543

The Families and Children of Fallen Military Service Members

Chapter 33

THE FAMILIES AND CHILDREN OF 

FALLEN MILITARY SERVICE MEMBERS

DOUGLAS H. LEHMAN, MSW, LCSW,* and STEPHEN J. COZZA, MD†

INTRODUCTION

MILITARY RESPONSE TO THE DEATH OF A SERVICE MEMBER

THE MILITARY CARE TEAM

GRIEF RESPONSES

Adult Grief Responses

Children’s Grief Responses

Children and Military Funerals

Traumatic Grief

Support Services and Organizations

SPECIAL CIRCUMSTANCES

Death, Illness, or Injury of a Leader

Suicide

Missing in Action and Prisoners of War

Mass Casualties

Death of a Spouse or Child

Media

SUMMARY

ATTACHMENT: RESOURCES FOR FAMILIES OF DECEASED SERVICE MEMBERS

*Treatment Provider, Department of Behavioral Health and Family Advocacy, Evans Army Community Hospital, 7500 Cochrane Circle, Fort Carson, 

Colorado 80913 

†

Colonel, US Army (Retired); Associate Director, Center for the Study of Traumatic Stress, and Professor, Department of Psychiatry, Uniformed Services 

University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814; formerly, Chief, Department of Psychiatry, Walter Reed Army 

Medical Center, Washington, DC
544

Combat and Operational Behavioral Health

INTRODUCTION

As of October 2007, over 4,000 US service members 

had died in the line of duty in Iraq and Afghanistan. 

Forty-four percent of military service members are 

parents1

 and constitute a relatively young adult population. Families of service members killed in combat are 

likely to include children of varying ages, one third of 

whom are under the age of 5. Not infrequently, these 

young families may include wives who are pregnant 

at the time of death or newborns who have never met 

their deceased parents. Deceased service members 

may have younger siblings, cousins, nieces, or nephews who, while not part of the nuclear military family, 

are other child mourners. Caring for the family after 

the loss of a service member requires sensitivity and 

consistency. This chapter will focus on the needs of 

the families of the fallen, with special emphasis on the 

needs of children and the programs in place to meet 

those needs.

MILITARY RESPONSE TO THE DEATH OF A SERVICE MEMBER

Beginning in 1950, the Army has published an instruction guide to assist survivors of fallen soldiers.2

A Guide for the Survivors of Deceased Army Members describes the notification process and services available 

to meet the needs of mourning families. Subjects range 

from discussing the role of the casualty assistance officer (CAO) to funeral and postfuneral procedures. 

Army Regulation 600-8-1, the Army Casualty Program,

3

describes in detail the responsibilities and services 

provided by the military to families of the deceased, 

explaining the casualty assistance program and the 

role and duties of the CAO. 

Family notification of combat death has changed in 

the past century. During World War II, Army families 

were informed of a service member’s death by a telegram from the Army Adjutant General. The telegram, 

which typically arrived weeks after the death, stated 

the known factual information about the death and 

offered a brief statement of regret. A letter offering 

the military’s condolences and outlining survivors’ 

benefits followed the telegram. By the end of the Korean War, the Army sought to improve this process by 

personalizing notification. Initial notification was still 

sent by telegram but was followed by the arrival of 

an Army officer who visited the family’s home, verified the death, and provided additional details. The 

personal visit was meant to convey greater organizational appreciation and respect for the sacrifice of the 

deceased soldier and the loss to the family.4

A substantial change in the notification process 

occurred during the Vietnam War, when the next of 

kin was first contacted with the news of death by a 

“casualty notifier,” an officer of equal or higher rank 

than the deceased. Personal notification was followed 

by a telegram of confirmation. Only equal ranking 

officers, senior officers, or noncommissioned officers 

made the death notification. To minimize the family’s 

shock, death notifications occurred only between 6:00 

am and 10:00 pm. The Vietnam era’s expanded casualty 

assistance program was similar to the current format 

for notifications and standards.4

 Another significant 

change occurred in 1970, adding notification of secondary next of kin, identified by the next of kin, such 

as former spouses, grandparents, or friends. The CAO 

offered assistance to the family during this difficult 

time.

Since Vietnam, other changes in notification and 

family assistance have taken place. After the 1985 

airplane crash in Gander, Newfoundland, that killed 

248 soldiers and 8 crew members, the CAO’s role was 

expanded to help the immediate family and to support the secondary next of kin in greater depth. These 

changes included regularly scheduled CAO family 

briefings, as well as government-funded travel to and 

from funerals and memorial services for certain family 

members.4

 Recently, a distinction has been made between the individual (or team) who notifies the family 

of the soldier’s death and the CAO who provides ongoing support to the family. This distinction is recognized 

as important because of negative associations with the 

death notification. After the notification, the family is 

informed of the CAO’s role, and the CAO calls on the 

family to offer assistance and support.4

Since 2003, death notification has changed as a result 

of surveys of Navy families and casualty assistance 

call officers (CACOs).5

 According to the CACO survey, 

95% of the families of deceased Navy military members had a high level of satisfaction with the services 

they received. Respondents identified the need for 

more training to increase knowledge of the CACO’s 

duties and responsibilities. The CACOs felt that they 

should remain engaged with the families for a longer 

period of time, as well as needing more knowledge 

about specific benefits. As a result, Navy training has 

been increased from 1 to 2 days, Web access has been 

expanded, and personnel services have increased to 

include operations for survivors available 24 hours a 

day, 7 days a week. The Navy responds to casualties 

through its casualty assistance calls program and the 

assigned program coordinator.
545

The Families and Children of Fallen Military Service Members

Recent changes to survivor benefits include allowing a surviving spouse and dependents to remain in 

Army base housing for a full year after the death of a 

soldier, compared to 6 months, which was the policy 

before the global war on terror, and an increase in 

the monetary survivor benefit to $400,000 across the 

services. Another change requires all death reports 

to be reviewed by a field-grade or higher-ranking officer. This change was made to ensure the accuracy of 

the report’s details and reduce the likelihood of later 

changes to the report that could lead to erroneous 

interpretations of the death.

Since 2006, the National Defense Authorization Act 

has mandated that all services collect data “regarding 

the incidence and quality of casualty assistance provided to survivors of military decedents, including surveys 

of such survivors and military and civilian members 

assigned casualty duties.”6 In response to the act, the 

Army’s Families First Casualty Call Center created an 

outreach survey instrument that collects information 

from outbound calls and mailed questionnaires. The 

survey was designed to capture feedback and the next 

of kin’s level of satisfaction during the casualty assistance process. 

The Army’s Casualty and Mortuary Affairs operation center (CMAOC) has been tasked with the collection and analysis of data received from completed 

surveys. The CMAOC began surveying next of kin in 

2005 with 33 questions related to four primary areas: 

(1) notification, (2) CAO performance, (3) Casualty 

and Mortuary Affairs activities, and (4) postinterment 

activities. The survey results below were collected from 

the families of service members who died between 

March 2005 and March 2006 (approximately 1,000 

identified contacts). The results indicate that families 

have largely been satisfied with the CMAOC process. 

A quality-assurance working group has identified key 

areas where CMAOC scored at least 90% satisfactory 

from the respondents:

	 •	 97% stated that their CAO displayed/expressed sufficient compassion for their loss;

	 •	 93% stated that their CAO made their family

a priority and was responsive to their needs;

	 •	 93% stated that their CAO explained all

funeral options and assisted with funeral arrangements;

	 •	 92% stated that the CAO explained all authorized expenses for the funeral; and

	 •	 91% responded that their CAO explained all

qualified benefits and entitlements.

The working group also proposed the following 

procedural changes to address areas of need identified 

by the survey: 

	 •	 Command should prioritize predeployment

education of benefits, living wills, entitlements, and forms. 

	 •	 An inventory process should be standardized

before deployment, and summary courtsmartial officers should determine whether 

the service member completed an inventory 

prior to deployment. 

	 •	 Throughout the CAO assistance process,

families should receive continuous updates 

about survivor benefits. 

