In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: Beyond the Birth Mother: How Entire Families Grieve Perinatal Loss - Part 2 of 3: Siblings

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🔗 The Best Resources I Found This Week

🧒 How teens really feel a year after a sibling dies
This longitudinal study followed adolescents at 7 and 13 months after a sibling’s death and found something surprising: fears increased over time instead of fading, especially fears about losing someone else or their own death.​
Read on PMC/NIH

🧬 Girls vs. boys: different grief patterns after sibling death
A mixed-methods study of adult siblings showed that women tended to recall the emotional and relational parts of perinatal death, while men focused more on specific details and data—helpful context for how boys and girls might talk (or not talk) about a baby who died.​
Read on PMC/NIH

📚 What school-age kids say 7 and 13 months after a sibling dies
This paper walks through how children 6–12 describe their sibling’s death, including guilt, loss of innocence, and big changes in school and friendships—exactly the age group many of your patients’ older kids are in.​
Read on PMC/NIH

🌱 Grief and growth: not every outcome is negative
Reporting on sibling bereavement, this article highlights that many kids describe becoming more mature, compassionate, and resilient after a sibling dies—but only when their grief is acknowledged and supported.​
Read on Medical Xpress

📖 Deep Dive

Beyond the Birth Mother: How Entire Families Grieve Perinatal Loss
Part 2 of 3: Siblings

This is Part 2 of 3 in our comprehensive series examining how stillbirth, miscarriage, and neonatal death ripple through families. While maternal grief has long dominated the conversation around perinatal loss, groundbreaking research reveals that fathers, siblings, teenagers, and grandparents experience profound and distinct forms of bereavement — yet remain largely unsupported by healthcare systems and society.

This three-part series examines each griever separately:

• Part 1: Fathers — The Invisible Mourners

• Part 2: Children and Teens — When Siblings Grieve

• Part 3: Grandparents — The Double Loss

Part 2: How Siblings Grieve Stillbirth and Miscarriage

When a baby dies—whether before birth, at delivery, or days after—there are often other children in the family. These children lose a sibling, lose the child they were preparing for, and lose something equally significant: they lose their parents' presence during the moment the parents need it most.

Sibling grief after perinatal death is what researchers call "disenfranchised grief"—a loss that is not, or cannot be, openly acknowledged, publicly mourned, or socially supported. Friends don't bring casseroles for a sibling lost to miscarriage. Teachers don't necessarily understand why a child's grades drop. Grandparents focus on consoling the bereaved parents. The surviving children grieve in silence, often hiding their own devastation to protect their grieving parents.​

Research examining how siblings respond to perinatal death finds profound impacts across every age and gender:

For young children (ages 6-12), the experience brings a loss of innocence. They develop unrealistic fears—"Could I die like my sibling? What did I do to cause this? Why didn't anyone protect my baby brother or sister?" They experience guilt, believing their own thoughts or wishes might have caused the death. They may blame themselves, struggle with sleep and appetite, and withdraw from friends who don't understand.​

For adolescents (ages 13-18), the loss triggers existential questions about death, meaning, and mortality. Fears—rather than decreasing—actually increase from 7 to 13 months post-loss, including intensified fear of losing someone else and preoccupation with their own mortality. Girls show significantly higher grief scores, more physical symptoms (sleep disturbances, appetite changes, fatigue), and depressive behaviors. Boys show concentration difficulties, hyperactivity, and are more likely to withdraw.​

Yet when asked directly, most surviving siblings say they're "fine" or "great." Research shows why: siblings are hiding their feelings to protect their grieving parents, especially their mothers.​

The Research Nobody Talks About: When Fears Grow Instead of Shrink

One of the most counterintuitive findings in sibling bereavement research is this: adolescents' grief doesn't follow a typical trajectory. In a landmark study following adolescents at 7 months and 13 months after a sibling's death, researchers documented something unexpected.

