Coping with loss: The dying child

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Abstract
This is the eighth in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice Series editors: Colin Murray Parkes and Andrew Markus The terminal phase of a life threatening illness may be defined as one where curative treatments are not applicable but palliation is given. There is evidence that children, even young ones, are usually aware that they are dying. They may pick up these cues from parents and hospital staff, who in one study gave significantly less time and attention to children who were terminally ill than to others.1 They may not let anyone know that they know. Child and parents may maintain a “mutual pretence,”2 and yet families who have an open communication fare better psychologically. The refusal of parents and medical carers to talk about issues of death and dying with children who have life threatening diseases impedes coping for the whole family.3 Parents appreciate staff openness and many years later remember vividly the method of imparting the bad news. Accurate information, delivered with skill and sympathy and updated regularly, lessens the parents' sense of helplessness and isolation and sets up a therapeutic alliance.4 #### Summary points