What Helps Bereaved Children? The Evidence on Support, and Its Limits

Support for bereaved children does help, but the research says it helps most clearly where children are already struggling, and that the effect of support offered to every bereaved child is small. The evidence base is also narrower than its importance deserves: a 2024 meta-analysis found only 39 studies worldwide, mostly of limited quality, and most of the research comes from four high-income countries^[1][2].

When a child's mum or dad dies, the people around them want to know what will help: a group, a counsellor, a programme for the whole family, or simply time, information and adults who keep talking. Most children's grief is a normal response, not an illness, and many cope with the support of family and school. Some go on to have serious, lasting difficulties. This study sets out what trials and reviews from around the world show about which kinds of support make a measurable difference, for whom, and where the evidence runs out. It describes evidence about groups of children; it does not recommend any particular therapy for any child.

Support offered to every bereaved child has small average effects

Researchers have been pooling trials of support for bereaved children for nearly two decades, and the reviews agree on the broad picture. A 2007 meta-analysis of the 13 controlled studies then available concluded that grief interventions for children “do not appear to generate the positive outcomes” of other psychological therapies, and that programmes did better when they were time-sensitive and used “specific selection criteria” to decide who took part^[4]. A 2010 review of 27 treatment studies published before June 2006 found effects that were “small to moderate”, and larger for children who already had symptoms or difficulties^[5].

The most recent meta-analysis, published in 2024, brought together 39 studies with 5,578 participants^[1]. For preventive support (offered to bereaved children in general, whether or not they were struggling), the pooled effect on grief symptoms was a Hedges’ g of 0.18 in controlled studies and 0.29 in uncontrolled ones. Both are small effects by the usual convention. Effects on post-traumatic stress and depression were significant only in the uncontrolled preventive studies, which have no comparison group. The authors note that the effects seen in uncontrolled studies shrink considerably once the natural course of grief is taken into account: many children feel somewhat better over time with or without a programme.

That is not the same as saying preventive support is worthless. A small average effect across many children can still matter, and some outcomes that families and children value, such as feeling less alone or understanding what has happened, may not show up on symptom scales. But it does mean the evidence cannot yet show that routine, one-size programmes for every bereaved child change mental health outcomes much on average. The 2024 review describes the evidence as a “small number of studies, mostly of limited quality”^[1].

The clearest benefits are for children who are already struggling

The picture changes for children who are showing high levels of distress. In the 2024 meta-analysis, uncontrolled studies of support for these children found large reductions in grief symptoms (g = 1.25), post-traumatic stress (1.33) and depression (0.61)^[1]. Among controlled studies of these children, the stronger test, the authors could calculate a pooled effect only for post-traumatic stress (g = 0.71); none could be calculated for grief or depression. The pattern matches the earlier reviews: the more a child is struggling, the more room there is for support to help, and the easier it is to measure^[4][5].

A 2017 systematic review screened 1,706 abstracts and found 17 studies from 1985 to 2015, 15 of them randomised controlled trials, and rated 13 as strong evidence^[6]. Many of the programmes supported both the children and the surviving parent, and some showed large effects on traumatic grief. The authors concluded that “relatively brief interventions can prevent children from developing more severe problems”, and called for more research with younger children.

Two trials show what targeted support can look like. In the Netherlands, 134 children and adolescents with prolonged grief (mean age 13, bereaved on average just over three years earlier) were randomised to a cognitive behavioural programme, Grief-Help, or to non-directive supportive counselling; both consisted of nine individual sessions plus five sessions for parents or carers^[7]. Grief-Help produced “significantly greater reductions in prolonged grief disorder symptoms at all posttreatment assessments”, and by 6 and 12 months it was also more successful at reducing depression, post-traumatic stress and internalising problems. In Bosnia, after the war, 127 war-exposed secondary school students in 10 schools were randomised to a classroom psychoeducation and skills programme alone or with an added 17-session trauma and grief group^[8]. Post-traumatic stress and depression fell in both groups, but maladaptive grief reactions fell only in the group that had the grief component. Prolonged grief as a diagnosis is covered in our study of prolonged grief disorder in children.

Supporting the family as well as the child has the longest-lasting evidence

One of the longest follow-ups of any trial in this field comes from the US Family Bereavement Program, a 12-session programme with separate components for the surviving parent or carer and for the children^[3]. It enrolled 244 children and adolescents aged 8 to 16 from 156 families, and kept in touch with 80% of them for 15 years. As young adults, those whose families had taken part had about a third of the odds of major depression of the control group (odds ratio 0.332). The analysis suggests the effect worked partly through fewer negative self-views and fewer internalising problems six years after the programme. A separate report from the same 15-year follow-up found that young adults from programme families used mental health services and psychiatric medication less, and that the parents themselves had lower rates of alcohol problems^[9].

One well-run trial in one country is not proof that the same programme will work everywhere. But it fits a wider body of research describing surviving parents and carers as “key grief facilitators” for children, while noting that “few longitudinal research studies on childhood grief currently exist”^[10]. More on why the surviving parent's own wellbeing matters is in our study of the parent who is left.

