THURSDAY, July 27, 2006 (HealthDay News) -- The death of a parent is one of the most stressful events a child can face.
But an honest word, a smile, and time spent together with a sick mom or dad can help kids get through, experts say.
With proper education and preparation, things can be done to mitigate the damage, conclude the authors of a review of the data on the issue.
The article provides an update on current approaches to helping children in three different age groups: ages 3 to 5, 6 to 8, and 9 to 11. In particular, the article stressed including the children in the dying process, as was appropriate for the age.
"This is certainly consistent with the hospice approach which sees that the patient is not simply the person with the terminal illness but the patient is the family," said the Reverend Paul A. Metzler, director of public education and community bereavement services for Hospice Care/Visiting Nurse Service of New York. "If there are school-age children at home, they need to be included, responded to, supported and provided age-appropriate information so that they too can emotionally prepare."
"The natural protective inclination is to scoot the kids away and what this article says is scoot them in wisely and judiciously," he continued. "Keep the kids in the circle. As hard as it is, it's better for them to be part of it."
The article appears in the July/August edition of CA: A Cancer Journal for Clinicians. The review was coauthored by Grace H. Christ, of Columbia University and Dr. Adolph E. Christ, of the State University of New York (SUNY) Health Sciences Center, both in New York City.
The article includes the voices of children who went through this wrenching experience. One child, upon hearing of his father's death, said, "I was surprised, but I knew it was going to happen because my mother kept me informed."
The experts note that children tend to be most anguished in the final days of their parent's life, rather than after the actual death.
That can be tough on children, because advances in medicine mean that a parent's "final days" can now stretch to weeks, months or longer. This reality introduces a whole new set of challenges for families facing bereavement.
Experts encourage "open communication" with children between the ages of 3 and 5, but stress that this doesn't mean full expression of intense grief in front of the child. One 3-year-old was fearful of going into her father's hospital room because her parents tended to cry together. So, a social worker helped structure the visits and also helped the parents control their emotions so the child could have more pleasurable visits.
Kids aged 6 to 8 were more likely to have "anticipatory anxiety" rather than the anticipatory grief more common to adolescents and adults. They sensed something was going to happen and worried that the family would not survive it. One 8-year-old boy with a terminally ill father worried that his grandparents and mother would also die and that "the whole word would end, and nothing would be there."
This age group also benefited from pre-planned hospital visits and described the importance of a final hug, squeeze of the arm and affirmation of love, perhaps even more than a final good-bye. One 7-year-old put herself to sleep for months with the memory of her mother squeezing her hands before she died.
After the parent's death, children in this age group tended to swing between regular activity and grief. "Kids grieve and approach anticipatory or post-death grieving very intermittently and allowing for that kind of 'I'm going to play with my friends' is really healthy, appropriate and to be expected," Metzler said. "Parents need to be flexible and relaxed about the fact that the child may one minute be crying and another wanting to turn on the television. That's necessary and fine. It's a break, a barrier, a safety zone for the kid."
Receiving information was also important, especially for kids aged 8 to 11, who have a need for "carefully sequenced" information about their parent's condition. Without adequate information, one 11-year-old boy felt that his father was mad at him. Once the situation was explained to him, he no longer believed this to be the case.
The importance of "incremental information" was brought home by the experience of children who lost parents in the 9/11 World Trade Center attacks. Because they had no warning, they were completely overwhelmed by the unexpectedness of the event.
The authors had several recommendations for helping children of all ages during a parent's terminal illness, including planning visits during long hospitalizations; viewing communication as a process with proper "dosing" of information, rather than a one-time event; and allowing children and adolescents to experience their grief intermittently.
"There are a lot of kids who lose mom or dad," Metzler said. "At one level, it's hell, but this also says that there's a lot of resilience and, therefore, given the right kind of mediation, we can really help children."
To learn more, head to the Dougy Center for Grieving Children and Families.