Chapter 3 Index

A. Ethics:

B.

The Pediatrician’s Role in a Child’s Death

Always remember the definition of being a doctor: to cure sometimes, to help often, to comfort, and console always.

I. Historical Perspective:

Before antibiotics, admission to the hospital was a death sentence.  Now faced with tools and the power to cure, doctors do not think in this way, and look as the death of their patients as a personal failure. As a result, doctors often think that there is nothing they could or even should do once the patient has died.

In fact, surviving family members often expect physicians to communicate with them, and are surprised when that does not happen.  Doctors often assume that there is nothing they can do ----- they are wrong.  We have a responsibility to aid individuals through their lives, crises and deaths - even if that means to just stand in silent support.

Example of how one family suffered a death of a baby, and had no communication with the doctors after that death.  The father wrote a letter to the editor of JAMA entitled: Death of a baby - neither forgiven nor forgotten (JAMA 268:1414;1992)

This man’s baby was an unanticipated breech baby with no Ultrasound or C-section scheduled. The baby prolapsed his cord, became brain dead and died at five days of age. The involved doctors did not call and talk to the family; in fact they did not return phone calls by the parents.  There were no letters of condolence, nothing. They did not consider it to be their problem to communicate with the family. As pediatricians we have duties that we need to be aware of so that this kind of thing does not happen with us.

II. What We as Pediatricians Need to Know About Counseling Families After a Death:

1. Most parents will want the pediatrician involved; appointments should be made in the office for sessions after hours without a chance of interruption.

2. Most parents will appreciate a letter of condolence, and the pediatrician attending the funeral.

3. Children have different manifestations of grief at different ages: (Pediatrics 89:516-518;1992) and need to be evaluated accordingly.

a. < 3 years: regression, sadness, fearfulness, anorexia, FTT, sleep disturbance, withdrawal
b. preschool: increased activity, enuresis, encopresis, anger, out of control, crying, and nightmares
c. school age children: poor school performance, crying, lying, stealing, nervousness, fatigue
d. adolescents: depression, somatic complaints, delinquent, promiscuity, drop out of school.

4. For children that die of SIDS, there are four major things that the pediatrician should consider doing: (Pediatric Annals: 24:373-378; July 1995): see next page:

Four things a pediatrician might considering doing at the time of a child’s death:

1. At the time of death

• express condolences to the family
• encourage parents to see and hold infant
• explain need for autopsy since a sudden unexpected death
• if think SIDS reassure that they could not have prevented

2. Early support following the death

• refer family to local SIDS program
• attend viewing and/or funeral and send a card
• listen empathetically
• discuss sibling reactions arrange appointment to discuss autopsy

3. Review autopsy

• meet with both parents to discuss results
• have literature and information available
• discuss grief response

4. Long-term family support

• send card or call around anniversary of birth and death
• be available to families as needed

Summary of Pediatrician’s Role in a Child’s Death:

1. Recognize that although you, the physician, have feelings of concern over a missed diagnosis, or feelings of inadequacy, this is not about you. Families want and need your help.
2. Surviving sibs: most often what you are consulted about: must know the different stages of grieving that occur
3. Parents: Try to reassure about their feelings of guilt: eg lying prone and SIDs; make sure that you have good follow-up and keep offering appointments.  At the very least, have one appointment to go over autopsy findings, feelings, etc.

Pediatrician’s Role in a Parent’s Death: Depending on how well the pediatrician knew the parent and family, involvement can be quite helpful.  Resources that could recommend:

A. For Parents:

• EA Grollman: Explaining Death to Children. Boston, Beacon Press. 1967
• M. Harris: The Loss that is Forever New York, Dutton Books, Penguin Publishing 1995
• E. Kubler-Ross. On Children and Death. New York, Collier Books Macmillan Publ. 1983
• A. Wolfelt: Helping Children Cope with Grief. Muncie IN, Accelerated Development Inc 1983

B. For Children:

• J. Krementz: How it Feels When a Parent Dies.  New York, Knopf Publishing Co. 1981
• E. LeShan: Learning to Say Good-bye when a Parent Dies.  New York, Macmillan Publ 1975
• E. Rofes: The Kids’ Book about Death and Dying. Boston, Little, Brown and Company 1985.

Next Page

© Medical College of Georgia
All rights reserved.

Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004