10/19/17

How to help your kids say goodbye to a beloved pet

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Tips on how to guide little hearts through their grief to help them deal with their loss and recover from it

By Jennifer Walker

Saying goodbye to a pet is an inevitable experience many families will experience.

And telling the truth to children and allowing them to grieve is crucial in helping them deal with their loss, as well as recover from it.

“I think it is important to tell children the truth but depending on their age and developmental level, the information you communicate will differ,” said Kyle Newstadt, individual and family therapist and director of Integrate Health Services. “Regardless, they should know the truth and if you know the pet is sick or death is on the horizon, it is important to communicate that with children.”

According to Ms. Newstadt, books can be helpful to introduce the topic to a child with the family without any other distractions. She said parents could explain to their children that the animal has been to the doctor for medicine and that they’re waiting to see if it helps the situation.

“Don’t hide the truth and say the animal is sleeping or he ran away; it’s abstract and kids wont understand that,” said Ms. Newstadt. “Stick to the truth and avoid unknown language, explain death but leave it up to the child and what they’re asking — children can surprise us.”

A toddler is unlikely to understand death but those words should be used, she added.

“Parents could explain that medicine was given to dog and it will help him close his eyes and he will die peacefully,” said Ms. Newstadt. “Wait for them to ask “what does death mean?’ and, depending on religious beliefs, that would be a good time to talk about that.”

According to the local therapist, it is important to allow your child to express their feelings and deal with grief. A pet memorial would be a crucial part of the process for a child and the entire family, she said.

“Ask the child and give them choices in ways they would want to memorialize their pet and maybe each child can think of something they want to do; a burial outside, pictures in places around the house, creating a scrapbook, or a special ceremony to talk about the memories they had with their pet is important and helps them deal with grief,” she said. “This will open lines of communication which is so important when a child suffers from the death of a pet.”

According to Durham Region registered vet technician Sarah Macdonald, it is required of veterinarian clinics to dispose of a pet’s body once it passes away. A large majority of clinics also offer cremation, she said.

According to Ms. Macdonald and Ontario.ca, homeowners are permitted to bury their pets on their own property. For those living in an apartment, Ms. Macdonald recommends cremation.

The ashes can be kept in a special urn inside the pet owner’s home or be scattered in a special location for a ceremony or as part of a memorial, she said.

For those looking for more ways to memorialize their pets with keepsakes, funerals, cremation ceremonies, and more, Ms. Macdonald recommends Gateway Pet Memorial, specializing in pet aftercare throughout North America.

Parents should be focusing on positive coping strategies by modelling self-expression, letting the child know that it is OK and normal to have these feelings of sadness and that it is important to express, said Ms. Newstadt.

“Children experience grief in different ways from adults; there is no right or wrong way,” she added. “They may appear to be coping well and weeks later experience sadness. Meet the child where they’re at.”

According to Ms. Newstadt, parents shouldn’t approach the conversation until the child is expressing sadness.

“It’s OK if the child isn’t demonstrating that they’re sad, there is no right or wrong way to experience grief,” she said. “It is typical for a child to ask questions or to say they’re feeling sad and then engage in play, it’s a developmentally appropriate way of grieving.”

Complete Article HERE!

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10/8/17

Many kids dying of cancer get intense care at end of life

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By Lisa Rapaport

Nearly two-thirds of children and teens with terminal cancer receive intense care at the end of life, often in hospitals and intensive care units, a U.S. study suggests.

Certain patients, including kids under age 5 and teens aged 15 to 21 as well as ethnic minorities and patients with blood malignancies were more likely to receive aggressive care than other children, the study also found.

“The rates of medically intense end-of-life care we found in our study and the disparities we found raise the question: Are we providing a palliative approach to end-of-life care for these patients?” said lead study author Dr. Emily Johnston of Stanford University School of Medicine in California.

“I hope this study makes pediatric oncologists and others taking care of these patients reflect on the end-of-life discussions they are having, particularly with these high-intensity groups,” Johnston said by email. “I also hope it lets families experiencing the loss of a child due to cancer know that there are different ways for that death to happen, so they can think about and advocate for what is best for their child and their family.”

