Work involving children as next of kin

1.0 Purpose

Children are next of kin when their parents or siblings experience health problems. These may include mental illness, substance dependence, or serious physical illness or injury. Children are bereaved when their parents or siblings die.

The guidelines shall:

• ensure that the municipality has systems in place to follow up children who are next of kin or bereaved, cf. Sections 10a and 10b of the Health Personnel Act.
• help ensure that children and siblings of people with mental illness, substance dependence, or serious physical illness or injury receive information, support and follow-up.
• help ensure that children and siblings of service recipients who die receive information, support and follow-up.

1.1 Applies to

Municipal management and healthcare personnel in health and care services.

Should also apply to: employees in services and sectors involved in following up children, young people and families.

1.2 Background

Caring for children who are next of kin or bereaved is part of the municipality’s health services and is also central to preventive health work. The guidelines shall help ensure:

• children’s right to be included, informed and heard when there is illness or death in the family.
• that children do not develop their own problems as a result of their parents’ or siblings’ health problems or death.
• the promotion of children’s health, quality of life and well-being.

1.3 Roles and responsibilities

The municipality must ensure that systems are in place for cooperation across services and that employees are familiar with their own and others’ roles.

1.3.1 Municipal management shall ensure that:

• work involving children who are next of kin or bereaved is included in relevant plans, procedures, guidelines and professional development plans at the individual, service and system levels.
• some employees have in-depth knowledge of children who are next of kin or bereaved.
• coordination of work involving children as next of kin is systematised, for example by assigning responsibility and expertise to specific roles.
• healthcare personnel and employees in relevant welfare services have the necessary expertise concerning children who are next of kin or bereaved.
• the municipality regularly evaluates and corrects its work involving children who are next of kin or bereaved.
• care for children who are next of kin or bereaved is included in cooperation and coordination between relevant welfare services and service levels.

1.3.2 Coordination of work involving children as next of kin should ensure:

• advice and input for the municipality’s improvement and quality work
• advice and input for healthcare personnel’s professional development
• an overview of local support services for children who are next of kin
• advice and input on coordination within the service and with other welfare services

1.3.3 Healthcare personnel shall:

• have basic expertise in work involving children as next of kin
• establish whether the service recipient has children or siblings under the age of 18
• ensure that the children’s needs are assessed, addressed and documented

Appendices

Sub-package 1 Guidelines (Word)

Are you responsible for professional development?Download sub-package 1 as a PowerPoint.

Resources

Self-assessment: municipal profile for work involving children as next of kin

Professional development plan for the municipality

2.0 Purpose

Healthcare personnel must know how to:

• establish whether the service recipient has children or siblings under the age of 18
• assess the children’s need for information, support and follow-up

Consent, written or verbal, must be obtained from the service recipient when cooperating with children, other caregivers or services.

If there is uncertainty about a child’s safety, life or health, see the procedure for notifying the Child Welfare Service (link to the municipality’s own procedures for notifying the Child Welfare Service).

2.1 Identify whether the service recipient has children or siblings under the age of 18

It must be established whether the service recipient has children or siblings under the age of 18.

When the service recipient has children or siblings under the age of 18, the following must be clarified for each child:

• The child’s name, date of birth and place of residence, language, any country of origin, length of residence in Norway, and need for an interpreter
• The service recipient’s relationship to the child: parental responsibility, day-to-day care, contact rights or sibling relationship

See the relatives’ guide for more information about the procedure

2.2 Clarify the children’s situation and needs

When a service recipient has children or siblings under the age of 18, the service recipient or other caregivers should be spoken to as soon as possible to clarify the following:

• What information has the child received about the admission, treatment and/or illness?
• How does the service recipient or other caregivers address the child’s need for information, support and reassurance?
• How is the child’s everyday life being taken care of in terms of structure, routines and activities?
• Does the child have responsibilities at home or towards the person who is ill that should have been carried out by adults?

When the child’s situation indicates that it is necessary, the child’s need for information and follow-up must be clarified and assessed. This is done in conversation with the service recipient/user, parents or other caregivers. In accordance with the child’s age and maturity, the child should be asked what they say they need. The child may be offered the opportunity to take part in the conversation, or to have a separate conversation with healthcare personnel, with the consent of the service recipient/user.

If it is assessed that the child has sufficient information and follow-up, the clarification is concluded and the assessment is documented in the service recipient’s/user’s medical record.

In longer follow-up processes, the child’s situation and needs must be assessed regularly to ensure whether the child’s needs have changed.

See the relatives’ guide for more information about the procedure

2.3 Guidance and support for the family

When necessary to meet the child’s needs, the service recipient/user, parents or other caregivers should be spoken to about guidance and support to help the child.

