1. The Dying Child
Chapter 9

2. Caring for a Family Facing the Death of Their Child
Offer sensitive, gentle physical care and comfort measures for the child
Provide continuing emotional support for the child, the family caregivers, and the siblings
Understand own feelings about death and dying
Know the grieving process that terminally ill patients and their families experience
Possess willingness to become involved

3. Team Members Involved in Caring for the Dying
Nurse (usually coordinates the care)
Physician
Chaplain
Social worker
Psychiatrist
Hospice nurse
Thanatologist (a person [sometimes a nurse] trained especially to work with the dying and their families)

4. Factors That Influence a Child's Understanding of Death
Stage of development
Cognitive ability
Prior experiences with death

5. Infant and Toddler Perceptions of Death
Have little if any understanding of death
May fear separation from beloved caregivers
Have no recognition of the fact that death is nearing and irreversible

6. Care Measures for the Dying Infant/Toddler
Answer questions simply and honestly
Encourage family caregivers to stay with the child to provide comfort, love, and security
Maintain routines as much as possible to give the toddler a greater sense of security

7. Preschoolers’ Perception of Death
They may believe they caused a person or pet to die by thinking angry thoughts (egocentric thinking)
Magical thinking plays an important part in their beliefs about death
Many view death as a kind of sleep
They may view personal illness as punishment for thoughts or actions

8. School-Age Children’s Perception of Death
6 or 7 years old
Still view death in the magical thinking stage of the preschool child
8 or 9 years old
Children gain the concept that death is universal and irreversible
Death is personified and may be called the devil, God, a monster, or the bogeyman
Often they view death as another new experience

9. Adolescent’s Perception of Death
The adolescent has an adult understanding of death but feels immortal
The adolescent facing death may express helplessness, anger, fear of pain, hopelessness, and depression
The adolescent may be upset by the results of treatments that cause weakness and altered appearances

10. Children’s Awareness of Impending Death
Children know they are dying
They sense and fear what is going to happen, even if they cannot identify it by name
Their play activities, artwork, dreams, and symbolic language demonstrate this knowledge
Involvement of the health care staff is important
They may dispel misunderstandings by giving honest, specific answers
They may help the child and the family resolve any problems or unfinished business

11. Types of Death Caregivers Grieve
Terminal illness
The family faces decisions about the child’s physical care, as well as learning to live with a dying child
The family is encouraged to talk to their child about dying
Sudden or unexpected death
The family has not had the opportunity to go through anticipatory grief
The family may have excessive guilt and remorse for something they felt they left unsaid or undone

12. Decisions Caregivers Face When a Child Dies Unexpectedly
Organ donation
Funeral arrangements
Autopsy

13. Nursing Care for the Dying Child
Reassuring the child that he or she will not be alone at the time of death
Reminding family members not to say anything around the unconscious child that would not be said if the child were fully conscious
Using gentle touching and caressing to provide comfort
Giving medications for pain intravenously
Keeping mucous membranes clean

14. Nursing Care for the Dying Child (cont.)
Applying petroleum jelly to the lips to prevent drying and cracking
Moistening the conjunctiva of the eyes with normal saline eye drops
Keeping the skin clean and dry
Turning and positioning regularly to prevent skin breakdown
Talking to the child and explaining everything that is being done

15. Settings for Care of the Dying Child
Hospice care
Home care
Hospital care

16. Factors Contributing to the Decision to Care for a Child at Home
Concerns about costs for hospitalization and nonmedical expenses
Family’s travel, housing, and food
Stress from repeated family separations
Loss of control over the care of the child and family life

17. Assessments of the Dying Child
The child’s developmental level
The influence of cultural and spiritual concerns
The family’s support system
Present indications of grieving (e.g., anticipatory grief)
Interactions among family members
Unfinished business

18. Goals for the Dying Child and the Family
Goals for the child
Minimizing pain
Diminishing feelings of abandonment by peers and friends
Relieving anxiety about the future
Goals for the family
Helping cope with the impending death
Identifying feelings of powerlessness

19. Nursing Measures to Relieve Pain
Positioning
Using pillows as needed
Changing linens
Providing conscientious skin and mouth care
Protecting skin surfaces from rubbing together
Offering back rubs and massages
Administering antiemetics, analgesics, and stool softeners as appropriate