	 •	 CAOs should perform a final review of applicable benefits with the families before ending their assignments (formalized by a check 

list). 

	 •	 CAOs should inform survivor families of

services available through casualty assistance 

centers. 

	 •	 Atraining module on personal-effect processing should be developed, and CAOs need to 

be trained in this area. 

In addition to these existing tools, the Office of the Secretary of Defense developed a universal survey to assess 

satisfaction with the casualty assistance process that was 

disseminated to surviving primary next of kin across all 

services beginning in the first quarter of 2007.

THE MILITARY CARE TEAM

The care team concept developed from the Spouses’ 

Project at the Army War College, Carlisle Barracks, 

Pennsylvania.7

 The team typically consists of spouse 

volunteers from a previously formed family readiness group in the same battalion or company as the 

deceased service member. Care team training mirrors 

CAO training, although it has been formalized in 

different ways at some sites. For example, spouses 

at Fort Carson, Colorado, have developed and use a 

“smart book” training manual.8

 In many other places, 

care team practices have been implemented with less 

formal procedural development. 

The care team offers short-term respite and supportive care to families of the deceased and also helps 

the families of seriously wounded soldiers. The team 

is designed as temporary transitional assistance until 

the survivor’s support structure is in place. Each care 

team consists of an on-site leader as well as other 

participants. The care team works with the casualty 

notification team if a surviving family member has 
546

Combat and Operational Behavioral Health

agreed to this arrangement. Care team members help 

activate preestablished plans to assist family members, 

coordinate more effective use of military and community resources, and develop additional personalized resources to assist surviving family members. 

Care teams have been successful in personalizing the 

notification and early assistance support to casualty 

families. The teams have also reduced stress on spouses 

of volunteers, relying on team strength rather than 

overburdening individuals.

GRIEF RESPONSES

Adult Grief Responses

Grief is a reaction people have to loss in their lives. 

Grief includes a range of responses that vary according 

to type of loss, its meaning to the individual, and each 

individual’s particular circumstances and experiences. 

When people grieve, they are coming to terms 

with life-changing loss. Healthy grieving allows the 

individual to begin finding new ways of living while 

coping with the gaps created by the loss. The grief 

process has no time limit. The phases described in 

Table 33-1 provide a general timeline that a grieving 

adult may experience; however, it is not uncommon 

for individuals to move back and forth between 

phases or manifest responses from multiple phases 

simultaneously. 

Everyone experiences the grief process physically, 

emotionally, psychologically, socially, and often spiritually. Physical reactions can include pain, dizziness, 

shortness of breath, and sleep disturbances (hypersomnia or insomnia). Grieving adults may experience 

a variety of emotional reactions, including shock, tearfulness, fear, anger, and envy. Adults may sometimes 

have confusing or contradictory thoughts. They may 

feel guilty, expect the return of the deceased, or become 

troubled by disturbed memories or dreams. Socially, 

a grieving adult is likely to feel lonely or isolated and 

may find a need to redefine or reestablish relationships. 

Grieving adults may find spiritual or religious practice 

to be profoundly helpful and reassuring. Sometimes 

the death of a loved one can cause adults to question 

the basis of their religious faith.

Grief symptoms may include an overwhelming 

sense of loss with strong feelings of yearning or longing 

for the loved one. Survivors may feel a profound sense 

of emptiness and a sense that a part of them has died. 

Grieving survivors often speak of generalized pain 

or heaviness in their chest. They may feel depressed 

and hopeless about the future. Things that once were 

important may no longer seem to matter. Those who 

suffer traumatic loss may cry easily and lose interest in 

eating; they may experience stomach upset, headaches, 

and feelings of restlessness. A commonality among 

survivors is the desire to preserve the memory of their 

loved ones and the belief that their loved ones believed 

in and drew meaning in their military mission. PolitiTABLE 33-1

ADULT GREIVING PROCESS TIMELINE

Phase I II III IV

Description Responses can result from 

the initial impact of 

notification and occur 

immediately after the 

notification

Responses comprise 

withdrawal and 

confusion

Responses consist of 

an adjustment to the 

death

Responses are characterized by reconstruction and reconciliation

Response “Fight or flight” Anger, fear, guilt, rage Positive thoughts 

begin

Hope

Thought Numb or disoriented Ambiguity and uncertaintyProblem solving Consolidation of problem solving

Direction Searching for a lost object Bargaining, detachment, depressionSearching for new 

objective

Reattachment

Search behavior Reminiscing Perplexed and scanningFocus on exploration Reality testing

Guidance needed Accepting feelings Task orientation and 

direction

Support and spiritual 

insights

Breakthrough and 

reinforced hope
547

The Families and Children of Fallen Military Service Members

cal, cultural, and economic states are crossed by these 

dual focuses.9

Children’s Grief Responses

Children experience a sudden and profound life 

change when they lose a parent in combat. In all cases, 

the death of a parent is premature to the age and health 

of that individual, as well as to the relationship with 

the child. Since 2001, thousands of children have lost 

military parents from combat operations in Iraq and 

Afghanistan. Military deaths have affected countless 

other children whose service member siblings, cousins, 

aunts, uncles, and other extended family members 

have died in the line of duty. These losses can be 

equally profound.

Similarly to adults, children mourn the deaths of 

loved ones. Family death affects children of all ages, 

from infants and toddlers to teenagers (see Exhibit 

33-1). Children, like adults, feel a deep sense of loss or 

sadness when a loved one dies. Many people assume 

that because children do not understand death in the 

same way as adults, they have less of an emotional 

response, but this is not true. Children are likely to be 

powerfully affected by the deaths of loved ones but 

may be less able to express confusing thoughts and 

feelings in words. While many children may express 

feeling sad, cry, or become more withdrawn, others 

express their emotions by reverting to earlier childhood behaviors. Infants and toddlers are likely to 

experience the death through the emotional responses 

or change in availability of the important adults in 

their lives, and react to these changes. Very young 

children can demonstrate changes in sleeping or eating 

patterns, increasing tantrums, or overactive behavior. 

School-aged children may express emotional concerns 

through physical complaints such as stomachaches or 

headaches. Teenagers often wish to present themselves 

as independent and not in need of adult help. Their 

sullenness or seeming disconnectedness should not be 

mistaken for a lack of emotional response to a death. 

Behavioral changes in any grieving child are more 

likely to be an emotional response than a disciplinary 

problem.

Children who lose military family members during 

wartime are similar to other grieving children in many 

ways. However, certain unique aspects characterize 

military family loss. Service members may be deployed 

for long periods before a death, and children may 

have become adjusted to the physical absence of the 

deceased parent or family member, making it more 

difficult to accept the permanence of the loss. Because 

military deaths during wartime are viewed as public 

events, family privacy during grieving may be diminished. Family members and communities should assist 

in protecting children from disturbing media exposure 

or other unwanted intrusions on the grieving process. 

Bereaved families living on military installations will 

likely be surrounded by community support and attention. Typically this interest is wanted and appreciated 

by families, but limits may need to be set by families to 

ensure that the attention does not become burdensome. 

Reserve and National Guard families or those living 

outside of military communities may find their grief 

is less well understood by well-intentioned civilian 

families in their neighborhoods. Children who attend 

schools with few other military children may find 

themselves isolated in their experiences of loss. Finally, 

not all military deaths are the same—some children 

may lose loved ones to combat, but others lose parents 

as a result of accidents or other causes.

A child’s response to parental death is related to the 

surviving parent’s response to the death: “Children 

appear to be at risk for concurrent and later difficulties primarily in the extent they suffer a higher probability of inadequate parental functioning or other 

environmental support before as well as after the loss 

of a parent.”10(p431) Bivariate and multivariate analyses 

show that the health of the surviving parent relates 

directly to how well a child will adjust11; however, 

even a “healthy” parental response does not guarantee 

a “healthy” child response. Even if a child appears to 

be transitioning well through the grieving process, it 

is helpful to notify other adults in the child’s life of the 

death. Teachers, coaches, healthcare providers, and 

spiritual and religious leaders can often offer support 

to grieving children within the context of their daily 

interactions. 

