A child’s death

As a general pediatrician, I am fortunate that most of my patients are thriving and healthy. Even those with chronic disease have the access to lifesaving medicines and treatments that offer most of them the opportunity for a long, full life. Perhaps in part because so many of my patients are healthy, and death is not something I must face on a regular basis, each time it happens I feel a bit lost and unprepared.

Very sadly, over the past several months, four of my patients have died – each under very different circumstances. While the sadness and loss I, and others on their medical team, felt each time we learned of an untimely death in no way comes close to what our patient’s families are experiencing, we are still affected. As a medical team, we also share a responsibility to families to extend our support through their grief – which may extend for many, many years, and we often may continue to provide medical care for siblings or other family members, whose grief may go unrecognized or forgotten.

Over the years, I have realized how important it is to recognize and confront my own feelings about a patient’s death in order to be able to support their family. I also have realized that it is equally important to provide an opportunity for the rest of the patient’s care team to grieve and debrief. Often the care team may look to the physician to start or provide the opportunity for this conversation. Many emotions may unearth themselves – from fear to grief to overwhelming sadness. Addressing these emotions in a safe environment helps to ensure that, as providers, we then are able to provide helpful support to families in mourning.

The American Academy of Pediatrics has published a very thoughtful and helpful clinical report, "Supporting the Family After the Death of a Child," which walks the provider through important issues and concerns (Pediatrics 2012;130:1164-9). The most powerful step providers can take, which is identified in this report and I fully agree with, is to call or personally visit the family. Attending the patient’s funeral or memorial service also can be meaningful and important, but a private, personal contact is invaluable to allow the family the opportunity to ask questions or express concerns they may not want to express publicly. This is not a time for us as providers to offer advice or justification, but merely to listen and grieve together.

That said, there are times when it becomes clear – for whatever reason – that a family doesn’t want to or isn’t ready to talk with someone from the medical care team. In those circumstances, I still think the mere act of trying to reach out and express your sadness and condolences is important. There have been times when families reached back out to me weeks or months later with questions or thoughts – an initial attempt at contact helps a family to know that you are available and willing to talk. One mother called me months after her child’s death – she had begun the process of cleaning out her daughter’s room and wasn’t sure how to dispose of her medications. A simple piece of information I was able to give her made an impossibly hard task a little easier, and was another touch point for us to talk about her daughter’s many strengths and how much we all missed her.

The AAP report also highlights some family support resources that are useful to know about and share with families. The loss of a child is indescribable, and many find comfort in sharing their feelings with others who have gone through a similar experience. Some resources highlighted in the report are The Compassionate Friends, a national self-help support organization for parents who have lost a child (www.compassionatefriends.org); SHARE, an organization that serves parents who have lost a child through pregnancy loss, stillbirth, or in the first few months of life (www.nationalshare.org); Bereaved Parents of the USA, providing support to bereaved caregivers and siblings (www.bereavedparentsusa.org) and Survivors of Suicide, for those who have lost a family member or loved one to suicide (www.survivorsofsuicide.com).

Through their own actions and the utilization of community resources, pediatric providers can be an important support for grieving families.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. To read more commentaries, visit pediatricnews.com/views/practical-parenting.html.

As a general pediatrician, I am fortunate that most of my patients are thriving and healthy. Even those with chronic disease have the access to lifesaving medicines and treatments that offer most of them the opportunity for a long, full life. Perhaps in part because so many of my patients are healthy, and death is not something I must face on a regular basis, each time it happens I feel a bit lost and unprepared.

Very sadly, over the past several months, four of my patients have died – each under very different circumstances. While the sadness and loss I, and others on their medical team, felt each time we learned of an untimely death in no way comes close to what our patient’s families are experiencing, we are still affected. As a medical team, we also share a responsibility to families to extend our support through their grief – which may extend for many, many years, and we often may continue to provide medical care for siblings or other family members, whose grief may go unrecognized or forgotten.

Over the years, I have realized how important it is to recognize and confront my own feelings about a patient’s death in order to be able to support their family. I also have realized that it is equally important to provide an opportunity for the rest of the patient’s care team to grieve and debrief. Often the care team may look to the physician to start or provide the opportunity for this conversation. Many emotions may unearth themselves – from fear to grief to overwhelming sadness. Addressing these emotions in a safe environment helps to ensure that, as providers, we then are able to provide helpful support to families in mourning.

The American Academy of Pediatrics has published a very thoughtful and helpful clinical report, "Supporting the Family After the Death of a Child," which walks the provider through important issues and concerns (Pediatrics 2012;130:1164-9). The most powerful step providers can take, which is identified in this report and I fully agree with, is to call or personally visit the family. Attending the patient’s funeral or memorial service also can be meaningful and important, but a private, personal contact is invaluable to allow the family the opportunity to ask questions or express concerns they may not want to express publicly. This is not a time for us as providers to offer advice or justification, but merely to listen and grieve together.

