Prolonged grief disorder in children: a new diagnosis, and how little is known

Prolonged grief disorder became an official diagnosis only recently, and very little is known about it in children. When a 2024 systematic review searched the world's research, it found just five studies that measured how common it is in bereaved children and adolescents. They put it at between 10.4% and 32%^[1]. A US study that followed bereaved children for up to three years found that, for most, grief after a parent's sudden death eased over time^[2].

Grief after a parent dies can be fierce and long. A child may still be longing for their mum or dad years later, and may have bad days around birthdays, anniversaries and the milestones that parent will miss. None of that is a disorder. Grief is the normal response to a death. The new diagnosis describes something narrower: grief that stays intense, stays at the centre of a child's life, and gets in the way of school, friendships and family life well beyond what their culture would expect. This study sets out how the two international diagnostic systems define it, what the small body of research on children shows, and why the numbers vary so much.

Two manuals now recognise it, with different rules

For decades, the main psychiatric classifications had no diagnosis for grief itself. That changed in two steps. The World Health Organization's ICD-11 included prolonged grief disorder as a new diagnosis. The American Psychiatric Association had earlier put a similar condition, "persistent complex bereavement disorder", into the 2013 DSM-5 only as a condition "for further study". It then replaced it with prolonged grief disorder in the DSM-5-TR, released in March 2022^[3][4].

Both use the same name, but the rules differ. The core of each is the same: a persistent, pervasive longing for the person who died, or preoccupation with them. DSM-5-TR then requires at least three of eight further symptoms, such as feeling part of oneself has died, intense emotional pain or intense loneliness, nearly every day for at least the last month. ICD-11 takes a looser approach, asking for intense emotional pain shown in any of ten listed ways^[4]. Both require that the grief clearly exceeds what would be expected in the person's social, cultural or religious context. Both require that it causes real difficulty in daily life. ICD-11 names educational functioning among the areas that may be affected^[4].

Summarised from Treml et al. 2024, Table 1, and the American Psychiatric Association^[3][4]. Neither manual is reproduced in full here.

The time rule matters for children. Under DSM-5-TR, a child or adolescent can be diagnosed once the death was at least six months ago, half the year required for adults^[3]. The cultural clause matters too. How long and how openly grief is expressed varies greatly between families, faiths and communities, and grief that is normal in one setting is not a disorder because it would look unusual in another.

For most children, grief eases. For a minority, it stays

The strongest evidence on how children's grief changes over time comes from a US study that followed 182 children and adolescents aged 7 to 18 for up to three years, from 2002 to 2007. Their parent had died suddenly, by suicide, an accident or a sudden natural cause, and families were recruited through coroners' records and a newspaper advertisement^[2]. Three distinct patterns emerged. In one group, 10.4% of the children, grief reactions showed no change 33 months after the death. Another 30.8% had grief that rose 9 months after the death and then gradually eased. The authors' conclusion was that grief reactions "abate over time for most children and adolescents"^[2].

Prolonged grief was not harmless for those it affected. It was linked with more difficulty in daily functioning, even after allowing for the children's mental health before and after the death. Children with prolonged grief were also more likely to have had depression before the death. Prolonged grief in the child, and in the surviving parent, went with a raised risk of the child later developing depression^[2]. That is an association in one sample, not proof that one causes the other. It does suggest the surviving parent's grief and the child's are closely bound up, a theme we explore in our study of the surviving parent's wellbeing.

Estimates range widely, because studies measure different things

How many bereaved children have prolonged grief disorder? The honest answer is that nobody knows with any precision, in any country. The 2024 systematic review screened 1,716 articles and found only five studies that reported its prevalence in bereaved children and adolescents. Their estimates ranged from 10.4% to 32%^[1]. Researchers developing a new children's assessment summarised the field as "around 10% of bereaved youths" having symptoms of the disorder^[5].

Studies since then show why a single figure is hard to give. In the Netherlands, 7.8% of 90 bereaved children aged 8 to 18 met the DSM-5-TR criteria, and the same share met the ICD-11 criteria, when assessed by clinician interview^[6]. Among 291 Dutch children seeking help after a death, 12.4% had probable ICD-11 prolonged grief disorder by self-report^[7]. In Turkey, 19.7% of 147 children and adolescents whose parent died in the 2023 earthquake met the criteria nine months later^[8]. A 2026 meta-analysis of young people whose parent or sibling died of cancer pooled a prevalence of self-reported prolonged grief symptoms of 28% after a parent's death. The confidence interval ran from 7% to 65%, and none of the studies used diagnostic interviews^[9].

These differences come from who was studied and how. Children recruited through services are likely to be struggling more than bereaved children in general. Sudden and violent deaths, and deaths in disasters, may carry a higher risk than expected ones, though the evidence is thin. We look at that question in our study of sudden and expected deaths. Questionnaires, interviews and time since the death all differ. None of the child studies above sampled a whole population.

The adult research gives some context. A 2017 meta-analysis of 14 studies of adults bereaved by non-violent deaths found a pooled prevalence of 9.8%^[10]. A review of studies using the ICD-11 criteria found estimates from 1.5% to 15.3% in bereaved adults. Of 46 study samples, 24 came from Europe, 10 from North America, 5 from Asia and none from South America^[11]. For children the evidence comes from even fewer countries.

