Books


Answering Children's Concerns about Illness and Dying

Introduction

Children require special consideration when they reside in a household with a seriously ill family member. In the past, children were often sheltered from the truth about the seriousness of a close relative's illness by parents and professionals. Siegel et al. (1992) emphasize that children are sensitive to changes in family dynamics and may experience distress associated with loss and separation related to hospitalizations, decreases in parental availability, changes if family emotional climate, changes in family routines, decreased financial resources.

Clinical observations indicate that children experience greater stress during the terminal stage of cancer than after a parent's death from the disease (Christ, 1993). Professionals who feel comfortable talking about issues surrounding terminal illness may offer guidance to parents dealing with children who are experiencing great changes in response to serious illness within the household.

Children's questions and reactions related to serious illness or the loss of the loved one may seem insensitive, but these responses are usually consistent with a child's social, emotional, and cognitive development. Children's fantasies about death will decrease if information is presented at an appropriate cognitive level. Lies and distortions of truth should be avoided. In certain cultures, open expression of grief establishes a model for children that may be fostered within the family culture.

Assessment

  • Decreased participation in social activities
  • Poor school performance
  • Increased irritability
  • Increased acting out
  • Increased clinging behavior

Intervention

Alert parents about the common concerns of children (7 - 16 years of age). These concerns include:

  • Fears related to cancer symptoms and side effects of treatment
  • (Weight loss, vomiting, hair loss, weakness, etc.)
  • Fear of the parent's future death
  • Anxiety or panic related to uncertainty about rapid changes in parent's health
  • Guilt about the cause of the illness
  • Concern that the healthy parent may also be vulnerable to illness

Use Bourne and Meier's (1988) booklet designed for children (pre-school to 10 years old) that sensitively addresses the topic of advanced illness. Parents should be encouraged to read this with their children to facilitate an open discussion about existing and expected changes caused by advanced illness in a family member.

Nurses should encourage honest discussion of terminal illness among adults and children within the family setting.

Children need assurance that family integrity, the home, and love will continue despite the sadness related to illness and death.

Older family members should be encouraged to discuss their true feelings openly with the children if this is a cultural norm.

Families that follow a cultural or religious tradition should be encouraged to share with their children its values, beliefs, and rituals related to death.

References

Bourne V & Meier J: What is happening? A booklet to be read to young children experiencing the terminal illness of a loved one. Oncology Nursing Forum 1988; 15(4):489-493.

Siegel K, Mesagno FP, Karus D, Christ G, Banks K, Moynihan R: Psychosocial adjustment of children with a terminally ill parent. J Am Acad Child Adolesc Psychiatry 1992; 31(2):327-333.





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