How do you handle impending death of a child

allnurses Guide · Apr 8, 2014

I am a mother who has been through this. I can tell you that as the nurse the most important thing you can do is to be there. Answer their questions. Present them with options. Let them do as much as they can for their child. Help them get to hold the child. Be present. Remember it is just as sacred to witness a death as it is a birth and honor that process. Always keep in mind it isn't about you, no matter how sad it makes you. A few quiet tears are welcome. Falling apart, loud sobbing, being judgmental are not.

KelRN215, BSN, RN · Apr 8, 2014

Do you mean how do you handle it at work with the family or how do you handle it yourself?

A lot of people say you don't but, honestly, I feel like I've gotten used to it. Many of my patients have poor prognoses and from the moment I meet them, I know what their outcome may be. One of my former patients (who I followed VERY closely for over a year- like at her house several days a week, sometimes every day) died yesterday. She had been in the hospital for over 2 months and was suffering. I do not feel sad about her death. She had no quality of life anymore and is now free of her cancer. This is the 3rd child I've worked closely with who died in the last month. It is a reality in my line of work.

With the family, help them any way you can. Sometimes they want to talk, sometimes they don't. Sometimes they want to do the memory making activities that are undoubtedly available at the hospital- making hand/foot prints, saving hair, flashes of hope. Child Life Specialists will be invaluable if there are siblings involved. Social Work and Chaplain will probably be helpful for the parents. If there is a Palliative Care team around, they have a lot of expertise with this.

Also realize that a child with a terminal prognosis is not necessarily actively dying when you are caring for him. I do not know what this child has but many children with terminal prognoses live for a long time. Cystic fibrosis is terminal- it will eventually kill the patient- but that patient may live 40 or so years before it does.

Christy1019, ASN, RN · Apr 8, 2014

In the ED I'm not generally dealing with a loss of a terminal child too often, but a parent losing a child hurts just as much whether they're expecting it or not. From the experiences I DO have with child deaths, and any pt death for that matter, make sure that you assist the family to hold or touch the patient as often as they want and as is feasible. I've known parents to hold their deceased children for hours after their passing.

Sorry I couldn't offer you more information, just do what you can to be calm and supportive during this sad time for the family...

HouTx, BSN, MSN, EdD · Apr 8, 2014

Can't handle it. I have never been able to achieve a sufficient amount of emotional distance with kiddos.... dealing with unsuccessful pedi codes turned me into a basket case requiring days off to recover. That's why I stuck with adult care environments. We all have our kryptonite & that's mine.

sistrmoon, BSN, RN · Apr 8, 2014

This is why I don't work peds. I couldn't handle it. I work adult Onc and it's hard enough dealing with young adults dying. As a mother, I just couldn't. I'm glad there are nurses who can.

xoemmylouox, ASN, RN · Apr 11, 2014

I have dealt with a few patient's passing. It's very tough on me. I try to not get attached, but I have a soft spot for some of the kiddos. While it breaks my heart I have to hold it together for the families. If you know the patient/family well they understand if you have tears. The most important thing is to not rush them. Let them take their time with the child. Try to do hand/foot prints, save some hair, etc. The family may not think of this at the time, but will cherish it much later. Always ASK first and ensure you wash the ink off of the hands and feet.

kheadrick · May 7, 2014

Thank you so much for your perspective as a parent. I think we get caught up in our roles and it was so helpful to hear from your role and what the family needs.

kheadrick · May 7, 2014

THANK YOU! It is good remember that sometimes it is a better thing to be out of pain and that there things worse than death sometimes. Your insights are so helpful. I appreciate you taking the time to write back to my question!

anon456, BSN, RN · May 7, 2014

And just remember that nurses and social workers can really make a difference in making the family feel safe, cared for, and supported. This will greatly help in the grieving process and the memories of that child passing away that the family must live with and replay over and over again.

When a close family member died unexpectedly after a few days in ICU, I can recall with clarity how supported we felt, how they treated my family member with dignity and allowed us the time we needed to say goodbye. I remember how they took the time to clean up my family member and present him to the family with fresh linens and groomed hair. They asked permission about everything they did for him, made sure the pastor was available, and allowed a steady stream of friends/co-workers/family (2-3 at a time) to come and say their last goodbyes and support each other in the lobby while waiting their turn to say goodbye.

In the peds world we nurses will take a child (dying or not) who is severely disabled or disfigured and make sure they are made as cute as possible with arranging pillows and stuffed animals and blankets. It helps a parent and visitors to see the child as a loved human being, not as a broken child. The beanie babies and baby blankets really soften the scariness of all the tubes and monitors.