Many adult patients with cancer who know they are dying choose less intense care, and aggressive treatment is associated with worse outcomes for families and caregivers, Johnston and colleagues write in Pediatrics. But less is known about treatment choices for children, Johnston told Reuters Health.

For the current study, researchers examined data on 3,732 patients age 21 years or younger who died of cancer in California from 2000 to 2011.

Researchers examined the intensity of medical interventions at the end of life by looking at how often patients had cardiopulmonary resuscitation (CPR), intubation, intensive care unit (ICU) admissions or dialysis within 30 days of death. Researchers also looked at how often patients had intravenous chemotherapy within 14 days of death and how many patients died inside hospitals.

Overall, 63 percent of patients died inside hospitals and 20 percent were admitted to ICUs.

Children were more likely to receive aggressive interventions at the end of life when they lived closer to a hospital, or when they received care at a hospital that wasn’t a specialized cancer center, the study found.

One limitation of the study is that the results also may not reflect what would happen outside California, or represent more recent trends in end-of-life care, the authors point out. Researchers also lacked data on how patient and family preferences or other factors might have influenced care decisions.

“We do not know a lot about how the end-of-life experience of children impacts on family bereavement outcomes,” said Dr. Joanne Wolfe, co-author of an accompanying editorial and director of pediatric palliative care at Boston Children’s Hospital.

“Some earlier studies have shown that the child’s experience of pain impacts bereaved parents’ long-term outcomes including anxiety and depression,” Wolfe said by email.

Communication is also key, said Dr. Kim Beernaert of Ghent University and Vrije Universiteit Brussel in Brussels, Belgium.

“We know that communication and information about decision making, treatment options, prognosis etc. is very important for how bereaved parents cope afterwards,” Beernaert, who wasn’t involved in the study, said by email.

With the right information and support for parents and families, many children who die in a hospital might be able to die at home instead, said Dr. Amos Bailey of the UCHealth Palliative Care Clinic at the Anschutz Cancer Pavilion in Aurora, Colorado.

“However, it is physically and emotionally challenging to care for a loved one in the home through death, and parents and children may feel more comfortable and safe in a hospital where it is likely they have been admitted before and come to trust and depend on staff,” Bailey, who wasn’t involved in the study, said by email.

“It will be important to understand if more parents or children would want to die at home or out of a hospital if they were supported,” Bailey added.

Complete Article HERE!

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09/2/17

Why teens need to understand care plans for dying parents

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By Lisa Rapaport

When children lose a parent during adolescence, their mental health as young adults may depend on how comfortable they were with the treatment and support provided at the end of their parents’ lives, a recent study suggests.

To understand the lasting psychological impact of the death of a parent during adolescence, researchers surveyed young adults who had lost a parent to cancer six to nine years earlier, when they were 13 to 16 years old.

Overall, 105 of the 593 young adults (18%) said they had little or no trust in the care provided during the final week of the parent’s life.

Compared to the participants who were satisfied with the final week of care, those who were unhappy were more than twice as likely to suffer from mental health issues like depression, anxiety and eating disorders, researchers report in the Journal of Clinical Oncology, online August 8.

“We already knew that children who have lost a parent are at risk for long-term psychological challenges including depression, risk of suicide, and risk of self-injury,” said Dr. Jennifer Mack, a researcher at Harvard Medical School and Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.

“However, a link to trust in the medical providers of the parent was not previously understood,” Mack, who wasn’t involved in the study, said by email. “This is important because it offers a potential path forward to greater resilience and healing after a parent’s death for young people who experience this type of profound loss.”

The current study focuses not on how teens felt when their parent was dying, or immediately afterwards, noted lead study author Kim Beernaert of the End-of-Life Research Group at Vrije University Brussels and Ghent University.

Instead, it looks at how they feel after several years have passed, Beernaert said by email.

