16.1 () Involving children and families when someone important died

Question 1

Name 3 key protective factors in child’s ability to cope and adjust to the death of someone important

Answer 1

1. Emotional availability of trusting adults
2. Child ability to express feelings about the loss
3. Open communication

Question 2

Infants and toddlers (0-2 years):
- Explain their developmental context/task
- Explain their understanding of death
- List 3 recommendations for this age group

Answer 2

Developmental context: establishing attachment and trust

No understanding about finality of death but notice absence of caregiver
Sensitive to emotional distress/grief of caregivers

Reaction: irritable, withdrawn

Recommendations:
1. Familiar routines/boundaries and consistent care
2. Reassurance
3. Simple explanations

Question 3

Pre-schoolers (3-5 years)
- Explain their developmental context/task
- Explain their understanding of death
- List 3 recommendations for this age group

Answer 3

Developmental context: driven by egocentrism, magical thinking, associative logic

Not able to understand death is irreversible and permanent; may attribute death to their own actions/attributes

Reaction: magical thinking, self-blame, ask questions about where loved ones went

Recommendations:
1-3. Same as infants and toddlers above
4. Frequent and repetitive reassurance to dispel misconception that the child contributed to death

Question 4

School age children (6-12 years)
- Explain their developmental context/task
- Explain their understanding of death
- List 3 recommendations for this age group

Answer 4

Developmental context: mastering skills, fairness, cause and effect, logic, peer relationships

Understand death is final and irreversible; may struggle with abstract ideas and fairness

Reaction: curious about death, ghosts, Skeletons

Recommendations:
1-3. Same as infants and toddlers above
4. May need to involve school/teacher for additional support

Question 5

Adolescents (13 and older)
- Explain their developmental context/task
- Explain their understanding of death
- List 3 recommendations for this age group

Answer 5

Developmental context: working on separation-individuation, identity formation

Understand death is final, irreversible, universal; may focus on personal effects of loss

Reaction: may hide sadness to fit in with peers

Recommendations:
1-2. Same as infants and toddlers above
3. Clear and honest information
4. Be careful of teenagers taking on too much adult responsibilities/engaging in risky behaviours

Question 6

The approach to involve children will need to take account of what 3 factors?

Answer 6

1. Child’s developmental stage
2. Adult’s capacity to be honest and open about progression of disease and imminence of death
3. Family’s culture around communication in general

Question 7

List 3 steps to talk to children about expected death of a parent

Answer 7

1. Use honest, straightforward, age-appropriate LANGUAGE (avoid euphemism, name the specific illness)
2. Check in frequently on child’s UNDERSTANDING
3. Welcome QUESTIONS as they arise

Question 8

A 7 year old child attends an oncology appointment with their parent. The parent asks if the child should leave the room while the parent talks to the doctor. How should the oncologist respond?

Answer 8

Welcome the child to engage in the discussion but defer to parent’s decision

Question 9

List 5 important elements of facilitating a visit between a child and an ill or dying parent in a hospital or hospice

Answer 9

Before visit:
- Explore and alleviate worries or reluctance about visiting
- Prepare children for what they will see - setting, equipment, other patients, physical condition of pt, functional status

During visit:
- Provide structure or activity for younger children
- Bring an extra supportive adult who can leave when the child is ready

After visit:
- Debrief after visit

Alternatives:
- Provide alternatives to a personal visit (e.g. making cards and drawings)
- Remember there are many opportunities to say goodbye (e.g. during funerals, during prayers)

Question 10

Is it appropriate for children to participate in funeral services?

How to involve children? What if they’re older/younger?

Answer 10

Yes children can participate

Prepare them for what to expect (setting, who will be there, what it will look like, what they will do, etc)

Older children may want to be involved (placing item on coffin, playing music, reading)

Younger children will need adult to accompany them and leave early if needed