Sibling Death Research Articles

Medium chain acyl-CoA dehydrogenase deficiency.

From 65 reported cases of medium chain acyl-CoA dehydrogenase deficiency, we found an average presenting age of 13.5 months and a mean age at death of 18.5 months. One quarter of patients died of a Reye-like syndrome and/or sudden infant death. In half the cases there had been at least one sibling death. Asymptomatic cases were not uncommon (12% of cases). The crises were generally induced by a prolonged fast and after a viral prodromal phase in three quarters of cases. The crises consisted of somnolence progressing to lethargy which could lead to coma. Vomiting was frequent (60% of cases). Seizures, which were found in 29% of cases, represented a bad prognosis. The physical examinations revealed frequently a variable and regressive anicteric hepatomegaly. Blood and urine analysis revealed in most instances hypoglycaemia (96% of cases) with hypoketonuria and sometimes metabolic acidosis. Hepatic and muscular cytolytic enzymes were frequently raised, as were plasma ammonia, urea, and uric acid. Plasma total or free carnitine concentrations, especially non-fasting, were diminished in most cases. Plasma saturated medium chain fatty acids and particularly unsaturated cis-4-decenoate were on the other hand raised during the crises or during fasting. Urinary organic acid analysis revealed a characteristic profile of medium chain aciduria: C6-C10 dicarboxylic acids, hydroxy acids, glycine conjugates, and carnitine conjugates. Oral loading tests with carnitine or phenylpropionate allow a precise diagnosis. The diagnosis is confirmed by specific assays in various tissues. Avoidance of prolonged fasting seems to be the mainstay of treatment.

Risk Indicators for Talipes Equinovarus in Washington State, 1987–1989

To identify risk indicators for talipes equinovarus, we compared 175 case children with talipes equinovarus of unknown etiology identified through the Washington State Birth Defect Registry with 1,470 control children sampled from resident live births. Infant gender, maternal smoking, death of a preterm sibling, and marital status were independently related to talipes equinovarus in an analysis based on information from birth certificate records. The findings differed by infant gender. The prevalence odds ratio for maternal smoking was 2.6 (95% confidence interval: 1.6-4.0) in males and 1.4 (95% confidence interval:0.6-3.2) in females.

Long-Term Effects of Sibling Death during Adolescence

The authors explored the long-term consequences for adolescents of surviving a sibling afflicted with cystic fibrosis. Seventy-five adults were interviewed whose siblings had died from cystic fibrosis in the 1960s and 1970s. Subjects were drawn from case records at Children's Hospital, Boston; Children's Hospital, Oakland; and the University of California, San Francisco. For quantitative analysis, a sample wasdrawn of25 survivors who were under the age of 19 years at the time of the death. Anxiety and depression scales derived from the Hopkins checklist were used, and a 3-point scale developed for guilt. There were no significant relationships between sibling adaptation and number of siblings lost, birth order and gender, family size, or time since death of sibling. The age of the surviving sibling at the time of the death was statistically significant. Those who had been between 13 and 17 years of age at the time of the loss expressed the most symptoms. They were troubled by a global sense of guilt, guilt over their handling of the sibling's illness and death, and survival guilt. They also manifested global anxiety, bodily concerns and feelings of vulnerability, fear of intimacy, excessive concern for others, somatic complaints, and sleeping difficulties.

