Pediatrics
What should our health care team keep in mind as we support a Dad with three young children under the age of 10 years whose wife recently died from breast cancer?

Every family has their way of addressing stressful situations and how information is communicated. This family functioning will now change, with the death of their mother and wife Your health care team will need to keep in mind that each family and family member will deal with illness and grief in their own unique way. Being sensitive to these changes and the challenges of determining how the family will function without one of the parents is the first step in trying to help this whole family cope with their grief and loss.

It is also important to consider the specific ages of these children and their developmental level, which will impact their understanding about death and grief. Children from ages 0-2 years will have a limited understanding of the world around them, have limited language skills and also experience the world in a very physical way. They will sense that something is different in terms of their schedule, routine and the emotions of those around them. As the adults surrounding them are grieving, they will require their routine and simple explanations about what is happening around them. If it is possible to have familiar caregivers and family to assist in caregiving, this will provide the comfort and consistency.

Children who are about 3-6 years of age have a limited understanding of the finality and permanence of death. They continue to have an incomplete understanding of how the body functions and the concept of illness. At this age, children require simple explanations about what is happening and the opportunity to ask questions. They may have misconceptions about what has occurred and therefore it is important to be direct and willing to answer the questions they have. Explaining the expected emotions of those around them helps them to understand that grief involves sadness and continues to happen over a period of time. At this age children process grief while they continue to take part in childhood activities, such as play.

Children from 6-10 years of age are beginning to understand the concept of illness, death and grief and also the permanence of death. They are becoming aware how illness impacts the body. However, their imaginations can be quite active and therefore their understanding of what is occurring may not be grounded in reality. The new emotions and feelings that they experience can be overwhelming and frightening. Maintaining open communication and being available to clarify any questions is important. At this age kids are curious about the physical changes and how a body is cared for after death. Children may also have questions about the spiritual aspect of death and grief.

As the children in this family grieve, it is vital to provide an avenue where they feel safe to ask questions and express their emotions. This may be with their father, at school, or with a family member or friend. The father will set the tone about how open he is to discussing how he is grieving and how his children are doing. He may need guidance about resources to support them as a family. This could include books, a grief support group to attend as a family, or perhaps counseling services. It would be helpful to explore the various options and link this family to local resources that are available to them.

It is important for this father to remember that he is going to be dealing with his own grief, and well as helping each of his children with their grief. This can be emotionally exhausting in and of itself. However, there are many physical adjustments to daily life that will also be occurring. This father may need assistance in his home as he adjusts to working and caring for his children on his own. If family is not available to assist him, he may need to consider hiring help to assist him in caring for his children. Your health care team could recognize if assistance is required and provide information on how this type of assistance can be accessed.

If these children attend school or daycare, it would be important to notify the staff about the death of their mother and how the children are coping. Teachers might notice changes in behavior and the academic performance of these children, which would be an expected part of the grief experience. Resources to assist with their grief may also be available through the school system.

Children often worry about forgetting things about someone they love that has died. You may want to encourage this father to write down memories of his wife for his children. Another part of remembering her would be to continue traditions as a family or incorporate specific memories into their everyday life. In this way, his children will also feel comfortable talking about their mother, which will ultimately help them as they grieve.

References

Himelstein, B.P., Hilden, J.M., Morstadt Boldt, A., Weissman, D. Pediatric palliative care. NEJM. 2004; 350:1752-62.

Torbic, H. But what about the children? A guide for home care and hospice clinicians. Home Healthcare Nurse. 2011; 29(2):67-77.