Children are extremely aware of the attitudes, behaviors, and emotions of the adults they see around 

them. Parents and caring adults should help children 

understand what they are likely to see as people 

mourn. Children can be reassured when they understand that expressions of emotions, including sorrow, 

are natural ways of showing how much people cared 

for the deceased and how much their loved one will 

be missed. Children will feel more confident when 

they see adults handling emotionally painful situations without losing control. Tears and sorrow are to 

be expected. However, adults should protect children 

from witnessing frightening or uncontrollable displays 

of emotion. If such a situation occurs, adults should 

talk to youngsters about what they witness so that the 

event is more understandable and less frightening.

Very little has been written about children experiencing the loss of a parent in a wartime environment; 

however, an overwhelming amount of literature 

explores the issues of grief in children experiencing 
548

Combat and Operational Behavioral Health

EXHIBIT 33-1

CHILDREN’S EMOTIONAL AND BEHAVIORAL RESPONSES TO DEATH 

Infants and toddlers: 

	 •	 crying

	 •	 searching for parents/caregivers

	 •	 clinging

	 •	 changing sleeping and eating habits

	 •	 regressing to earlier behavior (eg, bedwetting,

thumb sucking)

	 •	 repeating play or talk

Preschoolers (age 3–5):

•	 fearing separation (eg, from parents/loved

ones)

	 •	 clinging

	 •	 throwing tantrums, having irritable outbursts

	 •	 fighting

	 •	 crying

	 •	 withdrawing

	 •	 regressing to earlier behavior (eg, bedwetting,

thumb sucking)

	 •	 sleeping difficulty (eg, nightmares, difficulty

sleeping alone)

	 •	 increasing occurrence of usual fears (eg, the

dark, monsters)

	 •	 magical thinking, believing the person willreappear

	 •	 acting and talking as if the person is not sick or

is still alive

Younger school-age children (ages 6–9):

	 •	 reacting in anger, lying, bullying

	 •	 denying

	 •	 acting irritably

	 •	 blaming self

	 •	 fluctuating moods

	 •	 fearing separation, being alone, or experiencing

recurring events

	 •	 withdrawing

	 •	 regressing to earlier behavior

	 •	 having physical complaints (eg, stomachaches,

headaches)

	 •	 experiencing school problems (eg, avoidance,

academic difficulty, difficulty concentrating)

Middle-school children (ages 9–12)

	 •	 crying

	 •	 longing for someone who has died

	 •	 acting aggressively, irritably, bullying

	 •	 experiencing resentment

	 •	 experiencing sadness, isolation, withdrawal

	 •	 having fears, anxiety, pain

	 •	 suppressing emotions, denial, avoidance

	 •	 blaming self, guilt

	 •	 sleeping disturbance

	 •	 worrying about physical health and having

physical complaints

	 •	 declining academic success, discipline, attendance, memory

	 •	 thinking and talking repetitively

	 •	 expressing ‘‘hysterical” concerns and need to

help

Early teens and adolescents (ages 13–18):

	 •	 experiencing resentment, loss of trust

	 •	 feeling guilt, shame

	 •	 experiencing depression, having suicidal

thoughts

	 •	 distancing, withdrawal, panic

	 •	 swinging moods, irritability

	 •	 experiencing anxiety, panic, dissociation

	 •	 experiencing anger

	 •	 involving self

	 •	 exaggerating euphoria

	 •	 acting out (engaging in risky, antisocial, or illegal behavior)

	 •	 using substances

	 •	 fearing similar events, illness, death, the future

	 •	 changing appetite and sleep patterns

	 •	 experiencing physical complaints or changes

	 •	 declining academics, refusing to go to school

traumatic loss or death of a parent under other circumstances. The distinction is important to understanding 

how the death and loss of a loved one is further exacerbated by the subsequent social, educational, and 

financial changes that the military family experiences 

as isolation from a known life style and disruption of 

daily routines.11

Typically, the family is young; a social change occurs from military family to civilian family; the family 

moves; and the financial benefits are limited. Family 

moves likely lead to changes in communities, schools, 

peer groups, and activities. Thus, the family’s changes 
549

The Families and Children of Fallen Military Service Members

can limit the children’s support systems. Such transitions can be extremely challenging to both children 

and surviving parents. These transitions can, in some 

ways, become the most complicating elements of the 

death for children.

In a briefing for care team training, Chaplain James 

Ellison of Fort Carson asks the trainees to think about 

how many times they have experienced the death of 

an immediate family member and to reflect on the 

types of life-changing experiences that resulted. He 

then discusses how children who have experienced 

the death of a parent have a “life-changing experience” 

on three levels:

1. the loss of the parent,

2. the loss of the same relationship with the 

surviving parent, and

3. the loss of a sense of the family system.

Children and Military Funerals

Military traditions and rituals follow the death of 

a service member from the arrival of the uniformed 

death notification team through graveside military 

honors. Family members can decide to what degree 

they will incorporate military tradition into their 

mourning process. Many children and families find 

military ceremonies comforting; others do not. The 

military funeral tradition is long, rich, and includes 

activities and rituals that may evoke a variety of reactions. Children may have varying levels of information 

about the nature of death, and the family funeral may 

be the child’s first exposure to funeral ceremonies. 

Caskets, military uniforms, the firing of weapons, and 

the folding of flags can all spark curiosity, interest, 

and sometimes confusion and fear as well. Helping 

children prepare for and understand these events also 

helps them integrate the complex and emotionally 

charged experience of a military family funeral. 

Although funerals are a time of family pain, they 

are also a time of family gathering. Contact with other 

family members and close friends before, during, and 

after the ceremony can be reassuring to children and 

demonstrate that sadness does not need to be borne 

alone. Children and family members may choose to 

express pride for the life of the deceased, reminisce 

about shared experiences, or say nothing at all. Children particularly value the power of storytelling. 

Stories evoking positive memories of the deceased can 

be especially helpful.

It is best to allow children to establish their own 

levels of comfort and involvement in funeral services. 

Gentle adult reassurance can be very helpful. However, 

it is inadvisable to force children to attend viewings 

or funeral services when they demonstrate significant 

discomfort in these situations. If the family chooses an 

open casket viewing, children may or may not want to 

view the deceased. They should never feel compelled 

to approach or touch the body, nor should they be 

forbidden to come near the casket if they wish. When 

children choose to move closer, adults should monitor 

younger children, calmly comfort them if necessary, 

and answer any questions they might have. When 

properly prepared, most children will feel at ease 

participating in the funeral service. 

Children should be allowed to behave like children.

Their participation and activities during the funeral 

service may vary depending on age. Older children 

may appear uninterested or bored during the ceremony, but they may actually be trying to observe 

and integrate what they are experiencing. Some young 

children may appear to be uninvolved or run around 

and cause disruptions. Their activity may be the 

healthy expression of normal childhood behavior or a 

manifestation of their own anxiety. Disruptive, unruly, 

and disrespectful behaviors are likely to be signs that 

children are overwhelmed and would benefit by taking 

a quiet break away from activities. A funeral is typically 

not the appropriate time to discipline children. 

Traumatic Grief

Death within a family is always a painful experience. Like families of police officers and firefighters, 

military families are aware of the inherent risks of 

serving in harm’s way. Nevertheless, military deaths 

are painful and typically sudden and unexpected. 

Combat, combat-related, and training deaths, which 

are all forms of sudden traumatic death, are especially hard on military (families) widows. These deaths 

often cause significant damage to the body, often

making it non-viewable or non-recoverable.12(p50)

Traumatic deaths are distinct from anticipated 

deaths, and their effect on spouses, families, children, 

and communities may be profound. The following are 

general characteristics of traumatic deaths:

	 •	 can occur without warning, providing no

opportunity to anticipate, prepare, or say 

goodbye;

	 •	 can be untimely, including the death of one’s

child at any age;

	 •	 can occur as the consequence of violence and

can result in violent harm to the body;

	 •	 can include more than one person; and

	 •	 can be the result of the willful misconduct of

others, such as carelessness or negligence.
550

Combat and Operational Behavioral Health

Many individuals experience the sudden traumatic 

loss of a loved one at some point in their lives. Such 

losses can be complicated for adults and children to 

integrate. Communities often share these traumatic 

losses and experiences.