Young people who had little or no trust in the care parents received at the end of life were at least twice as likely to report still feeling bitter toward health providers for failing to make the correct initial diagnosis, stopping or never starting treatment, or not doing everything possible for the parent, the study found.

The mistrustful young adults were also more likely to still want more information about the parent’s disease, treatment decisions, and death.

The study wasn’t a controlled experiment designed to prove whether or how teens’ experiences during a dying parents’ final days influence mental health later in life.

Another limitation is the potential for factors not examined in the study to impact mental health for these young adults, as well as the potential for teens with psychological problems to be less trustful of medical providers than adolescents without mental health issues, the researchers note.

Still, the results highlight the importance of providing age-appropriate support and grief counseling to children and teens during a parents’ final weeks or months of life, said Dr. Amos Bailey, a palliative care researcher at University of Colorado Medicine in Aurora.

Resources tailored to young people are often lacking outside pediatric hospitals, Bailey, who wasn’t involved in the study, said by email.

“What is at stake for bereaved families is the potential for lifelong mental health problems that are probably more socially significant for a teenager (who) will live with this grief for 60 or more years as opposed to a widow who may outlive her husband by 3-5 years,” Bailey said.

Complete Article HERE!

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07/17/17

How to talk to children about death

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It’s not an easy topic, but being prepared with some answers can help.

Children learn about death at the 2016 Death Faire in Pittsboro, North Carolina.

When I die, I want to be burned. I don’t want any worms in my brain.”

“Wouldn’t it be awful to be alive when the world blows up? Everyone would die. I mean everyone.”

“Daddy, what’s a UN air strike?”

The quotes above come directly from my two adorable daughters, now age 5 and 7. It’s fair to say that of all the subjects I have discussed with them, death is perhaps the most challenging — and the most rewarding. That’s because preparing our children to think about and understand death, dying and their own mortality may be one of the most important responsibilities we have.

After all, we’re all going to die. Even if that feels an awfully long way off for many of us, the chances are that children will be exposed to death sooner rather than later in one form or another. With preparation, exposure to death or dying can be a productive opportunity for growth. Without it, it can be a deeply traumatizing experience that reenforces some of our culture’s most negative traits.

A few years ago, Caitlin Doughty — creator of the popular Ask A Mortician series on YouTube — offered a somber and heartfelt plea for less death-phobic parenting following the tragic school shooting in Sandy Hook, Connecticut. Among the advice she offered (I paraphrase):

Ask children what they know: By first gauging a child’s thoughts on death — or on a particular incident involving death — we can get a better sense of their level of understanding and begin to identify the concerns or worries they may have.

Be honest: If we don’t know the answer to something, it’s not our responsibility (nor is it advisable) to make something up. Instead, we can simply explain that we don’t know, but that we’re here to help work it out.

Protect, but don’t shelter: Just because we’re ready to talk openly and frankly about death does not mean we can’t still protect our children. In fact, by being ready to answer questions and share our experiences, we are better able to both “filter” what information our children receive and give them some context and tools for processing ideas or news they are exposed to elsewhere. Doughty strongly recommends protecting children from news “death porn” (her term), especially following tragedies like Sandy Hook.

You can watch a good introductory video from Ask a Mortician below:

Family culture matters

As someone who grew up in a half-Finnish family (Finns have a notoriously morbid sense of humor), it had never occurred to me to shield my children from death or dying. That’s probably a good thing, as both my father and my father-in-law were diagnosed with terminal cancer when my children were 1 and 3.

What I learned during that challenging time reinforces what Doughty says: Children are resilient, curious and well-equipped to explore the topics of death and dying, long before they’re ready to fully understand it (if any of us ever do). In fact, the biggest parenting challenges we faced when we were going though difficult times was not how we talked to our children, but how we managed the different and often conflicting messages about death that they receive from different sources.

How, for example, should a parent explain why one family member says “grandpa’s in heaven” while another doesn’t believe that heaven exists? How do you prepare your children to deal with friends or family members who may be less willing to talk about these difficult topics? What do you tell children about talking to other kids about death? Or how do you prepare them for what kids might tell them?