Sibling death, adolescent bereavement, and religion

Abstract The growing body of scholarship on adolescent bereavement has overlooked on the whole the role of religion for grieving adolescents. In this investigation, I studied the impact that attitudes toward religion have upon the grief reactions of teenagers bereaved over a sibling's death. The phenomenon of adolescent grief is placed in the context of the cognitive, moral, and psychosocial changes occurring in teenagers' lives. The sample comprised 42 adolescents, evenly divided between older (17-19-year range) and younger (14-16-year range) individuals; over 60% of the sample were female. Grief reactions investigated included (a) emotions such as shock, confusion, anger, relief, guilt, fear, loneliness, and depression; (b) persistent thinking about the dead sibling; (c) opinions whether initial grief reactions would subside; and (d) whether and in what direction the intensity of the feelings changed. Grief reactions discriminated adolescents grouped in terms of several attitudes toward religion: whether religion (a) had been important before the sibling's death; (b) currently held importance in the adolescent's life; (c) provided a source of help to deal with the death; (d) is difficult to believe; and (e) was considered valuable overall. In discussing results, I note that religious belief did not make coping necessarily any easier for teenagers, and that the increased importance of religion in the lives of many of the adolescents could indicate a development facilitated by mourning. Some ideas for further research are presented.

Adolescent Sibling Bereavement Symptomatology in a Large Community Sample

This study presents data on a recently developed instrument assessing symptomatology in a 13-to 18-year-old community sample of bereaved adolescents. Adolescents assessed within 18 months of their sibling's death showed consistently high levels of grief symptomatology. A second sample assessed more than 18 months after their sibling's death reported lower levels of grief symptomatology. However, a significant group of adolescents in this second sample continued to have high levels of grief reactions. Groups high and low on reported grief symptoms, when the death had occurred more than 18 months earlier, were compared on the Offer Self-Image Questionnaire. The data revealed dysfunctionalpatterns of self-concept in adolescents with high grief symptom levels. This pattern was not evident in the adolescents who were able to normalize their lives despite the traumatic experience of having a brother or sister die.

Death and Adolescent Bereavement

The author reviews research conducted in the 1980s regarding death and adolescent bereavement. Prior to 1981 little research attention was given to this subject. A plethora of material has appeared since then, with attention paid to adolescents bereaved over (a) a parent's death, (b) a sibling's death, and (c) their own impending death. Adolescent bereavement over a friend's death has mostly been overlooked Research needs in this field of inquiry include (a) longitudinal investigations to study the trajectory of adolescent bereavement, (b) development of theoretical models to explain adolescent bereavement, and (c) integration with the traditional areas of adolescence inquiry, such as cognitive developmen4 moral reasoning, gender socialization, and identify formation.

Adolescent Bereavement

The long-term effects of bereavement were assessed 7 to 9 years after death by interviews with 31 adolescent siblings from 21 families who participated in a longitudinal study of home carefor children with cancer. Categorical analysis of the semistructured interviews revealed that the majority of the adolescents viewed the experience as having fostered their personal or family growth. However, about I in 6 regarded the effects of a sibling death as continuing to have a negative impact on their lives. Factors associated with a more positive outlook were good communication in the family, ability to share the death experience with others, expression of pleasure in sibling's company, and reliance on the family for emotional support. Factors associated with a more negative outlook were withdrawal from family interaction, inability to use the family as a source of support, and difficulty in discussing one's experience with death.

Impaired Skin Fibroblast Carnitine Uptake in Primary Systemic Carnitine Deficiency Manifested by Childhood Carnitine-Responsive Cardiomyopathy

Evidence is emerging that primary systemic carnitine deficiency, a potentially lethal but eminently treatable inborn error of fatty acid oxidation, involves a cellular defect in the uptake of carnitine. We present four unrelated children with primary carnitine-responsive cardiomyopathy, weakness (with or without hypoketotic hypoglycemic encephalopathy), low serum and/or tissue carnitine concentrations, and severe renal carnitine leak. Dicarboxylic acids were absent in the urine of three children who were tested, and all four had a rapid and dramatic improvement in cardiac function, strength, and somatic growth after carnitine therapy. We studied carnitine uptake in cultured skin fibroblasts from all four children and seven of the eight healthy nonconsanguinous parents. [3H]L-carnitine uptake was evaluated in vitro under linear time kinetics. Substrate concentrations were varied from 0.1 to 1000 microM. Physiologic uptake was determined at carnitine concentrations between 0.1 and 50 microM. Nonspecific uptake was determined at a concentration of 10 mM. The four patients had negligible uptake throughout the physiologic range, implying a marked deficiency in the specific high-affinity, low-concentration, carrier-mediated uptake mechanism. At a concentration of 5 mumol/L, the mean velocity of uptake in the four patients was 2% of control values. Their parents showed intermediate maximal rates of carnitine uptake ranging from 13 to 44% of control Vmax values, but normal Km values, suggesting that the heterozygotes had a reduced number of normal functioning carnitine transporters. The observed reduction in Vmax values for the parents supports an autosomal recessive inheritance pattern and may be a more sensitive indicator of heterozygosity than serum carnitine concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent reactions to sibling death