At 7 months:

• Most adolescents knew what happened

• They were thinking about their deceased sibling regularly

• They were processing the reality of the death

By 13 months:

• Fears had increased, not decreased​

• Adolescents reported significantly more fears of losing someone else

• Preoccupation with their own death had intensified

• Many described greater family changes and personal changes than they had at 7 months

As one grief researcher noted, adolescents don't just grieve; they re-grieve losses throughout their lifespan as cognitive and emotional capacities deepen. An 8th grader who lost a sibling to miscarriage may re-experience that grief in high school when developing identity, again in college when gaining independence, and again in adulthood when expecting their own children.​

Gender Matters: The Different Ways Boys and Girls Grieve

Research shows that sibling grief doesn't look the same in boys and girls, and healthcare providers and families often miss what's happening beneath the surface because they don't know what to look for.​

Girls' grief tends to be more externally visible. They score higher on grief measures, report more physical symptoms (sleep problems, appetite changes, fatigue), and show more depressive behaviors. Girls are more likely to disclose their feelings with peers—their peak of disclosure with friends occurs in junior high school. They tend to focus on the emotional significance of the loss, frequently mentioning family members and hospital staff, the delivery process, and the act of naming their deceased sibling.​

Boys' grief is often quieter and more internally focused. They show different behavioral manifestations: concentration difficulties, hyperactivity, and behavioral problems. Their peak of peer disclosure doesn't occur until high school—years later than girls. When they do talk about the loss, boys tend to be more specific and data-focused, mentioning exact names, dates, and concrete details related to the death, rather than focusing on emotional aspects.​

The research is clear: the absence of visible tears doesn't mean the absence of grief. A boy who becomes hyperactive after a sibling's stillbirth isn't "acting out"—he's processing trauma. A girl whose grades plummet isn't "lazy"—she's depressed.

The "Forgotten Mourner" Problem

One sibling described their experience after their brother died in the NICU: "Everyone was focused on my parents' pain. Nobody asked me how I was doing. I was supposed to be the strong one, the one who helped take care of my parents."​

This is the core of sibling disenfranchisement: while parents' grief is validated and supported, siblings' grief is overlooked, minimized, or expected to be absorbed silently. Parents may not even recognize the depth of impact on their surviving children's peer relationships—siblings report changes in friendships far more frequently than parents observe.​

The result is that many siblings carry complicated grief that extends well into adulthood, complicated by the fact that nobody acknowledged their loss at the moment it happened.

What Makes Sibling Grief Worse: The Double Loss

Sibling grief isn't just about losing a brother or sister. It's also about losing their parents' presence, attention, and emotional availability during the months when parents are consumed by their own bereavement. This creates a double loss:​

1. The loss of the sibling they were expecting to know

2. The loss of parental presence, stability, and emotional availability

The second loss often impacts long-term outcomes as much as the first.

When parents are withdrawn, depressed, or emotionally unavailable due to their own grief, children may develop anxiety about losing their surviving parent. They may become caretakers themselves, suppressing their own grief to manage the household or care for their parents' emotional needs. Over time, this pattern can lead to complicated grief, depression, and anxiety that extends well into adulthood.​

The Positive Side: How Some Siblings Transform Grief Into Growth

Not all sibling grief outcomes are negative. Remarkably, research shows that many siblings experience psychological growth alongside their grief. By 13 months post-loss, nearly all surviving siblings reported positive changes in themselves, including feeling:

• More mature and emotionally sophisticated

• Stronger and more resilient

• More compassionate and empathetic

• More open-minded and less reactive to stress

• More independent

Some siblings reported feeling motivated by a desire to become more like their deceased brother or sister—carrying their memory forward through how they lived. For these young people, grief catalyzed growth.​

The difference between siblings who experience complicated grief and those who experience growth appears to center on whether their loss was acknowledged and validated and whether they received support during the acute crisis.