Ultimately, there are no simple answers to any of these questions. After all, death remains both a challenge and a mystery for adults, too. But starting children on the journey to understanding early will give them the confidence and the curiosity they’ll need to confront mortality in a healthy, open-minded and compassionate way.

And as this second video proves, just know that when you talk to kids about death, things can get pretty dark:

Complete Article HERE!

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07/15/17

The long goodbye: Home burial can bring comfort

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BY CATHERINE ASHE

I never had any reason to think I’d have to plan my own child’s funeral. And yet, last July, that’s exactly what my husband and I found ourselves doing. Our unborn son, James, had just been diagnosed with trisomy 18, a terrible chromosomal disease, at 32 weeks of gestation. We’d read the grim statistics for this disease, the second-most common trisomy after Down syndrome (trisomy 21), and we knew that his time with us was likely to be short.

This awful news forced us to confront impossible questions: How did we want his brief life to look? How did we want him cared for after death? Instead of buying diapers and looking at cute baby boy clothes at Target, I was looking at cemeteries and trying to decide between cremation and burial. At 32 weeks pregnant in the miserable summer heat, I was writing a eulogy for my unborn child.

Catherine Ashe and her son, James

During this time, I came across a beautiful article written by a grieving mother whose adult daughter had died at home in hospice care after battling cancer. The writer cared for her daughter’s body, held an extended at-home visitation, and then buried her daughter at home. The article moved me to tears, because it captured perfectly how I feel about death.

In a society where death is largely relegated to hospitals, impersonal mortuaries and mass cemeteries, home burial has fallen by the wayside. Yet just a generation or two ago, death was recognized as a natural part of life. The deceased’s remains were handled by the family, and burial was done at home, in a family plot. Visitations often lasted for days. There was time for loved ones to say goodbye in a peaceful, familiar and welcoming environment.

After reading that article, I started researching North Carolina’s funeral and burial laws, and what I found surprised me. Home burial is permitted, as long as the interment is on private land, and just about anyone can transport the body. At no point does a funeral home have to be involved. The only specific regulations involve burial of a body too close to a reservoir or other public water source.

When James was born, he surprised everyone with his strength. He had five wonderful months with us. During his 154 days on earth, he was always with either me or his father. We cared for him through the good times and the bad. He was a fat, contented baby with big blue eyes and crazy brown hair.

On Jan. 2, 2017, he slipped out of this world, cradled in our loving arms. At that point, he was a patient in Mission’s pediatric intensive care unit. After his death, we held him, his grandparents and uncles held him, and his care team said goodbye to him. And then we simply walked out of the hospital, carrying James in our arms. We had cared for him in life; now we would care for him in death.

On Jan. 3, we hosted an extended visitation at our house. This was made possible by a CuddleCot — a cooling device that will preserve a small body for quite some time. It’s a noninvasive alternative to embalming. During my research, I’d also learned that embalming a body isn’t necessary: Cooling serves the same purpose.

Thanks to the CuddleCot, we were able to have James at home with us so we could say goodbye. Prior to his birth, I’d read about other parents doing the same thing — and at the time, much as I’m ashamed to say it, I thought it was morbid. Why would you want your child’s body in the house with you?

It wasn’t till James died that I understood: James was still James. Nothing changed when he died. He was still my baby. It seemed only natural to bring him home to the place he’d known his whole life, to give us time to adjust to losing him, to give his sisters (ages 3 and 5) time to see him, say goodbye and understand that he was gone.

His visitation was lovely, as lovely as something so tragic can be. My husband and I were in our own home, so we were comfortable, able to retreat into our bedroom when we needed to, and there was no established time frame limiting visits. We spent two nights with him, saying goodbye, telling him all the things we wanted him to hear.

On Jan. 4 at 4:52 p.m. — the same time of day he was born — we buried James in our backyard with over 100 people in attendance. His presence there, in the yard where his sisters play, brings us comfort on some very dark days: Though his spirit is gone, his earthly remains are nearby. We visit him often, keep fresh flowers on his grave and have wind chimes in the maple that he’s buried beneath.