Adolescent reactions to sibling death

The Response of Children to the Dying and Death of a Sibling

This study investigated the behavioral adjustment of sixty-one children ages four to sixteen years during the terminal illness and first year following a sibling's death from cancer. Using the Child Behavior Checklist, data on behavior problems and competence were collected from parents and teachers. Data collection occurred before death during the terminal phase, and two weeks, four months, and one year post death. The results of data analysis by t-test comparisons generally indicated that the bereaved siblings demonstrated significantly higher levels of behavior problems and significantly lower social competence in comparison to normal children. The implications for practice are discussed.

The Impact of the Death of an Elderly Sibling

The Impact of the Death of an Elderly Sibling

Preventing psychosocial impairment in siblings of terminally ill children.

A review of the literature provides the basis for a discussion of the impact of sibling death on healthy children whose emotional needs may be unattended both by parents and professionals. Factors which may deter hospice practitioners from delivering effective psychosocial care to siblings are identified and recommendations for preventive intervention are enumerated.

Family recovery after death of a child.

Children from a national birth cohort living in families in which a sibling had died or been stillborn were compared with children living in similarly structured families where no such tragedy had occurred by a number of health, developmental, and behavioural outcomes. Surprisingly little ill effect from a sibling death (occurring either before or after the birth of study children) was apparent at the age of 5 years. Families experiencing a stillbirth or death of a child were socially disadvantaged. Even allowing for this and other likely intervening factors, however, a child whose adjacent sibling had died was significantly more liable to bronchitis or wheezing during the first 5 years. Mothers who had experienced the death of a child since the study child's birth had high scores on a psychological screening test, and were more likely to be single parents. Mothers who had lost a child were more likely to smoke during the next pregnancy. No significant differences between cases and control subjects were detected on other health, behavioural, or developmental outcomes. Stillbirth or death of a child appears to have little measurable effect on siblings assessed at 5 years of age. This study does not exclude important longer term psychological effects from sibling death.

Death of a sibling

Death of a sibling

Unspoken Grief: Coping with Childhood Sibling Loss.

A brother or sister is often a child's most important contemporary. Yet, the effect of sibling death on the surviving child has received little attention. This pathbreaking book takes a compassionate look at the problem and provides advice for parents and adults to help the surviving child.

Sibling Grief in Reaction to Sudden Infant Death Syndrome

Much of the literature that exists regarding psychologic outcomes of sudden infant death syndrome (SIDS) has focused on parental grief or family response; at least two studies suggest that a SIDS death also affected siblings. It is believed that children who experience the death of a sibling due to SIDS do grieve. Factors related to bereavement are the child's age at the time of the sibling's death, special circumstances of the SIDS death, and explanations and grieving response of the parents. However, no information currently exists that characterizes the course of the grief response of these children. Studies have indicated that about 1 year is a normal grieving period for adults. This study was conducted to evaluate the time frame of children's grief response to the death of a sibling from SIDS. A questionnaire was designed that incorporated child grieving behaviors from several sources; 151 questionnaires were distributed to families in which a SIDS death had occurred in the past 16 years in Iowa and Illinois. Information was obtained from 43 families for 50 children who were older than 2 years of age at the time of the sibling's death. With respect to the length of children's grief response, 54% were reported to have grieved longer than 1 year and only 40% were reported to have grieved less than 6 months. Thus, it appears that the length of the grieving response for these children is similar to that described for adults.

