Watch the video of Joel and his parents. First address the issue of a dying child:? What steps can parents of a terminally ill child take to prepare themselves for the death of their child? W

Module 3 Death & Dying Death in Childhood

Adult Assumptions About Children and Death • Children are seldom given the opportunity in

family discussions to talk about death-related topics

• Adults often have their own fears, doubts, and conflicts, which often get communicated to their children

• Freud thought that parents wanted to believe that their children live in a fairy-tale world safe from the reality of death

Lessons from the Research Case Histories • It is the death of particular people or animals that

enlists the child’s concern • Death-related experiences, attitudes and

behaviors are part of the intimate flow of life between children and their parents

• There may be several different orientations

toward death within the same household

Lessons from the Research Case Histories • Parents whose own discomfort interferes with

their responses to their children’s death-related curiosity are likely to perpetuate these anxieties for another generation

• There is now a transitional generation of parents

who are trying to communicate in an open manner with their children, although their own experience was of family silence about death

Stages of Death Comprehension in Childhood (Nagy) • Research conducted in 1948/1969, involving

378 children, ages 3 to 10 • Stage 1, ages 3 to 5, Focus on Absence

• Very curious about death and death-related items, like coffins, the cemetery, and also the funeral

• Death is a continuation of life but in a diminished form (such as diminished sight or hearing)

• Death is temporary • Death is departure and separation • Death aroused anxiety

Stages of Death Comprehension in Childhood (Nagy) • Stage 2, ages 5 to 9, Focus on Finality

• Death is represented as a person • Death is dangerous, invisible, like a skeleton, and

comes out in the dark • Death has mysterious power • Belief that death might still be eluded (for example,

you might get killed crossing the street, but not if you look both ways and be careful about crossing the street)

• Death is not recognized as universal and personal

Stages of Death Comprehension in Childhood (Nagy) • Stage 3, beginning about age 9, Focus on

Personal, Universal, and Inevitable • Realizes that death is final • Realizes that death will come to him or her as well • Discussion of death has a more adult quality • May add a moral, poetic, or religious dimension

Additional Research Findings • Children with superior intellectual and verbal ability

demonstrated more advanced death concepts than others their same age

• No difference in death concepts based on SES

• Gender: boys are more likely to depict violent deaths

than girls

• Younger children seem to focus on separation anxiety

• Older children see death as scary and begin to use symbols to represent death concepts

Cultural Influences on Children’s Concepts of Death • U.S. children depict violent causes of death;

Swedish children depicted chapels, cemeteries, tombstones, caskets, etc.

• Muslim children seem to grasp the universality and inevitability of death at an earlier age.

• Muslim children valued praying for the dead • Cultural influences also include:

• Historical events, like the Columbine shootings • Scenes depicted in media and digital games

Death in the Family: Effects on the Children • Parents’ attention and energy are focused

elsewhere (away from the needs of the surviving children)

• Bereaved children may express their distress in ways that seem disconnected from the loss • Problems in school • Displaying anger with family or playmates • Fear of the dark or of being alone • No obvious signs of sorrow (be brave, no crying)

• Often express memories through activities shared with the parent who died

Death in the Family: Children’s Responses • Focus on a few strong images, scenes or activities • May begin criticizing the deceased (out of anger) • Children whose father died: (based on research)

• Tend to be more submissive, dependent, introverted • Higher frequency of maladjustment, emotional

disturbance, suicidality, delinquent, and criminal behavior • Perform less adequately in school and on cognitive tests • Experience more physical symptoms • Become concerned that the family will fall apart

Post-traumatic Stress Disorder (PTSD) • An officially recognized diagnosis since 1980 • Children with PTSD may have:

• Difficulty paying attention and concentrating • Difficulty in making and keeping friends • A tendency to be frightened • Recurring anxious dreams • A need to express the trauma through play

• Particularly Internet Explorer noted following the terrorist attacks of 9-11-01

Helping Children Cope with Bereavement • Develop and maintain an open communication

pattern with children • Give children the opportunity to decide about

attending the funeral • Check out what the child is thinking and feeling –

do not assume that we know what death means to him or her

Helping Children Cope with Bereavement • Encourage the expression of feelings • Provide convincing assurance that there will

always be somebody to love and look after the child

• Professional counseling should be considered if the bereaved children are at special risk

• Select an age-appropriate book or two that speaks to a child’s sense of loss after a death

The Dying Child: Stages in the Acquisition of Information • I have a serious illness. • I know what drugs I am receiving and what they are

supposed to do. • I know the relationship between my symptoms and the

kind of treatment I am getting. • I realize now that I am going through a cycle of feeling

worse, getting better, then getting worse again. The medicines don’t work all the time.

• I know that this won’t go on forever. There’s an end to the remissions and the relapses. When the drugs stop working, I will die pretty soon.

Care of the Dying Child • Hospice has extended to caring for children • Attention to the following needs can enhance the care of

a dying child: • The opportunity to express their concerns through

conversation, play, drawing, or writing • Confirmation that they are still a normal and valuable

people • Assurance that family members and other important

people will not abandon the children • Reassurance that they will not be forgotten

Problems Observed in the Siblings of Dying Children • Confusion about the role they are supposed to play in

the family • Feeling deceived or rejected by parents • Uncertainty about the future • Changes in the relationships among siblings • Feelings of guilt and ambivalence • Frustrated in not being able to express their feelings and

fears to their parents who are so preoccupied with the feelings of the dying child and their own feelings

Guidelines for Sharing A Child’s Death Concerns • Be a good observer of your child’s behavior • Do not wait or plan for “one big tell-all” • Do not expect all of the child’s responses to be obvious

and immediate • Help the child remain secure as part of the family • Use simple and direct language • Be accessible • Be aware of all the children in the family • Keep the relationship going