Traumatic grief symptoms may occur following 

a sudden traumatic loss. In contrast to normal grief, 

traumatic grief symptoms may include feelings of 

horror and anxiety; other feelings may be emotional 

numbness and a sense of disconnection. Some people 

cannot remember significant parts of what happened; 

others are plagued by memories or a sensation that 

they are reexperiencing or reliving the event through 

painful flashbacks. Traumatic deaths often cause extreme distress that can interfere significantly with daily 

functions over an extended period of time.

Those suffering traumatic loss may develop symptoms of posttraumatic stress disorder (PTSD). PTSD is 

diagnosed when the following three symptom clusters 

are present: (1) reexperiencing of the traumatic event 

as indicated by painful, intrusive thoughts or avoidance indicated by marked efforts to stay away from 

activities, places, or things related to the loved one’s 

death; (2) emotional numbing, as indicated by feeling detached from others; and (3) difficulty sleeping, 

irritability, difficulty concentrating, and a tendency 

to become startled easily and detached from others. 

Even if full criteria for a diagnosis of PTSD are not met, 

individuals can suffer from symptoms caused by the 

loss, such as self-blame and guilt. People may imagine 

ways they could have or should have prevented this 

loss from occurring or ways they could have rescued 

the person, and they may experience guilt about events 

that occurred prior to the death.

Traumatic losses often threaten the survivor’s sense 

of personal safety, security, and ability to trust others. 

Accepting the reality of the sudden traumatic loss can 

take a significant amount of time. Survivors may know 

intellectually that their loved one is dead but may find 

themselves expecting the loved one to walk through 

the door or call on the telephone. Parting with a loved 

one’s possessions can be difficult. It may be especially 

disturbing when a loved one’s body is not recovered. 

Sudden traumatic losses often raise existential and 

spiritual issues, such an inability to make sense of the 

loss or a feeling of betrayal by God.13

For some children, the extent of emotional response 

may be similarly extreme, or they may have difficulty 

grieving in a healthy fashion. Some bereaved military 

children may reexperience the death through nightmares, troubling memories, or repetitive play. They 

may avoid being reminded of the person who died 

or may continue to demonstrate profound sadness 

or inconsolable anxiety long after the death. In such 

circumstances a child may demonstrate symptoms of 

traumatic grief, which requires professional evaluation and treatment. When adults are concerned that a 

child is struggling to adjust to the death, they should 

speak with the child’s pediatrician and seek referral 

to a child and adolescent psychiatrist, psychologist, or 

other mental healthcare provider. Such conditions are 

treatable but could worsen if left untreated.

Support Services and Organizations

Multiple community and healthcare services are 

available in military and civilian communities around 

the country to meet the needs of families that have 

lost a member during service. Several organizations 

now exist to provide support to military widows and 

widowers as well as military children who have lost 

parents. Gold Star Wives of America is an organization 

of military widows and widowers whose spouses have 

died while on active duty or from service-connected 

disabilities. This organization has been serving war 

widows and widowers from all conflicts and serviceconnected disabilities since its founding in 1945. 

The Tragedy Assistance Program for Survivors 

(TAPS) also provides a support network for the surviving families of those who have died in service. TAPS 

sponsors an annual children’s camp in Washington, 

DC, which provides 

multiple group and individual activities to assist 

the children in expressing feelings that may not be 

appreciated by others who cannot relate to their experience. The camp has normal social and outdoors 

activities to promote peer support and in addition 

to group sessions that allow the children to do important processing and grieving . . . there is (also) a 

program enabling the surviving spouses to do similar therapeutic work with other spouses, while the 

children are engaged in their camp.13(p273)

Several other organizations have developed programs to assist military children with the trauma, grief, 

and loss from their parent’s combat death, injury, or 

illness. More information about the National Military 

Family Association, Zero to Three’s Coming Together 

Around Military Families program, and the Military 

Child Education Coalition’s Living in the New Normal 

initiative, as well as other resources are provided in the 

attachment to this chapter.

Uncomplicated grief is often managed within 

families, communities, or groups of friends. Widowed 

spouses and children may find benefit in joining therapeutic or self-help groups that focus on grief. Typically, 

such groups include other grieving individuals and 

allow an opportunity for adults and children to interact 
551

The Families and Children of Fallen Military Service Members

with others who have had similar experiences. Grief 

counselors, chaplains, mental health providers, or peer 

facilitators may lead these groups. For some adults 

and children, individual grief counseling sessions may 

be more comfortable. Again, counselors, chaplains, 

mental health providers, or other professionals may 

provide these services. Military OneSource is also an 

important resource for identifying community services 

for families.

When symptoms of traumatic grief, PTSD, or 

depression are present, or when health risk behaviors such as increased alcohol use develop, referral 

to competent mental health treatment is necessary. 

Psychiatrists, psychologists, social workers, and counselors provide mental healthcare in military medical 

treatment facilities, through local community mental 

health services, and by participating TRICARE civilian healthcare professionals. However, the recent 

Department of Defense Task Force on Mental Health 

has identified multiple barriers that can block access 

of bereaved military family members to appropriate 

care.14 Widowed spouses and children should be encouraged to advocate for their own needs in finding 

resources. Primary care providers, chaplains, and 

community service professionals can all assist in this 

goal. Health and community professionals can also 

assist families who avoid mental healthcare because 

of the associated stigma.

Changes in cultural status of bereaved families can 

cause them to feel simultaneously disconnected from 

the military community and not yet comfortable in the 

civilian community into which they are transitioning. 

As stated in Military Widow: A Survival Guide, bereaved 

spouses may feel that 

even though you remain a military dependent, your 

status within the military has changed. You are a 

dependent without a living spouse. You are no longer affiliated with a particular command or unit. . . .

The unspoken lack of acceptance of, or comfort with, 

widows in the military infrastructure is a key aspect 

of what contributes to military grief complex.12(p108)

Such experiences can complicate the families’ ability 

to connect with needed mental health services.

SPECIAL CIRCUMSTANCES

Death, Illness, or Injury of a Leader

Emotions run high in a unit when a leader is killed. 

Somehow no one expects the leader to be vulnerable. Because the leader’s spouse is usually the one 

helping others, knowing how to help the spouse is 

often hard for the unit. Also, the leader’s spouse may 

find accepting help from the unit difficult. When a 

leader dies, the unit has suddenly lost its direction 

for the active duty members as well as their family 

members, creating a significant change in everyone’s 

life. Being aware of this effect can help the unit cope 

with the loss.

Suicide

For surviving family members dealing with the 

aftermath of a suicide, the grieving process can be 

compounded by feelings of failure, shame, and guilt. 

Public scrutiny and military inquiry into the nature of 

the death can complicate a family’s normal grieving. 

In such circumstances, families may be uncomfortable 

about using military or family traditions in honoring 

the dead. Because adults may be hesitant to share 

information with children (even information that is 

appropriate and could be helpful), children may be 

particularly vulnerable to problems integrating the 

death. Often children have an awareness of the nature 

of the death but are met with silence when they ask 

questions. Being sensitive to the unique nature of the 

child’s loss will better enable a caregiver to provide 

comfort and support. 

Missing in Action and Prisoners of War

Families of service members who are missing in 

action or prisoners of war are forced to deal with the 

uncertainty of the status of their loved one. The suffering that might have to be endured for an indefinite 

period of time exacerbates this highly emotional and 

painful ordeal. Providing ongoing emotional, spiritual, 

and logistical support to the families of these service 

members presents a unique challenge. It should be 

kept in mind that each family’s needs and wants will 

reflect its particular situation; families should be encouraged to ask for the type and amount of assistance 

they prefer.

Mass Casualties 

Multiple injuries or deaths are certainly one of the 

most difficult situations a military unit might face. 

