Abstract
The physician treating the child who is suffering from a potentially lethal illness must deal not only with the disease itself but also with the emotional reactions of the child and his family to the illness. Research indicates that families with a dying child constitute a high-risk group. The severe stress precipitated by a fatal illness may generate a broad variety of problems, ranging from jealousies and unresolved grief reactions in siblings to separation, divorce, or mental illness in parents.4, 5, 9, 17
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Recommended For Further Reading
ANTHONY, E. J., and KOUPERNIK, C., eds. The Child in His Family. Vol. 2: The Impact of Death and Disease. New York, Wiley and Sons, 1973. —a highly recommended collection of papers dealing with problems and reactions of children and parents to disease, death, and mourning.
BARTON, D. “Teaching Psychiatry in the Context of Death and Dying”. Amer. J. Psychiat. 130: 1290–91, 1973. —discusses the interpersonal and socio-cultural dimensions of death as well as ethical considerations and individual responses.
BERNSTEIN, D. M. “After Transplantation—The Child’s Emotional Reactions”. Amer. J. Psychiat. 127: 1189–93, 1970–71. —in this study it was found that anxiety about fear of death was often aroused whether or not there were signs of kidney rejection. Urges the psychiatrist, surgeon, and nephrologist to be alert and compassionate in dealing with the emotional problems which often arise in child transplant patients.
BINGER, C. M.; ALBIN, A. R.; FEVERSTEIN, R. C.; KUSHNER, J. H.; ZOGER, S.; and MIKKELSEN, C. “Childhood Leukemia—Emotional Impact on Patient and Family”. New Eng. J. Med. 280: 414–18, 1969. —good for the medical reader.
BOZEMAN, M. F.; ORBACH, C. E.; and SUTHERLAND, A. M. “Psychological Impact of Cancer and Its Treatment (III); The Adaption of Mothers to the Threatened Loss of their Children through Leukemia (II)”. Cancer. 8: 1–33, 1955. —describes parental reactions to diagnosis of acute leukemia in their young children, including shock, denial, anxiety, guilt, depression. Hostility to doctors and inability to comprehend information given are common reactions to the crisis precipitated by the illness and the ability of the physician to establish and maintain a supportive relationship with the parents may be crucial. An excellent discussion of the difficulties faced by hospital staff.
EASSON, W. M. “Care of the Young Patient Who Is Dying”. J. Amer. Med. Assoc. 205: 203–7, 1968. —reactions vary with age; clinical management must reflect this.
FEIFEL, M., and HANSON, S. “Physicians Consider Death”. Proceedings of Seventh Annual Convention, American Psychological Association, 201, 1967. —physicians frequently have particular problems with death.
FEIFEL, M. “Death”, in Farberow, M. L., ed., Taboo Topics, pp. 8–21. New York, Atherton Press, 1963. —it’s time death was no longer taboo!
FRIEDMAN, S. B. “Care of the Family of the Child with Cancer”. Pediat. 40: 498–507, 1967.
HOROWITZ, L. “Treatment of the Family with a Dying Member”. Fam. Proc. 14: 95–106, 1975. —focuses on the uses of transference and counter-transference in the treatment of families with a dying member.
KAPLAN, D. M.; SMITH, A.; GROBSTEIN, R.; and FISCHMAN, S. E. “Family Mediation of Stress”. Soc. Work. 18: 60–69, July 1973. —deals with the impact of stress on the whole family.
KLIMAN, G. Psychological Emergencies of Childhood. New York, Grune and Stratton, 1968. —excellent little book emphasizing the need to move towards an approach that can prevent the development of psychological emergencies.
KOOCHER, G. P. “Talking with Children about Death”. Amer. J. Orthopsychiat. 44: 404–11, 1974. —after describing responses of seventy-five children, ages six to fifteen, to questions about death, offers suggestions for discussing death with a child who has suffered a loss.
KUBLER-ROSS, E. On Death and Dying. Toronto, Collier-Macmillan, 1967. —classic book—should be read by all medical and nursing students, and all who deal with seriously ill children and their families.
LANSKY, S. B. “Childhood Leukemia: The Child Psychiatrist as a Member of the Oncology Team”. J. Amer. Acad. Child Psychiat. 13: 499–508, 1974. —preliminary report of an ongoing study of the leukemic child and his family. Discusses the impact of prolonged anticipation of death on child and family recommending that a child psychiatrist be part of the treatment plan.
LURIE, M. J., and GALLAGHER, J. M. “Innovative Techniques for Teaching Psychiatric Principles to General Practitioners”. J. Amer. Med. Assoc. 221: 696–99, 1972. —illustrates the need to remain “involved” to learn, although learning may be painful.
MARSTEIN, B. “The Effects of Long-Term Illness of Children on the Emotional Adjustment of Parents”. Child Devel. 31: 151–71, 1960. —emphasizes that disease produces “other” diseases.
PAKES, E. H. “Child Psychiatry and Pediatric Practice; How Disciplines Work Together”. Ont. Med. Rev. 41: 69–71, Feb. 1974. —deals with the important bridge between child psychiatry and paediatrics. The new physician should bridge that gap!
SCHOWALTER, J. E.; FERHOLT, J. B.; and MANN, N. M. “The Adolescent Patient’s Decision to Die”. Pediat. 51: 97–103, 1973. —compassionate definitive discussion of the problems faced by the medical team caring for an adolescent patient who chooses to die.
SOLNIT, A. J., and GREEN, M. “Psychologic Considerations in the Management of Deaths on Pediatric Hospital Services: The Doctor and the Child’s Family”. Pediat. 24: 106–12, 1959. —sound advice regarding the management of the family of the child who dies.
TOOLEY, K. “The Choice of a Surviving Sibling as ‘Scapegoat’ in Some Cases of Maternal Bereavement—A Case Report”. J. Child Psychol. Psychiat. 16: 331–39, 1975. —describes a pathological variation of the mourning process in mothers who suffer the psychologically damaging loss of a child whereby a surviving sibling is chosen as a scapegoat for their guilt and self-hatred. Suggests that counselling at the time of bereavement would help prevent this scapegoating. Interesting case report and analysis.
Additional Reading
RICHMOND, J. B., and WAISMAN, H. A. “Psychologic Aspects of Management of Children with Malignant Diseases”. Amer. J. Dis. Child. 89: 42–47, 1955.
ROTHENBERG, M. B. “Reactions of Those Who Treat Children with Cancer”. Pediat. 40: 507–10, 1967.
SCHOWALTER, J. E. “Death and the Pediatric House Officer”. J. Pediat. 76, 5: 706–10, 1970.
WEINER, J. M. “Attitudes of Pediatricians Toward the Care of Fatally III Children”. J. Pediat. 76: 700–705, 1970.
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© 1977 Macmillan Publishers Limited
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Pakes, E. (1977). The Dying Child and His Family. In: Steinhauer, P.D., Rae-Grant, Q. (eds) Psychological Problems of the Child and His Family. Palgrave, London. https://doi.org/10.1007/978-1-349-81464-0_18
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DOI: https://doi.org/10.1007/978-1-349-81464-0_18
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