I hope that by writing this, I can help others realize that home burial is possible for their loved ones — all of them, not just children.

Complete Article HERE!

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07/2/17

Supporting a child when someone dies – Part 1

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Talking about death and who can help

The death of someone close is one of the hardest things anyone has to face. It can be especially difficult to help a child manage their grief while you’re dealing with your own. Although you can’t protect a child from the pain that follows a bereavement there are things you can do to help them come to terms with their loss.

Talking about death

Although you may wish to protect your child from unhappiness, avoiding talking about the person who died isn’t helpful and can cause problems in later life. Talking about death can be difficult, even for people who are familiar with it. You may worry that you will frighten your child or say the wrong thing. But it’s important to be open and to answer any questions they have as honestly as you can. What children imagine can be far worse than the reality.

  • Try to avoid telling your child not to worry or be sad. It’s healthy to get attached to people. And, like you, your child might find it hard to control their feelings.
  • Don’t try to hide your pain, either – it’s alright to cry in front of a child. It can help to let them know why you’re crying.
  • Be sure to give the child plenty of reassurance. Let them know they’re loved and that there are still people who will be there for them. A cuddle can make a big difference and make them feel cared for. It’s also a good idea to stick to a routine, if you can. This can help the child feel more secure.

Sometimes it might seem as though they haven’t heard what you’ve said or aren’t affected by it. They could also seem to move in and out of their grief – being upset at some times and not at others. This is just their way of coping and they’ll deal with what they’ve been told in their own time.

Child Bereavement UK   has a useful information sheet (PDF download) for explaining death to children. Here are some other things that may help:

Be honest

Children need to know what happened to the person that died. Try to explain in clear, simple language that’s right for their age and level of experience. You might also try giving them information small amounts at a time, especially young children, as this can help them understand. Once you’ve explained that someone has died, the details can follow.

Use plain language

Talking around the subject doesn’t help and may lead to misunderstandings. Avoid explanations such as ‘the person has ‘gone to sleep’ or ‘gone away’. They may make your child frightened to go to sleep or worry as soon as you leave the house in case you don’t come back. Even if you believe the person who died has gone to heaven this can be confusing and worrying for a small child.

Encourage questions

Be prepared for your child to be curious and to ask the same questions again and again. This can be distressing but remember it’s a part of their need for reassurance and helps them process the information.

It’s not easy, even for adults, to understand death and dying. A child’s understanding will depend on their age, gender, stage of development, family background, personality and previous experience. Think about what to say and give the same answers each time. Be led by what they want to know and don’t be afraid to tell them you don’t know the answer to something.

Reassure them

It’s common for children to feel that the person has died as a result of something they may have said or done. Explain simply how and why they’re not to blame.

Ask them to tell their story

Asking children to tell their story of the death and experience of grief will let them know they are important and that their relationship with the person who died has been recognised. It can help you to understand what they know about what happened and correct anything that’s not quite accurate. It can also help children to discover that the way they see things changes with time.

Listening to their story will also help you better understand the child’s grief. Avoid comparing it to what you think they should be feeling or overusing words like ‘time’ as a way of trying to reassure them.

What people want more than anything, whether child or adult, is control over grief, feelings, and needs. Immediate comfort, the ability to express their feelings about the loved one and stability are all important in helping someone cope.

People who can help

Each person’s grief is as individual as the person who’s been bereaved and it can sometimes be easier to deny feelings than to acknowledge them. How children respond will depend on many things including:

  • their age
  • their stage of development
  • what they’ve read or seen on TV
  • their understanding of death and dying

Sometimes two children from the same family might need completely different types of support. The relationship that the child had with the person who died can also affect how they grieve.

Take things one day at a time. If at any time you feel unable to cope remember you’re not alone. Friends, family, healthcare professionals, teachers at your child’s school and others can all help. There may also be specialist child bereavement services that you can use including Child Bereavement Network  , Cruse Bereavement Care   or Winston’s Wish  .

