblings died of different causes and this risk persisted even when the researchers tried to control for other variables.

No one questions that death of a sibling, or other close family member or friend, is a stressful experience for children. But too often this impact is felt by the general public to be short-term; often it is assumed that children’s resiliency will allow them to bounce back quickly and completely. This study highlights what bereaved children and their families know all too well – the impact of the death on children of a loved one is significant and long-term.

This information should not lead us to warn families after a death that surviving family members are likely to die earlier. Rather, it should reinforce our commitment as a society to provide grieving children with both the immediate and ongoing support they need and deserve. It should prompt us to stop dismissing or overlooking the impact of bereavement in children and redouble our efforts to support grieving children as if their lives depended on it. Because now it has been shown, that at least to some degree, it literally does.