In cooperation with the service recipient/user, parents or other caregivers, the measures to be implemented to support the child and family should be assessed and agreed upon.

Possible measures include:

• talk to parents about how they can support the child
• talk to parents about how they can talk to the child about health challenges and treatment
• talk to parents about the child’s everyday life in kindergarten, school, leisure activities and social network.
• give children who are next of kin the opportunity to visit their parents/siblings at the institution
• talk to parents about caring for children who are next of kin to siblings
• offer conversations with the child when needed, with the parents’ consent
• help ensure that children who are next of kin receive the necessary follow-up in cooperation with other services
• provide families with information about relevant support services (link to the municipalities’ website with local services)

See the relatives’ guide for more information about guidance and support for the family

2.4 Supporting children bereaved by a parent or sibling

When a parent or sibling dies, or is expected to die, the service recipient/user, parents or other caregivers should be spoken to in order to clarify the child’s need for information and follow-up.

The following should be done:

• provide general advice about children and grief
• offer help with how parents or other caregivers can talk to children
• provide information about relevant support services (link to the municipalities’ website with local services)
• provide assistance in contacting services in the home municipality, such as kindergarten, school, child health centre or school health service.

Read about supporting children who are bereaved in the relatives’ guide.

Appendix

Sub-package 2 Competence (Word)

Are you responsible for competence development?Download Sub-package 2 as a PowerPoint.

Resources

Flowchart

E-learning course on children as next of kin – For municipal health and care personnel(kslaring.no)

10 tips for helping parents/guardians with life-limiting illness talk to their children

BARNESPOR | When children are next of kin in substance use and mental health services

A short film for children about death

3.0 Purpose

Municipalities should have an accessible overview on their websites of local support services for next of kin. The services should be made known to next of kin and personnel, including general practitioners, and the overview should be updated regularly.

3.1 Content

The overview should include information about who children who are next of kin are and how best to support them, as well as an overview of the services available in the municipality and who can support the family.

3.2 Suggested content for the municipality’s website

Children and young people are affected in different ways when someone in the family is struggling. Openness and predictability are important in enabling children who are next of kin to live good lives.

There are many reasons why children are next of kin or why everyday life becomes difficult. These may include circumstances in the family such as:

• mental illness, physical illness or injury
• alcohol or substance abuse
• when someone close to them dies
• parental separation
• serious financial difficulties
• witnessing violence in the family
• a parent who is in prison

3.2.1 What can you do yourself?

General advice for parents on how they can support their children:

• Help create predictability and security by telling the child what is happening.
• Maintain daily routines as far as possible.
• Be available, open and inclusive, and let the child take part in the community.
• Try to understand how the child perceives the situation.
• Do not pressure the child to talk.
• Make time for the child and do things together.
• Show that it is okay for siblings to react differently to what is happening.
• Facilitate positive experiences with peers.
• Seek support from other adults when needed

3.2.2 How we work with children who are next of kin in our municipality

In our municipality, we want all children and young people who are next of kin to be included and have the right to express their views about their own support needs. This is ensured by enabling staff to guide parents, talk with the child, and refer them to relevant support services.

The welfare services in our municipality must ensure that children and young people who need help receive the right support at the right time. The services must work together to strengthen children’s overall upbringing and learning environment.

For questions, contact: address of the relevant service that can help the family further.

Appendix

Part 3 Information for the public (Word)

Are you responsible for professional development?Download Part 3 as a PowerPoint.

4.0 Purpose

Employees working in services where children and young people spend most of their day are in a key position to support children and young people affected when parents, siblings or close caregivers experience serious physical and/or mental illness, substance dependence, serious injury/disability or death. When such situations arise, children may feel insecure or vulnerable, or become worried, and they may need support. If children who are next of kin are not cared for and met with insight and understanding, the situation may negatively affect the child’s development, health, everyday life in kindergarten or school, and social life. 

4.1 What employees in kindergartens and schools should know

Parents are responsible for meeting their children’s basic needs, but all families may face situations where they need help and support to meet a child’s needs. To help ensure that children receive the support they need as early as possible, employees in kindergartens and schools must know about signs and signals that may give cause for concern, and know how they can support children living in families where someone has health challenges or dies. 

4.1.1 Risk factors and protective factors:

Employees must know which circumstances increase the risk of children developing mental, social and behavioural problems, such as serious health problems or death. Such circumstances can lead to conflict-ridden family interactions, poorer parenting or neglect. 

Protective factors are circumstances that reduce the risk of a child developing problems of their own when risk factors are present, such as support from a social network and openness about the family’s situation. 