Children are measured with tools that are still being built

Part of the uncertainty is about measurement. Writing in 2023, a Dutch research team noted that no instrument yet existed to assess prolonged grief disorder in children and adolescents according to the DSM-5-TR and ICD-11 criteria^[5]. Earlier children's questionnaires were built on older definitions. In the US, researchers developed a 39-item checklist for children aged 8 to 18. It was designed around how grief shows itself at different ages, and was tested with 367 bereaved young people^[12].

The Dutch team's new clinician interview was tested in 2026 with 90 children. The results were mixed. Some items, such as those on disbelief and avoidance, did not fit well with the others, and scores were only weakly stable over three months^[6]. The choice of criteria can also change the answer a great deal. In the same 291 Dutch children, the earlier DSM-5 definition identified 3.4% as probable cases and ICD-11 identified 12.4%^[7]. In adults, a representative German survey found a prevalence of 4.7% to 6.8% among bereaved people, depending on which criteria and scoring rules were applied^[4].

Strict criteria can also miss children who are struggling. A follow-up analysis of the US study above found that the proposed DSM-5 criteria correctly identified only 20% to 41.7% of the children with prolonged grief reactions, depending on the time point. A short six-item screen did better. Its items covered longing for the person who died, being unable to accept the death, shock, disbelief, loneliness and a changed view of the world^[13]. For services, that suggests a label matters less than noticing which children's grief is not easing.

What is known about risk, and about help

The 2024 review found that girls, children who tend to avoid thinking about the death, and children facing ongoing stresses such as economic hardship, other trauma or other losses appeared more likely to have severe symptoms or the disorder. Social support appeared to be protective^[1]. A 2026 review of 18 studies, covering 5,034 children and adolescents with an average age of about 13, found that other mental health problems were linked with grief difficulties. Only three of its studies followed children over time^[14]. In the Turkish earthquake study, more severe depression symptoms were associated with prolonged grief disorder^[8]. For children bereaved by war, a 2025 review found significantly higher risks of post-traumatic stress, depression, anxiety and prolonged grief disorder. It also found that self-esteem, coping skills, social support and cultural values could buffer those risks^[15].

On help, the evidence is early but encouraging. In a Dutch randomised trial, 134 children and adolescents with prolonged grief disorder received one of two forms of support. Each had nine individual sessions, with five sessions for their parents or carers. Both forms produced moderate to large improvements, and the more structured of the two did better over the following year^[16]. A 2025 review of ten studies found generally positive results from the interventions tested. It noted that most child programmes involve the surviving parent, which adult treatments generally do not^[17]. We set out the wider evidence in what helps bereaved children, and the broader picture of mental health after a parent's death in our study of mental health outcomes.

What the evidence asks of us

The research is small, but it points in a few clear directions for services, schools, funders and policymakers.

• Keep normal grief and the disorder apart. Most bereaved children do not develop prolonged grief disorder, and their grief eases over time^[2]. Long, intense grief that fits a family's culture is not a diagnosis. Both manuals say so^[4]. Support for bereaved children should not depend on a child being labelled.
• Notice the children whose grief is not easing. Prolonged grief in children was linked with difficulty in daily life and later depression^[2]. Researchers and reviews call for early identification of children at higher risk, particularly where care is scarce and after war^[14][15]. Schools and services that see children over time are well placed to notice.
• Support the whole family. Children's and surviving parents' grief were bound up together^[2], and most child interventions tested so far involve the parent^[17]. Social support appeared protective^[1].
• Fund better research, in more countries. The reviews and studies here repeatedly ask for larger, more diverse studies using tools designed for the new criteria^{[1][6][9][11]}. As far as the reviews cited here report, no country yet has a population-wide estimate for children. Most of the evidence on children comes from the Netherlands and the US, and a review of adult studies using the ICD-11 criteria found none at all from South America^[11].

Bereavement charities often see these children long before any clinic does. Their records and evaluations could help fill this gap, if funded to do so. We set out the wider gaps in our study of what the data on bereaved children leave out.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. Where it discusses suicide, it follows the Samaritans’ media guidelines.

Why we're publishing this

A new diagnosis can be misread in two ways. It can make ordinary grief look like an illness, or it can be dismissed as unimportant for children. Families and the organisations that support them deserve a clear account of what the diagnosis means, how little is yet known about it in children, and what the evidence that exists actually shows. We publish this so that bereavement services, schools and funders can cite the evidence accurately when they make the case for support for bereaved children. It sits within our research library on children and young people bereaved of a parent.

How to read this data

To our knowledge, no country publishes official statistics on prolonged grief disorder in children, and the reviews cited here found no population register study of it. Every figure here comes from a research study, usually of a few hundred children or fewer. Most were recruited through services, coroners' records, advertisements or a single disaster, so they do not describe all bereaved children. Studies used different definitions (older criteria, DSM-5-TR or ICD-11), different tools (self-report questionnaires or clinician interviews) and different times since the death, so their figures are not directly comparable and should not be read as a trend. A "probable" diagnosis from a questionnaire is not the same as a clinical diagnosis. The US follow-up study measured patterns of grief over time, not the formal diagnosis. Links between prolonged grief and depression are associations, not proof of cause. Most of the evidence comes from the Netherlands, the US, Turkey and Germany; we have said which country each figure covers.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual child or family. If you are worried about a child or about yourself, please speak to a GP or another qualified professional.

Sources

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