Pregnancy as a Reaction to Early Childhood Sibling Loss

Surrogate mothers, illegitimately pregnant teenagers, married women seeking abortions, women convicted of manslaughter, and sister survivors of early childhood sibling loss may share a common conflict. These women may be in a state of incomplete mourning, unconsciously wishing to master a trauma by turning a passive experience into a life event they can control. Pregnancy can function as that life event. Replacement daughters and/or sister survivors can present as our patients with a search for or an avoidance of pregnancy as a crucial though unconscious issue. Literature written about this sequelae of early sibling death is reviewed according to psychosexual and object relationship stages. Common and uncommon consequences are discussed. Vignettes from the course of psychoanalytic therapy with women whose brothers had been accidently killed; whose sibling had died of metabolic disease; and those whose siblings had been relinquished to foster care are used to illustrate the immediate and long-term reactions. The range of these include varieties of separation anxiety as well as learning inhibitions in latency; exaggerated pseudo heterosexuality and other risk taking at puberty; problems in self-esteem regulation relative to either the idealized memory of the missing sibling or the omnipotence connected with survivor guilt. This paper focuses on the choice of a sexual partner and pregnancy issues as symptoms of reworking established conflicts around self-valuation and abandonment by sibling and grieving parents. As the family relationships around the lost sibling become less distorted in her analysis via transference resolution, so do the feelings about contemporary relationships. Becoming pregnant is then not an event burdened by the past.

The interpersonal and emotional consequences of being an adult child of an alcoholic.

The purpose of this study was to compare adults raised in an alcoholic home (N = 409) with those adults raised in a nonalcoholic home (N = 179) on their perceptions of alcohol-related differences in the home, violence, sexual abuse, communication, and interpersonal differences experienced as adults. The adults who were raised in alcoholic families reported significantly less utilization of interpersonal resources as a child; had significantly more family disruptions characterized by a higher divorce rate and premature parental and sibling death; reported more emotional and psychological problems in adulthood; experienced more physical and sexual abuse as children; and more frequently became alcoholic and married alcoholics when compared to adults raised in nonalcoholic families.

Growth, nutritional status and infant mortality of Turkish immigrant preschool children.

Turkish preschool children in Stockholm, Sweden, 59 born 1979, 32 born 1976 and 43 siblings of preschool age have been studied as to nutritional status including anthropometric parameters, dental caries, haemoglobin level and bacteriological and parasitological findings in faeces and as to deaths of siblings in Turkey and Sweden. Growth was very close to that of the Swedish standard. Two of three children with slightly subnormal growth had had recent direct or indirect contact with the home country. There were no signs of nutritional deficiency but dental caries was common. There was little anaemia. One case of shigellosis was found. Mortality of infancy was significantly reduced after immigration. The group had made a successful nutritional adaptation in Sweden considering their origin in regions of Turkey with a high prevalence of growth failure. Health care in this group should aim at prevention of diarrhoeal disease on visits to Turkey as well as of dental caries.

The Invisible Loss: the Impact of Perinatal Death on Siblings

The impact of perinatal death on surviving siblings has been virtually unexplored. After reviewing the effects of perinatal loss on the bereaved parents, its impact on remaining children is discussed. Perinatal sibling death is considered an event with impact determined by the interaction of the child's emotional and cognitive responses with the reactions, distortions, and communications of the parents. Four distinct constellations integrating intrapsychic and family responses to perinatal death are elaborated. Ways in which parents can help their children deal with perinatal loss are discussed. A flexible approach to treatment is recommended in which individual child therapy, parental therapy and/or family therapy may all be used, depending upon the etiology and locus of the difficulty.