How Different Ages Experience Perinatal Loss

Young children (ages 6-8):

• Concrete understanding of death (temporary, reversible)

• Unrealistic fears about their own safety

• Guilt beliefs ("I caused this by being mean")

• Need reassurance they didn't cause the death and won't die too

• Benefit from simple, honest explanations

• May experience separation anxiety from remaining parent

School-age children (ages 9-12):

• Growing recognition of death's permanence

• Concrete thinking but capacity for guilt and responsibility

• May assume caretaking role for grieving parents

• Vulnerable to shame among peers about family loss

• Can participate in meaningful memory-making rituals

• Need permission to still be a child despite family crisis

Adolescents (ages 13-18):

• Abstract, existential questions about meaning and mortality

• Heightened vulnerability to depression (especially girls)

• Likely to hide emotions from parents to protect them

• Peer relationships become central to support system

• Higher risk for substance abuse, risky behavior, school problems

• Same-sex sibling losses particularly difficult (identity disruption)

• Can participate in advanced grief work but need peer-specific support

What Hospitals and Healthcare Providers Miss

Most L&D nurses receive no specific training on how to address the other children in a family experiencing perinatal death. The focus is exclusively on the parents—and almost exclusively on the mother.

Yet the siblings in the room are experiencing something profound:

• They may have been present for part of the delivery

• They witnessed their parents' devastation

• They experienced the reality of the death viscerally

• They now face the aftermath without support

The "rights of parents" after a baby dies are well-documented in bereavement literature. But what about the rights of siblings? To be acknowledged? To ask questions? To participate in memory-making if they wish? To grieve openly rather than in hiding?

Currently, most hospitals don't have specific protocols for siblings after perinatal death. Many nurses don't know what to say to a 10-year-old who just learned their baby sister was stillborn. Most discharge planning focuses on mothers' physical recovery and emotional support—not on the surviving children in the home who will need support when family life resumes.

How to Support Siblings in the Immediate Crisis

At the hospital:

• Acknowledge the sibling's loss directly ("I'm so sorry about your baby brother")

• Ask age-appropriate questions about their understanding and feelings

• Offer choices about whether they want to see/hold the baby

• Use the baby's name and treat the baby with dignity (siblings are watching)

• Give siblings permission to grieve however feels right—tears, anger, silence, or questions

• Explain the situation in language they understand, answering questions honestly

In follow-up:

• Ask the parents specifically about the surviving children's reactions

• Provide resources specifically for siblings (age-appropriate grief books, support groups)

• Suggest that parents check in separately with each child, acknowledging their grief apart from the parents' own

• Recommend that parents monitor for behavioral changes, sleep problems, or withdrawal

• Suggest that siblings might benefit from talking with a counselor who specializes in child grief

Over time:

• Recognize that siblings will re-grieve this loss at different developmental stages

• Validate that it's normal for grief to resurface at puberty, first romantic relationship, own pregnancy planning, etc.

• Include siblings in anniversary remembrances if appropriate

• Help parents understand that surviving children didn't cause the death and won't "get over it" quickly

The Missing Conversation: What Siblings Want Adults to Know

Siblings who have experienced perinatal loss often express similar needs:

These voices point to a critical gap: siblings' grief is real, valid, and deserves acknowledgment from healthcare providers, families, and society. When we see a sibling in a bereavement room, we're seeing a young person who has lost someone and who will reprocess that loss throughout their entire life. They deserve support, honesty, and permission to grieve.

The Path Forward

Recognizing sibling grief requires three shifts:

1. Expanding hospital bereavement protocols to explicitly include siblings, with age-appropriate resources and communication strategies

2. Training healthcare providers on how grief manifests differently in boys and girls, young children and adolescents, and what signs of complicated grief to watch for

3. Supporting parents in understanding that their surviving children are grieving too, and that acknowledging their children's loss doesn't diminish the parents' own grief—it honors the entire family's experience

When we validate sibling grief, we change the trajectory of their healing. We transform them from forgotten mourners into acknowledged members of a grieving family. And we give them permission to carry their sibling's memory forward throughout their lives.

Series Navigation

Part 1 of 3: When Fathers Grieve
Part 2 of 3: When Siblings Grieve ← You are here
Part 3 of 3: When Grandparents Grieve (Coming Next)

How did today’s deep dive land for you?

(Select one)

⭐️ It was extremely helpful and gave me new insight

👍 Helpful, mostly a good refresher

✅ I didn’t learn anything new, but it validated what I already do

😕 It missed the mark or I have feedback

👋 That’s a Wrap!

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Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.

These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.

Until next week,

Trina and Jay
Co-founders of Forget Me Not