1. Concrete tools for Healthcare Professionals who provide pre-bereavement support for families with children
Heather J Neal
BRIDGES: A Center for Grieving Children
Mary Bridge Children’s Hospital and Health
Center
February 20, 2015

2. Early Loss Reflection
Think of an early loss experience in your own life. It may not have been a death.
Can you remember feelings associated with the loss? What were some of these feelings?
Was there someone or something that helped you feel supported at the time of the loss?

3. Types of Incidents New Diagnosis of a serious illness
Impending death in a hospital
Choosing to go home to die
Sudden, traumatic events
Removal of life support
Other

4. General Factors Children grieve as part of a family Children re-grieve
Children are often repetitive in their grief
Young children are concrete thinkers
Children may focus on causation
Children may also focus on contagion

5. Tasks of Grief William Worden
To accept the reality of the loss
To work through the pain of grief
To adjust to an environment in which the deceased is missing
To find an enduring connection with the deceased in the midst of embarking on a new life

6. The Six Reconciliation Needs of Mourning Children Alan D. Wolfelt, PhD
Acknowledge the reality of the death.
Move toward the pain of the loss while being nurtured physically, emotionally, and spiritually.
Convert the relationship with the person who has died from one of presence to one of memory.
Develop a new self-identity based on a life without the person who died.
Relate the experience of the death to a context of meaning.
Experience a continued supportive adult presence in future years.

7. Recommendations for Supporting Children
Process the circumstances or event within the context of his/her developmental ability.
Understand the concept of “death” and “grief”
Understand feelings and behaviors associated with normal grief responses
Identify and practice healthy ways of coping
Honoring the relationship and establishing continuing bonds
Identifying and accessing support systems

8. Children’s Needs Ages 2 – 4
Comfort; Reassurance that they will be cared for
and that their basic needs will be met
Honest information
A regular schedule
Ages 4 – 7
Clear, honest answers with words they use and understand.
Ages 7 – 11
Encourage expression of feelings
Offer physical outlets for grief expression
Be available, but also allow alone time
Ages 12 – 18
Listen
Be available
Don’t try to take away their grief

9. Assessment Considerations
What is the patient’s comfort level with the child knowing details about the disease, prognosis, etc.?
What is the culture in the family regarding illness, speaking openly, sharing difficult things with children?
What is the child’s history with death - other family members, friends & pets?
What are the family and child’s coping responses related to illness, death?

10. Assessment Considerations
What has the child been told about the disease?
If the patient is not living in the same home as the child, when was the last time the child saw the family member?
What does the child know about the disease?
Has the child attended conferences with the doctor?
Has the child accompanied the patient to chemo or radiation treatments?
Has the child visited the patient in the hospital?
Has the child assisted with any care giving?

11. When the family doesn’t want to share with their children…
Always consider the culture of the family, including ethnic and spiritual beliefs and practices.
Educate that the child may overhear conversations and imagine things that are worse than the truth.
Children may also be picking up on the emotional atmosphere in the home and the changes in lifestyle that have occurred as the family has adjusted to the illness.

12. Frequently Asked Questions
Protecting children from painful realities
Age consideration: “Is my child too young to understand?”
How to initiate conversations about difficult topics such as terminal prognosis, impending death, or a death which has occurred.

13. Visiting the hospital and saying goodbye
Children should be given choices which include:
Assurance that there is no right or wrong choice
Information about what to expect, using concrete medical language
Information about life expectancy
Information about other opportunities to see their loved one’s physical body

14. Primary Components of Communicating Medical Information to Children
Inform the child
Allow some choice and control
Tell the truth using correct medical language.
Answer questions the child has.
Reassure the child that their needs will continue to be met.
Causation and contagion.

15. Additional Questions
& Discussion