That said, there are times when it becomes clear – for whatever reason – that a family doesn’t want to or isn’t ready to talk with someone from the medical care team. In those circumstances, I still think the mere act of trying to reach out and express your sadness and condolences is important. There have been times when families reached back out to me weeks or months later with questions or thoughts – an initial attempt at contact helps a family to know that you are available and willing to talk. One mother called me months after her child’s death – she had begun the process of cleaning out her daughter’s room and wasn’t sure how to dispose of her medications. A simple piece of information I was able to give her made an impossibly hard task a little easier, and was another touch point for us to talk about her daughter’s many strengths and how much we all missed her.

The AAP report also highlights some family support resources that are useful to know about and share with families. The loss of a child is indescribable, and many find comfort in sharing their feelings with others who have gone through a similar experience. Some resources highlighted in the report are The Compassionate Friends, a national self-help support organization for parents who have lost a child (www.compassionatefriends.org); SHARE, an organization that serves parents who have lost a child through pregnancy loss, stillbirth, or in the first few months of life (www.nationalshare.org); Bereaved Parents of the USA, providing support to bereaved caregivers and siblings (www.bereavedparentsusa.org) and Survivors of Suicide, for those who have lost a family member or loved one to suicide (www.survivorsofsuicide.com).

Through their own actions and the utilization of community resources, pediatric providers can be an important support for grieving families.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. To read more commentaries, visit pediatricnews.com/views/practical-parenting.html.

As a general pediatrician, I am fortunate that most of my patients are thriving and healthy. Even those with chronic disease have the access to lifesaving medicines and treatments that offer most of them the opportunity for a long, full life. Perhaps in part because so many of my patients are healthy, and death is not something I must face on a regular basis, each time it happens I feel a bit lost and unprepared.

Very sadly, over the past several months, four of my patients have died – each under very different circumstances. While the sadness and loss I, and others on their medical team, felt each time we learned of an untimely death in no way comes close to what our patient’s families are experiencing, we are still affected. As a medical team, we also share a responsibility to families to extend our support through their grief – which may extend for many, many years, and we often may continue to provide medical care for siblings or other family members, whose grief may go unrecognized or forgotten.

Over the years, I have realized how important it is to recognize and confront my own feelings about a patient’s death in order to be able to support their family. I also have realized that it is equally important to provide an opportunity for the rest of the patient’s care team to grieve and debrief. Often the care team may look to the physician to start or provide the opportunity for this conversation. Many emotions may unearth themselves – from fear to grief to overwhelming sadness. Addressing these emotions in a safe environment helps to ensure that, as providers, we then are able to provide helpful support to families in mourning.

The American Academy of Pediatrics has published a very thoughtful and helpful clinical report, "Supporting the Family After the Death of a Child," which walks the provider through important issues and concerns (Pediatrics 2012;130:1164-9). The most powerful step providers can take, which is identified in this report and I fully agree with, is to call or personally visit the family. Attending the patient’s funeral or memorial service also can be meaningful and important, but a private, personal contact is invaluable to allow the family the opportunity to ask questions or express concerns they may not want to express publicly. This is not a time for us as providers to offer advice or justification, but merely to listen and grieve together.

That said, there are times when it becomes clear – for whatever reason – that a family doesn’t want to or isn’t ready to talk with someone from the medical care team. In those circumstances, I still think the mere act of trying to reach out and express your sadness and condolences is important. There have been times when families reached back out to me weeks or months later with questions or thoughts – an initial attempt at contact helps a family to know that you are available and willing to talk. One mother called me months after her child’s death – she had begun the process of cleaning out her daughter’s room and wasn’t sure how to dispose of her medications. A simple piece of information I was able to give her made an impossibly hard task a little easier, and was another touch point for us to talk about her daughter’s many strengths and how much we all missed her.

The AAP report also highlights some family support resources that are useful to know about and share with families. The loss of a child is indescribable, and many find comfort in sharing their feelings with others who have gone through a similar experience. Some resources highlighted in the report are The Compassionate Friends, a national self-help support organization for parents who have lost a child (www.compassionatefriends.org); SHARE, an organization that serves parents who have lost a child through pregnancy loss, stillbirth, or in the first few months of life (www.nationalshare.org); Bereaved Parents of the USA, providing support to bereaved caregivers and siblings (www.bereavedparentsusa.org) and Survivors of Suicide, for those who have lost a family member or loved one to suicide (www.survivorsofsuicide.com).

Through their own actions and the utilization of community resources, pediatric providers can be an important support for grieving families.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at [email protected]. To read more commentaries, visit pediatricnews.com/views/practical-parenting.html.