1. “There is always rain around me.” Supporting Children with Seriously Ill Parents Kathleen Brown, NP and Thuy Pham, MD Santa Clara Valley Medical Center

2. Anna aged 7 when her dad died

3. Mrs. N’s Story

4. Does Tommy understand the concepts of death?

5. Losing a Parent by Age 15 in USA

6. Definitions GriefMourningBereavement

7. Concepts of Death IrreversibilityFinality UniversalityCausality

9. Factors to Consider… Developmental level Cognitive skills Personality characteristics Religious and spiritual beliefs Teaching by parents/significant others Media input Previous experience with death

10. Factors to Consider… Developmental level Cognitive skills Personality characteristics Religious and spiritual beliefs Teaching by parents/significant others Media input Previous experience with death

11. Infants to age 2 years

12. 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

13. 0-2yr: Interventions Provide maximal physical comfort – Familiar persons – Transitional objects (favorite toys) – Consistency Use simple physical communication

14. True/False : Young children do not grieve.

15. >2 to 6 years

16. >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

17. >2-6yr: Interventions Minimize separation from parentsCorrect perceptions of illness as punishmentEvaluate for sense of guiltUse precise language (dying, dead)

18. 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.

20. >6 to 12 years

21. >6-12yr: Predominant Concepts of Death Adult concepts of death Death can be personal Interested in physiology and details of death

22. >6-12yr: Interventions Evaluate child’s fear of abandonment Be truthful Provide concrete details if requested Maintain access to peers Allow child to participate in decision making

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

24. >12 to 18 years