When multiple tragedies occur at the same time, the 

affected surviving families share a unique bond. After 

a few days or even weeks, they may be interested in 

getting connected with each other. Even when tragedies occur at the same time, no two families manage 

the events exactly the same. 
552

Combat and Operational Behavioral Health

Death of a Spouse or Child

In many instances military units adopt the cohesive 

characteristics and nurturing tendencies of a family. 

When trauma occurs within a unit, the potential for impact on many or all members of the “unit family” can 

be far reaching, especially in the case of the death of an 

active duty service member’s spouse or child. The loss 

of a spouse or child in any circumstance is traumatic, 

but when it occurs within the close-knit atmosphere 

of a military unit, the effects can be compounded. But 

the same circumstances that make this loss so painful 

for a unit are the very sources for rallying support, 

providing comfort, and creating a healing environment 

for those left behind.

Media

Americans are particularly proud and interested in 

the lives of their servicemen and women. Today news 

coverage is instantaneous to audiences throughout the 

world. Whenever a service member is killed or injured, 

Americans want to know the “who, what, when, where, 

and why” of the incident, and the media is eager to 

report it. Embedded reporters may provide immediate 

coverage of the spouse’s deployed unit, and fatalities 

may become special reports on the evening news. With 

the presence of cellular and satellite phones, it is possible for the news of the death of a service member to 

bypass the normal channels of notification.

In the most stressful hours of coping with trauma 

in the unit, the media may approach family members 

for a formal interview, an informal comment, or a gut 

reaction. Mentoring the affected family members by 

encouraging them to use the public affairs office for 

any media interaction is beneficial. Contacting the 

command whenever the media approaches a unit’s 

family member is also advisable. 

SUMMARY

The families and children of service members who 

die in the line of duty face profound challenges. Most 

military families are by nature healthy and resilient, 

and most can be expected to transition through a 

period of grieving to a new state of health within the 

civilian communities to which they move. However, 

all grieving families can benefit from community 

resources. Professionals need to be mindful of the 

expected reactions of adults and children as they 

traverse healthy grieving. As this chapter highlights, 

impediments to healthy resolution can occur when 

symptoms of traumatic grief, PTSD, depression, or 

health-risk behaviors develop. Professionals must 

also remember that children who lose a parent are at 

added risk for developing behavioral problems, in 

comparison to their nongrieving peers. Awareness 

of developmental differences in children of all ages 

can be instructive in understanding when children 

are adjusting well and when they could benefit from 

additional help.

REFERENCES

1. US Department of Defense. 1st Quadrennial Quality of Life Review. Washington, DC: DoD; 2004.

2. US Department of the Army. A Guide for the Survivors of Deceased Army Members. Washington, DC: DA; 1989. DA Pamphlet 608-4.

3. US Department of the Army. Army Casualty Program. Washington, DC: DA; 2007. Army Regulation 600-8-1.

4. Ender MG, Bartone PT, Kolditz TA. Fallen soldiers: death and the US military. In: Bryant CD, ed. Handbook of Death 

and Dying. Thousand Oaks, Calif: Sage; 2003: 544–555. 

5. Michael Wardlaw, Casualty Assistance Director, US Navy. Measuring Customer Satisfaction for Navy Casualty Assistance 

Calls Program (CACP). Unpublished research proposal; data are from casualty assistance call officers’ surveys, 2003. 

	 6.	 National Defense Authorization Act. 10 USC §1475. Available at: http://uscode.house.gov/download/pls/10C75.

txt. Accessed March 25, 2011. 

7. Army War College Spouses’ Project. A Leaders Guide to Trauma in the Unit. Carlisle Barracks, Penn: Army War College; 2004: 6. Available at: http://www.carlisle.army.mil/usawc/dclm/docs/traumapdf.pdf.Accessed December 12,

2009.

8. Roy C. Care Team Smart Book [unpublished manual]. Fort Carson, Colo: Family Readiness Center; 2005.
553

The Families and Children of Fallen Military Service Members

9. Deb Busch, founder of Helping Unite Gold Star Survivors at Fort Hood, Texas. Personal communication, December 

13, 2007.

10. Tremblay GC, Israel AC. Children’s adjustment to parental death. Clin Psychol: Sci Pract. 1998;5:424–438.

11. Katler N, Lohnes K, Chasin J, et al. The adjustment of parentally bereaved children: factors associated with short-term 

adjustment. Omega: J Death Dying. 2002–2003;46(1):15–34.

12. Steen JM, Asaro MR. Military Widow: A Survival Guide. Annapolis, Md: Naval Institute Press; 2006.

13. Hardaway T. Treatment of psychological trauma in children of military families. In: Webb NB, ed. Mass Trauma and 

Violence: Helping Families and Children Cope. New York, NY: Guildford Press; 2004: 259–282.

14. Department of Defense Task Force on Mental Health. An Achievable Vision: Report of the Department of Defense Task Force 

on Mental Health. Falls Church, Va: Defense Health Board; 2007. Available at: http://www.health.mil/dhb/mhtf/

MHTF-Report-Final.pdf. Accessed November 5, 2009.
554

Combat and Operational Behavioral Health

ATTACHMENT: RESOURCES FOR FAMILIES OF DECEASED SERVICE MEMBERS

Organizations and Programs

The Arlington National Cemetery Commemorative Project 

In 2009, the Arlington National Cemetery Commemorative Project, in partnership with Rich Clarkson and 

Associates and the National Geographic Society, produced For Children of Valor: Arlington National Cemetery.

This volume is a special commemorative gift book for children who since September 11, 2001, have lost close 

loved ones who were on active duty and are now buried at Arlington National Cemetery. For Children of Valor

was written to help these children understand and process their grief. The book also includes a resource guide 

for parents.

Military OneSource 

Military OneSource is a service provided by the Department of Defense at no cost to active duty, National 

Guard, and reserve service members and their families. Military OneSource is available by phone, online, and 

face-to-face through private counseling sessions in the local community. Its highly qualified consultants provide 

assistance with childcare, personal finances, emotional support during deployments, relocation information, and 

resources needed for special circumstances. Assistance includes personalized consultations on specific issues 

such as education, special needs, and finances, as well as customized research detailing community resources and 

appropriate military referrals. Available at: http://www.militaryonesource.com. Accessed August 19, 2009.

TRICARE 

TRICARE is the healthcare program serving active duty service members, National Guard and reserve 

members, retirees, their families, and survivors worldwide. As a major component of the military healthcare 

system, TRICARE brings together the healthcare resources of the uniformed services and supplements them 

with networks of civilian healthcare professionals, institutions, pharmacies, and suppliers to provide access to 

high-quality healthcare services while maintaining the capability to support military operations. Available at:

http://www.tricare.mil. Accessed August 19, 2009.

Military Homefront

Military life comes with unique challenges, from shopping at the commissary to moving to foreign lands. 

Having trusted information on how to deal with these challenges can make the difference between stress and 

success. Military Homefront provides accurate and up-to-date information about Department of Defense programs serving troops and theirfamilies.Available at: http://www.militaryhomefront.dod.mil.AccessedAugust

19, 2009. 

The Military Child Education Coalition’s Living in the New Normal Initiative

Sparked by concerns about military children dealing with illness, injury, or death of a parent, the Living in 

the New Normal (LINN): Helping Children Thrive in Good and Challenging Times initiative was developed by 

the Military Child Education Coalition (MCEC) through collaboration with experts in the fields of trauma and 

grief, resiliency, healthcare, and child development. LINN encourages families to ensure that their children have 

the tools to weather life’s storms, fosters home-front efforts to support military children, and provides educators 

and other concerned adults with information to help them support children during times of uncertainty, trauma, 

and grief. LINN’s efforts are predicated on the belief that children are courageous and resilient and that these 

skills can be strengthened through deliberate encouragement by the adults in their lives. Available at: http://

www.militarychild.org/linn.asp. Accessed August 19, 2009.
555

The Families and Children of Fallen Military Service Members

National Military Family Association

The National Military Family Association is dedicated to providing information to and representing the 

interests of family members of the uniformed services. Its Web site provides extensive information for military 

families and support service staff. The association publishes a monthly newsletter as well as a weekly legislative e-mail newsletter, the Government and You E-News. Available at: http://www.nmfa.org. Accessed August

19, 2009.