Survey evidence from Sweden points the same way, though it shows associations rather than the effect of any programme. In a nationwide survey of young adults whose parent had died of cancer when they were teenagers (622 of 851 eligible, 73% response), 98% said teenagers should be told when a parent's death is near, but only 59% had been told, and 43% had not realised death was imminent until a couple of hours before^[11]. In the same cohort, 57% said that in the first six months they did not have a way to grieve that felt okay, and those young people had 4.32 times the odds of reporting unresolved grief years later^[12]. Poor family cohesion in the first year was linked to a higher risk of moderate to severe depression symptoms later on^[13].

Most of the evidence comes from a handful of rich countries

A 2026 evidence and gap map for the Campbell Collaboration gathered 99 primary studies and systematic reviews on bereavement interventions for children and young people aged 0 to 24, searched up to mid-2024^[2]. It found that “most evidence was identified in the USA, Australia, Canada and The Netherlands”. The most studied age group was 10 to 14, most programmes ran for 6 to 10 sessions, and the authors identified “the need for higher quality evidence as well as longitudinal evaluations”. Younger children are under-researched too, a gap the 2017 review also flagged^[6].

That matters because the causes of parental death, family structures and available services differ widely between countries, and findings from a handful of high-income settings may not hold elsewhere. Trials in low- and middle-income countries are few, but they exist. In Uganda, a cluster-randomised trial of 326 children aged 10 to 15 whose parents had died of AIDS-related illness (the study's term is “AIDS orphans”) tested school-based peer support groups with monthly health checks; after 10 weeks, the intervention group showed “significant improvement in depression, anger, and anxiety but not for self-concept”^[14]. The Bosnian school trial described above is another example from a post-conflict setting^[8]. Neither had a long follow-up, and neither can be assumed to transfer to other countries without testing.

New formats are being tested as well. In Australia, researchers co-designed an unguided online cognitive behavioural programme with 11 bereaved children and have set out plans for a randomised trial with children aged 6 to 12, comparing eight modules over four weeks with a waiting list^[15]. No results had been published at the time of writing.

What the evidence asks of us

The research does not say that bereaved children are better left alone, and it does not say that one programme is the answer. Read together, it points to a few things services, funders, schools and policymakers can act on.

• Make sure children who are struggling are noticed and reached. The clearest benefits in the meta-analyses are for children with high levels of distress^[1][4][5]. That depends on adults who know the child, at home and at school, being able to spot when grief is turning into something more, and on specialist help being available when it does. Who currently gets support is covered in our study of access to bereavement services.
• Support the family, not only the child. The longest-followed evidence of benefit comes from a programme that worked with the surviving parent as well as the children^[3][9], and Swedish surveys show that young people wanted clear information when a parent's death was near^[11] and link family cohesion in the first year to how they fare later^[13].
• Fund evaluation alongside services. The most recent reviews describe the research as sparse, mostly of limited quality and short on long-term evaluation^[1][2]. A service that has not been evaluated has not been shown to fail; the gap is in research and its funding, and services need the means to take part in good evaluations.
• Build evidence beyond four countries and beyond the 10–14 age band. Younger children and children in low- and middle-income countries are the least studied^[2][6], even though trials in Uganda and Bosnia show rigorous studies are possible there^[8][14].
• Measure what matters to children and families. Symptom scales are only part of the picture; feeling informed, less alone and able to grieve in a way that feels okay^[12] deserve a place among the outcomes trials report.

The wider mental health picture after a parent's death is set out in our study of mental health outcomes, and the whole library is at research on bereaved children.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. It uses “orphans” only where that is a study's own term.

Why we're publishing this

Childhood bereavement services, hospices, schools and the people who fund them are often asked a fair question: does this help? The honest answer is that some support clearly does, for some children, and that the evidence is much thinner than the need. We have set out what the trials and reviews show, including their limits, so that the organisations working with bereaved children can make their case on solid ground and argue for the research the field still lacks. The case belongs to bereaved children and their families.

How to read this data

Most figures here come from meta-analyses, which pool the results of many studies, and from randomised controlled trials, which compare children offered a programme with similar children who were not. Controlled studies are a much stronger test than uncontrolled ones, because grief usually eases with time on its own; an uncontrolled before-and-after study cannot separate that from the effect of support. Effect sizes are reported as Hedges’ g, where about 0.2 is conventionally small, 0.5 medium and 0.8 large. The Family Bereavement Program result is an odds ratio, not a risk ratio. The Swedish figures come from a nationwide survey of young adults bereaved of a parent to cancer; they describe recollections and associations, not the effect of any intervention, and may not apply to other causes of death or other countries. Several sources could be read only as abstracts, and we have used only what the abstracts report. Almost all trials come from high-income countries, mostly the US, Australia, Canada and the Netherlands, and few follow children for more than a year.

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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