“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

Interested in physiology

and details

of death

>6-12yr: Interventions

Evaluate child’s fear of

abandonmentBe 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