Zero to Three’s Coming Together Around Military Families Initiative 

The nonprofit Zero to Three organization’s Coming Together Around Military Families initiative increases 

awareness of the impact of trauma, grief, and loss on very young children through specialized training and 

support for the professionals who are supporting military families in and around military installations with 

high deployment rates. Of primary focus are the special circumstances of families that experience trauma and 

loss as a result of a service member’s deployment.Available at: http://www.zerotothree.org/military.Accessed

August 19, 2009.

Tragedy Assistance Program for Survivors

The Tragedy Assistance Program for Survivors (TAPS) was founded in the wake of a military tragedy in which 

surviving family members realized that the tragedy they shared, losing a loved one in the line of military duty, 

was far different from other types of losses. These families shared pride in their spouses’ service to America as 

well as tremendous sadness at the ultimate sacrifice their loved ones made. TAPS has experienced, empathetic 

caseworkers who act as liaisons with federal, state, and private agencies in helping family members find solutions to problems. Available at: http://www.taps.org. Accessed August 19, 2009.

Gold Star Wives of America

Founded in 1945, Gold Star Wives of America Inc is an organization of military widows and widowers whose 

spouses died while on active duty or from service-connected disabilities. Gold Star Wives received a federal 

charter from Congress on December 4, 1980. Available at: http://www.goldstarwives.org. Accessed August 19,

2009.

Uniformed Services University of the Health Sciences Center for the Study of Traumatic Stress 

The Center for the Study of Traumatic Stress conducts research, education, consultation, and training on preparing for and responding to the psychological effects and health consequences of traumatic events, including 

natural (hurricanes, floods, and tsunamis) and human-made disasters (motor vehicle and plane crashes, war, 

terrorism, and bioterrorism). The center’s work spans studies of genetic vulnerability to stress, individual and 

community responses to terrorism, and policy recommendations to help the nation and its military and civilian 

populations. Available at: http://www.centerforthestudyoftraumaticstress.org. Accessed August 19, 2009.

The National Child Traumatic Stress Network

Established by Congress in 2000, the National Child Traumatic Stress Network is a unique collaboration of 

academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children and their families across the United States. Combining knowledge of 

child development, expertise in the full range of child traumatic experiences, and attention to cultural perspectives, the network serves as a national resource for developing and disseminating evidence-based interventions, 

trauma-informed services, and public and professional education.Available at: http://www.nctsn.org.Accessed

August 19, 2009. 
556

Combat and Operational Behavioral Health

American Academy of Child and Adolescent Psychiatry 

Established in 1953, the American Academy of Child and Adolescent Psychiatry is the leading national professional medical association dedicated to treating and improving the quality of life for children, adolescents, 

and families affected by mental disorders. The academy is a membership-based organization composed of over 

7,500 child and adolescent psychiatrists and other interested physicians. Its members actively research, evaluate, diagnose, and treat psychiatric disorders, giving direction and responding quickly to new developments 

in addressing the healthcare needs of children and their families. The academy widely distributes information 

in a effort to promote understanding of mental illnesses and remove the stigma associated with them, advance 

efforts in prevention of mental illnesses, and assure proper treatment and access to services for children and 

adolescents. Available at: http://www.aacap.org. Accessed August 19, 2009.

American Academy of Pediatrics 

The American Academy of Pediatrics is an organization of 60,000 pediatricians committed to the attainment 

of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young 

adults. Its uniformed services section was founded in 1959 with a mission to improve the health of infants, children, adolescents, and young adults served by medical providers in the US Army, Navy, Air Force, and public 

health agencies. The section provides unique educational forums to address the global issues of military pediatric 

providers. Available at: http://www.aap.org. Accessed August 19, 2009.

Suggested Literature and Resources Guide from the Military Child Education Coalition 

The MCEC recommends the use of these books by children experiencing and coping with trauma, grief, and 

loss only with direct parental supervision or guidance and support from other caring adults. This list was compiled by a committee of MCEC advisors representing various perspectives: psychologists, educators, military 

families, grief specialists, and professional developers, and is reproduced here with permission from the MCEC. 

The statements included in this list are opinions based on the MCEC perspective and guiding principles and are 

not intended to be a comprehensive review of the literature, but rather a guide.

Early Elementary Level

	 •	 A Bunch of Balloons, by Dorothy Ferguson.

 Synopsis: Author discusses loss and grief by introducing a story about a little child who loses a balloon. 

The author then introduces the topic of death and grief and leads the reader through activities using 

balloons to capture what is lost and what remains in the grieving child’s life. The goal is to help grieving 

children acknowledge what they have lost and celebrate what they still have left when someone they 

love has died. 

	 •	 I Had a Friend Named Peter: Talking to Children About the Death of a Friend, by Janice Cohn.

 Synopsis: A young child learns of the sudden death of her school friend, Peter, who was accidentally hit 

by a car while chasing a ball. Excellent introduction helps adults understand the many questions children 

pose following the death of a loved one. Addresses dying, funerals, and burial in direct language. Also 

has a school setting with teacher and classroom. Picture book. 

 Teachable moments: Have child talk about memories of the deceased—the likes and dislikes of the 

person. For sudden death situations, ask children how they would say goodbye to the person.

	 •	 A Good Day, by Kevin Henkes.

 Synopsis: Four little creatures encounter dilemmas in their day. Using their circumstances, relatable to 

the young child, this story presents a simple message of reassurance in times of sadness, disappointment 

and challenge. This book encourages hope and resilience and invites discussion with children regarding 

their own situations.

	 •	 Ragtail Remembers—A Story That Helps Children Understand Feelings of Guilt, by Liz Duckworth.

 Synopsis: The death of an old cat who was a playful companion and good friend of the storyteller, a 
557

The Families and Children of Fallen Military Service Members

mouse named Ragtail. The language is clear and direct, which lends to the open discussion of feelings 

and emotions that are experienced when there is a death and loss. It demonstrates the importance of 

friends, the help rendered by a wise bluejay that acts as a faithful guide and teacher and becomes a new 

friend and playmate of the mouse. It is also about honoring and remembering in death.

	 •	 The Fall of Freddie the Leaf, by Leo Bascaglia.

 Synopsis: Freddie learns about the cycle of life from his fellow leaf friend, Daniel. Freddie comments 

on his experience regarding his mentor’s death and then his own death. 

 Caution: ensure child understands that death is not sleeping, but is permanent. 

	 •	 The Wall, by Eve Bunting.

 Synopsis: In this moving picture book, a little boy and his father visit the Vietnam Veterans Memorial 

(“The Wall”) to find the name of the boy’s grandfather. They notice details: items left in remembrance, 

the uniformity of the engraved lettering, a veteran who is an amputee, and more. Together they make 

a rubbing of the name, which is a popular tradition. 

	 •	 When Dinosaurs Die: A Guide to Understanding Death, by Marc Brown and Laurie Krasney.

 Synopsis: Uses dinosaurs to explain in simple language the feelings people may have regarding death 

of a loved one and ways to honor the memory of someone who has died. Does not tell a story; addresses 

fears, curiosity, customs, and acknowledges military death and war.

 Caution: Some may take offense that the death of a pet is represented as equal to the death of a person. 

 Teachable moments: Dinosaurs are extinct (this can cause a whole separate discussion). Look closely at 

the drawings for details related to the children’s questions in the book.

Mid-Elementary Level

	 •	 Everett Anderson’s Goodbye, by Lucille Clifton.

 Synopsis: Written in verse and beautifully illustrated with charcoal line drawings, this book features a 

young African-American boy whose father has died. The theory of stages of grief is presented through 

the eyes of the young boy and his profound loss. Theories differ in describing grief as stages, phases, 

or processes. Stages imply a linear progression. Current research emphasizes grief as a process with 

phases that individuals may experience at different times. 

	 •	 Geranium Morning, by Sandy Powell.

