Pediatric End of Life Care

Question 1

Infant and Toddler (1-2)

Answer 1

• Has no concept of death
• Reacts to separation and loss
• Responds to changes in routines, caregivers, parental emotions

Question 2

Infant and Toddler (1-2)
Nursing Interventions:

Answer 2

• Allow rooming in
• Be supportive of the parent: don’t say i know how you’re feeling, bring them food,
• Consistent caregivers

Question 3

Early Childhood (2-7)

Answer 3

• Sees death as temporary and reversible like sleep
• May see death as punishment (egocentric)
• Fears Separation, abandonment & pain
• May fear contagion of terminal illness

Question 4

Early Childhood (2-7)
Nursing interventions:

Answer 4

• Allow the child to express their feelings
• Play, drawing- death imagery

Question 5

Concrete Operations (7-11)

Answer 5

• Begins to see death as irreversible
• May view death as destructive, scary, violent
• Often unable to comprehend own mortality
• Sees death as naturalistic
• Identifies with spiritual beliefs re: death and afterlife

Question 6

Formal Operations (11- Adulthood)

Answer 6

• View death as final, irreversible
• Interested in details about biological death and funerals
• May feel sad, afraid & lonely
• May deny own mortality through risk taking
• Aware of immensity of loss: understand how it will affect others around them; leave belonging to siblings and sympathize with parents

Question 7

Formal Operations (11- Adulthood)
Nursing Interventions:

Answer 7

• Don’t take anything personally
• Be supportive in helping the adolescent with their coping mechanism
  — Music, visitors, scrapbook, etc.

Question 8

Communication Strategies

Answer 8

• Be open when the child initiates a conversation. Disruptive behavior, withdrawal, anger, hyper alert, state, or sleeping more than usual may indicate the child’s struggle with emotion, and be an opportunity to engage the child in discussion
• Assess how much the child knows and how much he or she wants to know. Identify any fantasies and concerns, and provide correct information. Be honest with a child when a clear question is asked.
• Sometimes parents don’t want the child to know
• Allow the child to express his or her feelings, and to be upset. Empathize it with the child.
• Reassure the child that you will be available to listen and give support
• Recognize that some children communicate best through nonverbal means: art, play, music, and writing. The child may be willing to talk through a puppet or a stuffed animal.
• Acknowledge the importance of the child’s life. Let dying children know that they will never be forgotten.
• Allow the child to participate in decisions concerning their death as much as possible