4.1.2 Signs and signals in children that may give cause for concern:

Children living in families facing health challenges may show signs and signals in their emotional expression and behaviour, physical and psychosocial wellbeing, or there may be changes in interactions between parents and children. This also applies to children living in families where someone dies. 

• Emotional expressions and behaviours in the child may include changes in behaviour, such as going from outgoing to withdrawn, becoming withdrawn, reserved and sad, anxious or fearful, or angry. 

• Physical signs and signals in the child may include poor hygiene and diet, unexplained pain, headaches or stomach aches, and persistent symptoms such as nausea and dizziness. 

• Psychosocial issues may include difficulties relating to others, concentration difficulties, involuntary school absence, delayed development or being subjected to bullying. 

The relationship and interaction between parents and children may be affected when parents have health challenges. Parents may express concern about the child or the family’s situation. This may be reflected in parents not keeping appointments, a lack of cooperation, or a lack of information sharing between home and kindergarten/school. 

4.2 How can kindergartens and schools support children and parents?

In consultation with the parents and the child, employees in kindergartens and schools should assess what needs to be done to ensure the child is as well as possible. 

4.2.1 Support for children

Suggestions for how employees can support the child: 

• Work with the child to find out whether they have a trusted person who can be available to them. 

• Talk with the child and agree on what might help, such as the need to withdraw for a break or other accommodations. 

• Ensure consistent routines—strive for stable relationships around the child and avoid unnecessary changes to the child’s kindergarten/school day and surroundings. 

• Show understanding of feelings through words and actions—acknowledge that feelings are natural. 

• Make time for breaks, play, laughter and friends. 

• Involve the other children and let them show care if the situation calls for it, for example in the case of serious illness or death. Agree with the child on what the other children should be told, so that the child feels in control of the situation. 

• Provide information about where the child can get support beyond kindergarten and school, such as from a public health nurse and other low-threshold services. 

4.2.2 Support for parents

Suggestions for how employees can support parents: 

• Ensure good communication: from the parentsand from the kindergarten/school. For example, arrange regular contact, provide informationabout how the child’s feelings about the situation at home are expressed at kindergarten/school.There should be a low threshold forcontact in both directions.  

• In consultation with the parentsand the child, the kindergarten/school assesses what should be done to ensure the child is as well as possible.Agreed measures should be evaluated regularly. 

• Involve the network if practical help and/or emotional support is needed. 

• Have an overview of which services andlocalservicesareintendedtocontactor. 

• Herefer to the municipality’s website about children as next of kin. 

4.2.3 Examples of good routines in kindergarten and school at the system level

• Ensure that systems are in place for children to express their views on all matters concerning them, and that these views are given due weight in accordance with the child’s age and maturity. 

• Ensure that all staff members have the necessary knowledge, for example by providing training on children living in families facing health challenges or bereavement, regularly practising difficult conversations, and facilitating peer guidance. 

• Develop an annual cycle to ensure regular focus on the topic among staff, parents and children. 

• Ensure smooth transitions between departments/grades and between kindergarten and school. Agree with the child and parents on what information should be passed on. 

• Map the family situation during admission interviews and/or conversations with parents to foster openness between home and kindergarten/school. Encourage parents to share information about changes in the family situation. 

• A plan for dealing with crises and grief. This should be reviewed and known to all staff. 

• Systems for evaluating and adjusting measures implemented in collaboration with the child and parents. 

Appendices

Sub-package 4 Employees working in kindergartens and schools (Word)

Are you responsible for professional development?Download sub-package 4 as a PowerPoint.

Resources

Managing crises and grief in kindergartens | udir.no

Pupils with particular vulnerabilities | udir.no 

I know 

BARNESPOR | When children are next of kin in substance use and mental health services 

Life and such 

11 introductory questions about children and substance use 2022 | KORUS 

The teacher’s guide “See Me, Teacher” – children and young people in grief and crisis 

Zippy’s Friends – coping skills in schools - Voksne for Barn 

“The importance of kindergarten when children are next of kin” by Heidi Wittrup Djup

References

 

UN Convention on the Rights of the Child (regjeringen.no)

Health Personnel Act.Lovdata.

Next of Kin Guidance - Norwegian Directorate of Health

Early identification of at-risk children and young people - Norwegian Directorate of Health

Coordination of services for children, young people and their families - Norwegian Directorate of Health

Management and quality improvement in health and care services - Norwegian Directorate of Health

Wittrup, H., D., (2021),The importance of kindergarten when children are next of kin,Fagbokforlaget 

Osen, N.L., Relling, M., Overvik, M. & Haugan, M. (2025),Conversations with children and families when children are next of kin. A practical handbook for health personnel, Kommuneforlaget.