Grief and Grieving of Children Case Study

Profile

Davie Johnson is an 8-year-old who lives with his parents, two sisters (4-years-old and 15-years-old), and a 12-year-old brother. One year ago Davie was diagnosed with myelogenous leukemia. Following chemotherapy he was in remission for ten months. Two months ago his symptoms returned and despite additional chemotherapy, the disease has progressed and no remission has been achieved. Currently Davie is hospitalized and his condition is terminal. His parents have been told of his prognosis.

Questions

  1. Taking into consideration his age, how can the nurse support Davie during this difficult time?
  2. How can the nurse help Davie’s parents support Davie? His siblings?
  3. What grief reactions should the nurse expect from Davie’s 4-year-old sister? Fifteen year old sister? Twelve year old brother?
  4. What are some risk factors for the family associated with the loss of a child?

Answers

  1. Although children may not understand a diagnosis, therapy, or prognosis, they are very good at picking up on the cues around them. They recognize that something bad is happening to them and their family. They sense fear and tension. Thus it is important for the nurse to answer Davie’s questions honestly without taking away hope. This honesty allows the child to cope better emotionally and to participate in his care. Because some children who may not be able to verbalize their concerns can draw how they feel, this should be encouraged. Some children may find it less threatening to talk through a third person such as a stuffed animal. Davie also needs to be reassured that thoughts cannot cause illness or death.
  2. It is important for the parents to take into consideration

the growth and development levels of each child. The parents should be open and honest. They also need to reassure the children that bad thoughts cannot cause illness or death. The parents should include the siblings in planning a special way of remembering Davie. All family members should participate in support groups as appropriate for their age.

  1. A. Davie’s 4-year-old sister does not understand the finality of death. Because of the magical thinking typical of this age, she may believe that dead people can be brought back to life. She may believe bad thoughts or wishes can cause death. Davie’s 4-year-old sister may develop fears such as fear of sleeping. She may regress in her behavior and have temper tantrums or other acting out behavior.

B. Davie’s 15-year-old sister has a more adult understanding of the finality of death. She is able to recognize the effect of death on others and may feel angry or guilty. Though she understands the finality of death, she does not really believe anything bad will happen to her.

C. Davie’s 12-year-old brother understands death is permanent and irreversible. However he may still associate bad thoughts with death and thus feel guilty. He may have fears of his own death.

4. Family members may grieve differently and therefore Individual expectations may cause stress. Some family members will be more demonstrative in their grieving and grieve for a longer period of time. Parents may be so sad they are unable to talk about their dead child, and/or answer the siblings’ questions. Somatic symptoms such as insomnia and anorexia etc. are common.