Red flags & when to go in person for Grief & Bereavement Support

Audience: pediatric

Grief and bereavement are natural responses to losing someone important. Children and adolescents may experience many feelings, such as sadness, anger, confusion, or loneliness. Support through talking, counseling, and understanding can help them cope. Telemedicine can provide helpful guidance and emotional support for grief, especially when in-person visits are difficult. However, some warning signs mean it is important to seek in-person care quickly. These include intense or lasting distress, thoughts of harming oneself or others, or severe changes in behavior or daily functioning. This guide explains when telemedicine can help and when in-person care is needed, what to prepare for a tele-visit, and what to do afterward. Remember, telemedicine support is valuable but does not replace professional in-person assessment and care when needed.

Red flags — go in person / ER

• Child expresses thoughts of self-harm or harming others — seek emergency care immediately.
• Child shows severe withdrawal from family, friends, or activities lasting more than two weeks.
• Sudden and extreme changes in behavior, mood, or ability to function daily — arrange urgent in-person evaluation.

What telemedicine can do

• Providing emotional support and counseling for mild to moderate grief symptoms.
• Offering education about grief and coping strategies.
• Monitoring ongoing grief responses and advising when to seek further care.

What telemedicine cannot do

• Managing severe mental health crises such as suicidal thoughts or behaviors.
• Diagnosing or treating complex psychiatric conditions requiring medication or close monitoring.
• Addressing situations involving abuse, neglect, or safety concerns that need immediate in-person intervention.

Understanding Grief and Bereavement in Children

Grief is the natural reaction to loss, such as the death of a loved one. Children may show grief differently than adults. They might feel sad, scared, angry, or confused. Sometimes they may not talk about their feelings but show changes in behavior, like trouble sleeping or acting out. Understanding these signs helps caregivers support them better.

When Telemedicine Can Help

Telemedicine allows children and families to talk with trained counselors or healthcare providers from home. It can provide emotional support, coping strategies, and guidance on what to expect during grief. It is often useful for regular check-ins, education about grief, and mild to moderate emotional distress.

Red Flags That Need In-Person Care

Some signs mean a child needs to be seen in person by a healthcare professional quickly:

If you notice these, seek emergency or urgent care immediately.

Preparing for a Telemedicine Visit

Before the tele-visit:

After the Telemedicine Visit

After the visit:

How to prepare for your tele-visit

• Choose a quiet and private place for the tele-visit.
• Ensure reliable internet connection and device functionality.
• Have a trusted adult available if the child is young or needs support.
• Prepare a list of questions or concerns about the child's grief.
• Gather any relevant medical or counseling history to share if asked.

After your tele-visit

• Follow recommended coping strategies and support plans.
• Monitor the child's emotional and behavioral changes closely.
• Keep in touch with the healthcare provider for follow-up or new concerns.
• Seek immediate in-person care if red flags or worsening symptoms appear.
• Encourage open and supportive communication within the family.

FAQs

Can telemedicine fully replace in-person grief counseling for children?

Telemedicine can provide valuable support and guidance but often cannot replace in-person care, especially for severe or complex cases. Some situations require face-to-face assessment and treatment.

What should I do if my child refuses to talk during a telemedicine visit?

It's common for children to feel shy or uncomfortable. Encourage them gently but do not force them. Sometimes building trust takes time. Let the provider know so they can adjust their approach.

How long does grief usually last in children?

Grief varies widely. Many children gradually improve over weeks to months, but some may take longer or need extra support. Persistent or worsening symptoms should be evaluated by a professional.

When is it urgent to seek in-person care for a grieving child?

Urgent care is needed if the child talks about self-harm or harming others, shows severe withdrawal, or has drastic behavior changes affecting daily life. These are serious warning signs.

Can family members join the telemedicine session?

Yes, having supportive family members present can help the child feel safe and provide useful context for the provider. However, privacy and comfort of the child should be respected.

Sources

1. Grief: Coping with the loss of your loved one — MedlinePlus, U.S. National Library of Medicine.
2. Helping Children Cope with Grief and Loss — American Academy of Pediatrics.
3. Bereavement and Grief — Centers for Disease Control and Prevention (CDC).
4. Supporting Children and Adolescents through Grief and Loss — Substance Abuse and Mental Health Services Administration (SAMHSA).

This telemedicine guidance is for educational purposes only and is not a substitute for professional in-person medical or mental health care. If you have concerns about a child's safety or health, seek immediate in-person evaluation or emergency services.