 Synopsis: Two elementary-aged kids, a boy and a girl, each lose a parent, a father and a mother, respectively. The father dies suddenly in an accident and the mother dies from illness. The children help each 

other deal with their grief; story expresses the value of shared experience as the root of recovery. 

 Teachable moments: Talk about the benefit of sharing a new friendship with someone who has had a 

similar experience. 

 Note: This book is out of print, but used copies may be available online. 

	 •	 I Don’t Have an Uncle Phil Anymore, by Marjorie Pellegrino.

 Synopsis: When a young boy’s uncle dies, he must board a plane and fly to the funeral. He recalls the 

fun times he had with his Uncle Phil and how he used to play and do special things with his Uncle Phil 

and his cousin. He worries about his cousin and aunt and who will play with his uncle now. The boy 

witnesses the support of his uncle’s fellow firefighters when the funeral procession passes the firehouse. 

The boy calls this a sad parade. The boy hugs his cousin Jenny and comforts her when she exclaims 

while playing blocks, “I don’t have a daddy anymore.”

	 •	 I Miss You—A First Look at Death, by Pat Thomas.

 Synopsis: The story uses language that is gentle, simple, clear, and straightforward, directed to a little 

girl. It explains death as a natural part of life, that after death, the body stops working. It discusses the 

funeral and provides an excellent discussion of the variation in cultural practices and beliefs regarding 

death. The question, “What about you?” that appears at the bottom of several pages stimulates discussion of questions a child may have about death, feelings and emotions a child may experience, and the 
558

Combat and Operational Behavioral Health

difficulty of understanding. There are suggestions for how to use the book at the end that are useful 

and instructive. A list of suggested books and resources is provided; the glossary is rather brief. 

 Caution: On page 23, one line, “the souls of other people who have passed away,” is unusual because 

otherwise very factual and realistic text is used throughout the story. 

	 •	 Memory String, by Eve Bunting.

 Synopsis: A young girl’s mother dies and her stepmother helps her remember the love they shared using buttons as mementos. Highlights stepmother relationship as helpful. 

 Teachable moments: Gather buttons—including military buttons or insignia—to make a memory string. 

Discuss the meaning of each button and why it holds that meaning.

	 •	 The Hero in My Pocket, by Marlene Lee.

 Synopsis: A brother and sister, ages 10 and 7, experience the loss of their father who died serving in the 

US military. The children progress through the grief process and positive recovery is encouraged. 

 Teachable moments: Children can write or draw their part of the story on “Hero Pages” in the book to 

give voice to their thoughts and feelings. Discuss keepsake memento child may have (or want) of the 

deceased (95% of children have a keepsake object [transitional linking object] from a deceased parent 

that they keep in their rooms). Gather “remember letters” or have class write “remember letters.”

	 •	 What Does That Mean? A Dictionary of Death, Dying and Grief Terms for Grieving Children and Those Who

Love Them, by Harold Smith and Joy Johnson.

 Synopsis: More of an encyclopedia than a dictionary, the clever format of word, pronunciation, definition and example or quotes, sometimes from known literature, could be a good, objective classroom 

resource. 

	 •	 Owen & Mzee, by Isabella Hatkoff, Craig Hatkoff, and Paula Kahumbu.

 Synopsis: This is the tale of a baby hippo named Owen and his friend Mzee, a 130-year-old giant tortoise. 

Owen is a survivor and an orphan as a result of the December 2004 tsunami in Southeast Asia. This 

profound true story offers a potent reminder that even in the face of tragedy, the power of friendship 

endures—and that our most important friends are sometimes those we least expect. A true demonstration of resilience and living in a “new normal.” 

	 •	 Annie Loses Her Leg but Finds Her Way, by Sandra J Philipson and Robert Takatch.

 Synopsis: Based on an actual incident, this is both a poignant and funny story of a 9-year-old English 

springer spaniel who loses her front leg to cancer. Two children, Annie and her high-spirited brother, 

Max, experience her illness and recovery in very different ways. Max is in denial, and Annie is in a state 

of sad acceptance. This is a book about love, loss, friendship, and optimism. 

Elementary and Early Teen Level

	 •	 A Taste of Blackberries, by Doris Buchanan Smith.

 Synopsis: Two ’tween boys, best friends, “planned to have fun all summer,” but one boy dies suddenly. 

Novel follows range of thoughts, emotions, and actions of surviving best friend. 

	 •	 Coping With Death and Grief, by Marge Eaton Heegaard.

 Synopsis: Eight vignettes about the death of a person and the children affected. Several different kinds 

of death and relationships are illustrated in easy-to-read format, followed by factual discussion points 

about grief, changes in relationship, realities of day-to-dayness, and many other aspects. References 

military funerals, playing “Taps,” and much discussion about school settings, including death discussed 

in the classroom. 

 Teachable moments: Discuss the concept of grief as a fact, a normal aspect of the human condition. 

Discuss how the relationship to someone is a primary factor in one’s experience with grief. 

	 •	 How It Feels When a Parent Dies, by Jill Krementz.

 Synopsis: Eighteen kids, boys and girls ages 7 to 16, wrote personal essays about their experiences and 

feelings about the death of their parent. Different types of loss are represented, as are a range of normal 

feelings: anguish, guilt, confusion, anger, as well as the children’s lives since the death. 
559

The Families and Children of Fallen Military Service Members

 Teachable moments: Discuss how book shows that grief reactions and responses are as individual as 

people. With teenagers, discuss aspects that make it individual (age at time of death, family composition, type of death). 

	 •	 Part of Me Died, Too: Stories of Creative Survival Among Bereaved Children and Teenagers, by Virginia Lynn 

Fry.

 Synopsis: First-person stories by kids of different ages who experienced loved ones’ deaths (father, 

mother, friend, other relative) from different means (sudden death, lingering illness, and suicide). They 

describe their reactions and effects. Table of contents lists type of death and ages of kids so reader can 

go right to the section. In the epilogue the kids reflect on their original writings and talk about how they 

are now. Also lists follow-on reading suggestions. 

 Teachable moments: Discuss how the book shows that grief reactions and responses are as unique as 

individuals. With teenagers, discuss aspects that make it individual (age at time of death, family composition, type of death). 

	 •	 What We Do When Someone Dies, by Caroline Arnold.

 Synopsis: Fact-based book that explains vocabulary related to someone dying and afterwards (obituaries, 

funeral service, etc). Ranges from concept that all living things must die to what happens to the body, 

funeral ceremonies, and afterwards. Acknowledgment of multicultural beliefs and customs. Acknowledges that people die in war. Discusses Memorial Day and Arlington National Cemetery. 

 Teachable moments: Discuss military-related traditions (“Taps,” veterans’ cemeteries, flags, etc). Discuss how having facts helps alleviate some of the fear associated with the difficult topic of death (fear 

of the unknown, fear of taboo topic, etc). Further discussion on respecting culture and traditions of 

different religions and nationalities, and allow child to choose topics to discuss further since book is 

fact-based.

Teen Level

	 •	 Fire in My Heart, Ice in My Veins—A Journal for Teenagers Experiencing Loss, by Enid Samuel Traisman.

 Synopsis: A workbook that allows teens to describe their feelings and thoughts related to the death 

of someone they cared about. A brief statement appears at the top of the page, followed by several 

responses to encourage and focus their expressions in writing or drawings to remember and honor the 

one who died. The statements are very probing. This process allows teens to be open and candid about 

their feelings. 

 Teachable moment: Provides valuable discussion opportunities between caring adults and teens experiencing loss. 

	 •	 The Grieving Teen: A Guide for Teenagers and Their Friends, by Helen Fitzgerald.

 Synopsis: Written about and for teens, this guidebook covers a wide range of situations and topics—and 

suggestions—for grieving teens and those who care about them. Teen voices are heard throughout the 

book. Does not discuss death of service members but it does discuss secondary losses and complicating 

factors such as dealing with the press and sudden death. 

 Teachable moments: Discuss what kind of secondary losses or compounding factors someone may have 

experienced.

	 •	 The Healing Your Grieving Heart Journal for Teens, by Alan Wolfelt and Megan Wolfelt.

