Insights for Crisis Responders When a Child Dies

One of the most frequently presented dilemmas that those who deal with death must face is how to manage this harrowing experience.

Knowing what to say and do to help those in crisis takes empathy, understanding and a willingness to learn about grief. While most first responders roles during this crisis are frequently transitory, there may be an occasion where a particular child or circumstance affects you on a more personal level. Thus, perhaps as a paramedic, firefighter or crisis interventionist, you have the opportunity to work on a more intimate and ongoing basis with the family. For such situations, we haveĀ outlined some fundamental guidelines which can foster positive interaction and confidence for you as a support individual.

Rational behavior doesnā€™t come easyā€¦.

So donā€™t expect parents to be logical or objective when their child has died. Traumatic experiences make it difficult to think clearly. Instead, allow them to express their feelings by being a good listener, maintaining eye contact (when culturally appropriate), speaking slowly, gently, and precisely, and giving honest answers to their questions.

Letting go is tremendously painfulā€¦Ā 

In crisis situations, when logic and reasoning may be affected by the chaos and trauma, encourage parents to do what they do best- what is the most natural behavior. Allow parents to ā€œparentā€ their child. It is their greatest responsibility and most innate desire. They need to participate in their childā€™s care and be with their child as much as possible. The chance to say goodbye one last time is of critical importance to most families. In a recent survey conducted by the MISS Foundation, more than 75% of families who chose not to hold their child after he or she died, later regretted that decision. Most families should be allowed and even encouraged to see and hold their child, if circumstances allow.

Understanding the impact of surpriseā€¦

Prepare the family (parents, grandparents and siblings) for what they will see and experience. Explain machines, tubes, needles or other equipment if the child is still alive. If the child has died, prepare them by explaining the natural postmortem process and why the childā€™s body may look different. Be gentle and compassionate. Try to avoid complicated terminology or medical vernacular. Encourage them to ask questions. In the case of sudden death, lividity should be explained with compassion. Pooling blood can be mistaken for bruising and may frighten parents. Honest communication about the physiological changes which have occurred may help alleviate some of the trauma and perhaps assuage some of the parentsā€™ fears.

Maintaining good communicationā€¦

Two things which concern parents most about their childā€™s death are pain and fear. Often they are afraid to ask questions about the pain or fear their child may be having or may have gone through prior to their death, so offer some answers to them as honestly and gently as possible. Let them know you believe their child has died peacefully and without pain, if this is truly the case. Remember that good communication requires trust, and trust can only be achieved through honesty. Tell them everything you know about their childā€™s condition or cause of death. Information helps families feel in control of a situation, which otherwise, is out of their control. However,Ā howĀ you say something is more important than what you say. Bring your whole, open heart to this experience.

Give parents permission to talk about their feelings and express their emotions. Keep in mind that most parents experience a type of ā€œemotional anestheticā€ (Cacciatore, 1998) and they may not realize the extent of their loss during the crisis. It may seem like a nightmare, surreal, and their reactions may not be what you would expect. Be patient with them and try to respect feelings of anger, denial, confusion, and delirium. Treat mothers and fathers equally in giving information. Donā€™t forget that siblings, grandparents, aunts and uncles grieve too. Though the focus should be the parents, it may also help to offer information and support to peripheral family when possible.

The element of commitmentā€¦

If you have become their main source of support during this tragedy, then you are a very important person for the family. They may often look to you for help in many aspects during the initial stages of the event. Please donā€™t rush away immediately after speaking with the family.

Beyond the call of duty.

If possible, go to the visitation or funeral. It means more than you can imagine. Always refer to the child by his or her name. Offer to take pictures or video tape the service for the family. Offer to answer any questions they may have regarding their childā€™s emergency care. They will remember your thoughtfulness for the rest of their lives.

Remember that several months after the childā€™s death, the emotional anesthetic often wears down and reality begins to, slowly, set in for parents. Often, it is at this time when families feel even more isolated and sorrowful. Check in with them, if possible, at around three-six-and twelve months. Make sure they kept the support numbers you gave them and that they know what resources are available to them within the community.

Lemonade out of lemonsā€¦

The ultimate no-no is the use of platitudes or cliches! Do not rationalize a childā€™s death. No matter what the physical condition of the child or how much of a ā€œburdenā€ the child would have been, most parents would still prefer to have their child with them under any circumstances.

Lean on meā€¦

Touching is a basic form of comfort and communication. Remember that it is a crucial time for you as a professional to show your humanness. If you feel the need to express your own emotions, cry with them. You are in a position of leadership and you lend validity to their emotions. Most parents, even years after their childā€™s death, recall with great fondness a paramedic or physician who shared a moment and cried with them. Vulnerability can sometimes reflect immeasurable strength.

The gift of choiceā€¦

Most parents appreciate being asked about organ donation. They should be offered the option to consider this. Some parents who were never asked reported they felt left out or even insulted that their child may not have been ā€œworthy.ā€ Reassure the parents that their child will be treated with respect and dignity if they choose organ donation.

Support doesnā€™t stop hereā€¦Ā 

Donā€™t suggest ā€œbusy workā€ as grief intervention or therapy. Rather, encourage support group participation and give them names and numbers. The last thing grief-stricken parents need is to have to search through the telephone directory for support and help.