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Advice for doctors after the death of a child

January 23, 2013 6:51 am

Abraham Lincoln (in a letter to a girl whose father died in the civil war): “It is with deep grief that I learn of the death of your kind and brave father; and especially that it is affecting your young heart beyond what is common in such cases.  In this sad world of ours, sorrow comes to us all; and to the young it comes with bitter agony because it takes them unawares.  The older have learned ever to expect it.”

Fortunately in pediatric care, the death of a child is uncommon.  When it occurs, it can have a devastating effect on the family; a recent article provides a lot of useful advice for this situation (Pediatrics 2012; 130: 1164-69).

Key points:

• Most parents experience a profound sense of guilt when harm comes to their child even if through no fault of their own.  The duration and intensity vary considerably.
• Parents invest much of their hopes for the future in their children; this extends to fetuses and infants.
• Family events may reawaken grief.  In addition, many parents report that their greatest fear is that the child will be forgotten.
• Even in children with severe disabilities, the parents’ sense of loss is not usually diminished.
• Peer-support groups can be very helpful (see below).
• Complicated grief which occurs more often in the setting of previous psychiatric problems often require mental health support.  Previous parent-child troubled relationships may intensify grief as well.
• Certain types of death like suicide, homicide, or due to drugs/alcohol can contribute to more intense grief.
• Siblings are often considered ‘the forgotten mourners.’  Grieving parents may not be able to provide adequate support. Sibling issues include ‘survivor guilt’ (especially in the setting of intense sibling rivalry), overprotection, idealization/replacement child, and general issues of sibling grief.
• Most helpful for pediatricians: provide an opportunity to meet with family members to listen.  “The pediatrician might say, simply ‘I’m so sorry to hear about _____’s death.  What a terrible loss for you and your family.’ Recommends avoiding expressions like “he/she is better off now” which parents may perceive as diminishing the value of the child.

Resources recommended by article:

1. Compassionate Friends 877-969-0010 –self-help groups
2. http://www.nationalshare.org –newborn death or stillbirth support
3. http://www.bereavedparentsusa.org –support for bereaved family members
4. http://www.survivorsofsuicide.com –support for those who have lost loved ones to suicide

Additional resources/references:

• Useful Books recommended by previous article (Pediatrics 2000; 105: 445):

“The Fall of Freddie the Leaf” Leo Buscaglia
“When dinosaurs die: a guide to understanding death” Laurie Brown
“Caring for your grieving child” Martha Wakenshaw

• NEJM 2001; 344: 1162. Suggestions for Writing a Condolence Letter:

There are ways to make the difficult task of writing a condolence letter easier. The letter may describe in detail the extent and depth of the relationship between the physician and the patient, or it may be a much shorter expression of sympathy. Whatever one writes, it is important to avoid superficial attempts to assuage grief, such as, “It was meant to be” or “I know how you feel.” In order to avoid issues of legal liability, the letter should focus on the sadness of death rather than revisit the clinical details of the illness..

One can begin the letter with a direct expression of sorrow about the death, such as “I am writing to send you my condolences on the death of your husband.” In our condolence letters, we try to include a personal memory of the patient and something about the patient’s family or work. Specific references to achievement at work, devotion to family, courage during the illness, or the patient’s character can bring life to the letter. We also state that it was a privilege to have participated in the patient’s care. We point out the comfort the patient received from the family’s love. We conclude the letter with a few words of support to let the family know our thoughts are with them. These suggestions are intended not as a substitute for the expression of genuine thoughts and feelings but as an aid in approaching the task.

• One of my favorite movies deals with these issues: Ordinary People – Wikipedia, the free encyclopedia
• Chest 2007; 131: 1245-1246. Nice editorial
• For doctors who have had an unexpected patient outcome, I would recommend reading, “Complications” by Atul Gawande.  Complications: A Surgeon’s Notes on an Imperfect Science: Atul …

Posted by gutsandgrowth

Categories: Pediatrics

Tags: child death, condolence letter, grief

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2 Responses to “Advice for doctors after the death of a child”

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   By Tell me about your mother | gutsandgrowth on August 11, 2013 at 9:03 am

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   By Heartfelt Apologies | gutsandgrowth on March 3, 2017 at 7:02 am

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