“ There is always rain around me.” Supporting Children with Seriously Ill Parents

“There is always rain around me.”

Supporting Children with Seriously Ill Parents

Kathleen Brown, NP and Thuy Pham, MD Santa Clara Valley Medical Center

Anna aged 7 when her dad died

Mrs. N’s Story

Does Tommy understand the concepts of death?

Losing a Parent by Age 15 in USA

Beginning of 20th Century Middle of 20th Century 1998

25%

10%

4%

Definitions

Grief

Mourning

Bereavement

Concepts of Death

Irreversibility Finality

Universality Causality

Factors to Consider…

Developmental level

Cognitive skills

Personality characteristics

Religious and spiritual beliefs

Teaching by parents/significant

others

Media input

Previous experience with death

Factors to Consider…

Developmental level

Cognitive skills

Personality characteristics

Religious and spiritual beliefs

Teaching by parents/significant

others

Media input

Previous experience with death

Infants to age 2 years

0-2yr: Predominant Concepts of Death

None

However…– May sense that something is wrong– Acutely aware of loss and separation– Perceive others emotions, especially significant adults– Sensitive to changes in the schedule

0-2yr: Interventions

• Provide maximal physical comfort– Familiar persons– Transitional objects (favorite toys)– Consistency

• Use simple physical communication

True/False: Young children do not grieve.

>2 to 6 years

>2-6yr: Predominant Concepts of Death

• Believes death is temporary and reversible (like sleep)

• Does not personalize death

• Believes death can be caused by thoughts

>2-6yr: Interventions

Minimize separation from parents

Correct perceptions of illness as punishment

Evaluate for sense of guilt

Use precise language (dying, dead)

True/False: Children need to understand and make sense of their experience in order to help them

learn that dying and death are part of life.

>6 to 12 years

>6-12yr: Predominant Concepts of Death

Adult concepts of death

Death can be

personal

>6-12yr: Interventions

Evaluate child’s fear of abandonment Be truthful Provide concrete

details if requestedMaintain access to

peers

Allow child to participate in

decision making

True/False: Adults know better whether or not to allow a child to participate in funerals or other post-

death rituals.

>12 to 18 years