 Synopsis: Guided journal encourages teens to self-explore through self-expression. Designed as a companion book to Healing Your Grieving Heart for Teens: 100 Practical Ideas. Useful weeks, months, or even 

years following the death of a loved one. 

	 •	 When a Friend Dies: A Book for Teens about Grieving and Healing, by Marilyn Gootman.

	 	 Synopsis: The book is about acceptance and compassion. Focuses on answering teen/preteen questions

about death.

	 •	 You Are Not Alone: Teens Talk About Life After the Loss of a Parent, by Lynne Hughes.

 Synopsis: The author, Lynne Hughes, the founder of the Comfort Zone Camp for grieving children who 

have lost parents or siblings, personally experienced the death of her parents at an early age. The voices 
560

Combat and Operational Behavioral Health

of teens who have attended the camp provide illustrative insights into ways young people have dealt 

with loss. As the title suggests, teens are encouraged to seek help and to know that there are others who 

share feelings of immeasurable loss. 

	 •	 Finding My Way: A Teen’s Guide to Living With a Parent Who Has Experienced Trauma, by Michelle D Sherman and DeAnne Sherman.

 Synopsis: An interactive workbook format that offers teens practical tools and information about posttraumatic stress disorder and other responses to trauma. Clearly and concisely written, it encourages 

teens to address their own emotions and key issues in dealing with a parent who has experienced trauma. 

The gentle guide, using honest and concise language, offers valuable tools for coping, identifying social 

support networks, and dealing with friends. An extensive resource list, glossary, and frequently-askedquestions section completes this useful manual.

	 •	 Facing Change: Falling Apart and Coming Together Again in the Teen Years, by Donna O’Toole.

 Synopsis: Founded on the belief that young adults can make effective choices that can transform pain 

into resilience, the author provides an abundance of information and coping choices to assist the process. 

A book about loss, change, and possibilities. 

Adults—General

	 •	 Ambiguous Loss: Learning to Live With Unresolved Grief, by Pauline Boss.

 Synopsis: Offers insight into the meaning and impact of ambiguous loss and suggestions for coping. 

Author draws from her own research, including interviews with military spouses of service members 

who are missing in action or prisoners of war. Ambiguous Loss is applicable to families of those with 

traumatic injury or Alzheimer’s disease, or who are missing. 

	 •	 Helping Children Cope With the Loss of a Loved One: A Guide for Grownups, by William Kroen.

 Synopsis: Answers questions relative to developmental ages, uses vignettes along with practical and 

theoretical advice. 

	 •	 Life and Loss: A Guide to Help Grieving Children, by Linda Goldman.

 Synopsis: Tools, ideas, and inventories for educators and other community members to use in helping 

kids commemorate loss. Discusses different types of childhood losses and avoids clichés. Provides an 

example of a “community care team” concept to help the grieving child. 

	 •	 Raising Our Children to Be Resilient, by Linda Goldman.

 Synopsis: Resource for adults to understand how children experience traumatic events and empowering 

them to be resilient.

	 •	 Raising an Emotionally Healthy Child When a Parent Is Sick, by Paula K Rauch and Anna C Muriel. 

 Synopsis: A friendly and accessible guide to communicating with children about illness, death, and dying. Assists parents in understanding unique temperaments of individual children and practical advice 

and examples of how to establish and organize a family support system. 

	 •	 Military Widow, by Joanne M Steen and Regina Asaro.

 Synopsis: An insider’s perspective to understanding and surviving the death of a military service member, 

as well as implications for surviving dependents. Helpful blend of personal experiences and professional 

references and research. Addresses the unique aspects and challenges of military widowhood.

	 •	 Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment, by

Martin EP Seligman.

 Synopsis: “Positive psychology” is a new approach to psychology focusing on mental health rather than 

mental illness. Readers learn that happiness can be cultivated by identifying and using many of the 

strengths and traits that they already possess; their signature strengths. By calling upon these strengths 

in all the critical aspects of life, one develops buffers against misfortune and negative emotion. Break 

free from learned helplessness to learned optimism resulting in greater resilience.
561

The Families and Children of Fallen Military Service Members

	 •	 A Parent’s Guideto Building Resiliencein Children and Teens: Giving Your Child Roots and Wings, by Kenneth 

R Ginsburg.

 Synopsis: This practical guide assists parents in showing their children how to be more resilient when 

facing compounding stressors by developing healthy coping strategies. Dr Ginsburg introduces parents 

to the seven “crucial Cs”: (1) competence, (2) confidence, (3) connection, (4) character, (5) contribution, 

(6) coping, and (7) control, and how they work together to help kids 18 months to 18 years bounce back 

from challenges and manage stress.

Adults—Educational Focus

	 •	 Grief Comes to Class: An Educator’s Guide, by Majel Gliko-Brado.

 Synopsis: Short, to-the-point guide, based on results of a study conducted through the College of Education at Montana State University to obtain perceptions and feelings about bereaved children. The views 

of teachers, parents, and the children are represented in the discussion of the environment, culture, individual personality, and circumstances. Examples of children’s experiences are interspersed throughout 

the text, especially helpful in the section on developmental changes among children of different ages, 

with special attention on teen grief. The “What You Can Do to Help” section offers sample letters and 

activities for the classroom, with a teacher/parent/student conference plan that can be modified and

personalized. 

	 •	 Helping Children Grieve & Grow—A Guide for Those Who Care, by Donna O’Toole.

 Synopsis: This booklet provides a useful, easily understood synopsis to help children to grieve and to 

grow. The format is functional in its arrangement of concise information with practical suggestions on 

understanding reactions and what to do to encourage the children. It speaks of resilience in children and 

offers resources available both nationally and locally. The language is compassionate and demonstrates 

that the writer has broad experience in the field.

Adults—Reference

	 •	 25 Things to Do: Activities to Help Children Suffering Loss or Change, by Laurie A Kanyer.

 Synopsis: Practical and simple activities to engage a child suffering a painful loss or change. A creative, 

sensitive, “Mr. Rogers”-like reference for parents and caregivers. Encompasses a broad range of loss 

topics children may encounter in their developmental years; from the loss of a pet, to the divorce of 

their parents, to the death of a loved one. 

	 •	 35 Ways to Help a Grieving Child, by the Dougy Center: The National Center for Grieving Children and 

Families.

 Synopsis: Drawn from stories, suggestions, and insight shared by children and their family members at 

the Dougy Center, this book explores behaviors and reactions of children at different ages and maturity 

levels; outlets for children to safely express their thoughts and feelings; and ways to be supportive during difficult times, such as a memorial service, anniversary, or holidays. 

	 •	 How to Go on Living When Someone You Love Dies, by Terese A Rando.

 Synopsis: Step-by-step guide for adults to talk about death with children of all ages to help understand 

what they think, how they feel, and what they comprehend. Directly addresses how adults can help, 

providing checklists, scripts, and quick reference information.

	 •	 How Do We Tell Children: Helping Children Understand and Cope When Someone Dies, by Dan Schaefer and 

Christine Lyons.

 Synopsis: Written by a former funeral home director who dealt with thousands of families, this book 

helps adults understand how to talk with children openly about death. Covers age range from 2 to 

teenager. Helpful for adults to understand what children can and cannot grasp at certain developmental 

stages. 

	 •	 Losing Parents to Death in the Early Years, by Alicia Lieberman.

 Synopsis: Written by one of the mostrespected professionals in the field of early trauma/loss, the author
562

Combat and Operational Behavioral Health

explains how vulnerable children can be given their immaturity. Addresses difficult issues that arise as 

a result of death due to military service or socially-stigmatized causes.

	 •	 Treating Trauma and Traumatic Grief in Children and Adolescents, by Judith Cohen.

 Synopsis: This book describes the state-of-the-art cognitive-behavioral therapies used in treating children 

who are exposed to trauma and traumatic death. While it is mainly targeted for therapists and clinicians 

who work with this population of children, it is also an excellent reference for others who would like 

to understand the most effective, evidence-based approaches to helping children and adolescents who 

suffer with trauma-related disorders.