Alternatively there may be a local children’s bereavement service in your area – ask your GP or search online.

External websites

Care for the Family  

Child Bereavement Network  

Cruse Bereavement Care  

The Child Bereavement Charity  

ChildLine: 0800 1111 (24-hour helpline)  

DadsNet  

Dying Matters  

Grandparents Plus  

Grief Encounter  

Healthtalkonline  

Netmums  

Samaritans: 116 123 (24-hour helpline)  

WAY Foundation  

Winston’s Wish  

Complete Article HERE!

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06/14/17

When a Pet Dies, Helping Children Through the ‘Worst Day of Their Lives’

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Reading age-appropriate books about a pet’s death, like this one for ages 4 to 8, may be helpful in getting a child over the grief.

The loss of a pet is often a child’s first experience with death. Understanding the unique ways that children view pets and respond to their passing can help parents to ease the grieving process.

Joshua Russell, an assistant professor of environmental science at Canisius College in Buffalo, who has studied the effects of pet loss in children, explained that for many children, pets are more than just animals. “Many kids describe their pets as siblings or best friends with whom they have strong connections,” he said.

In a study of 12 children ages 6 to 13 who had lost a pet, published in the journal Environmental Education Research, Dr. Russell found that even years after the pet’s death, some children still described the loss as “the worst day of their lives.” He also discovered that children come up with unique ways to rationalize their pet’s passing and that the way a pet dies influences how children grieve.

“Children, in particular, have a distinct sense of existential fairness around whether or not an animal lived until an appropriate age,” Dr. Russell said.

Like adults, children more readily accepted their pet’s death when it was expected in some way. For example, children were less affected when they knew in advance that the animal would have a short life span. They seemed to know that a fish or hamster, for instance, would not live as long as a dog or cat. When an animal was sick, they generally agreed that euthanasia relieved the pet of its suffering. If an animal is terminally ill, parents can help prepare the child by talking about the impending loss, as well as the feelings of sadness it will evoke.

This book is written for children ages 8 to 13.

Yet when pets died in tragic and unexpected ways, the loss was harder for the child to accept. “When a pet dies suddenly, it highlights the unpredictability of the world. It tells children that the people and animals they love can die without warning,” said Abigail Marks, a clinical psychologist in San Francisco who specializes in childhood grief.

Of course, a child’s age and developmental level affect how he or she understands death, and a child’s grief looks very different from an adult’s. Children do not always cry or immediately show emotion. But this does not mean they are not deeply affected by the loss.

“Kids under the age of 5 will have a hard time understanding that the pet is gone forever because it’s difficult for them to grasp the concept of death,” said Jessica Harvey, a psychotherapist in San Francisco who specializes in pet grief.

One way young children may express their grief is through play. After the loss of a pet, they may pretend, for example, that a stuffed cat or dog became ill and passed away. Parents can help their children through the grieving process by actively participating in this type of imaginary play.

Reading age-appropriate books about pet death may also be helpful. “Goodbye, Brecken,” by David Lupton, for children ages 4 to 8; “Kate, the Ghost Dog: Coping With the Death of a Pet,” by Wayne L. Wilson, for ages 8 to 13; and “Memories of You,” by Erainna Winnett, for ages 7 to 12, are some examples.

School-age children will often have questions about the animal’s death, and the back-and-forth that ensues may open up larger conversations about love, loss and what happens after we die. When telling a school-age child about a pet’s death, Dr. Marks recommends being honest about what happened. Doing so lets a child know that it is not taboo to talk about death or painful feelings, which can set the stage to process other sorts of loss in the future. Parents should also validate any emotions that arise as the child mourns.

She said that a child’s grief would ebb and flow; they may cry one minute and then resume playing or talking about other things the next minute. Parents should be more concerned if a child has nightmares, increased anxiety or difficulty sleeping. If these symptoms persist, psychological counseling may help.

…and of course, our personal favorite.

Dr. Marks said it was also important for parents to follow their child’s lead. “If they are asking about the details of the pet’s death, it’s a sign that they want to talk about it,” she said. “They are looking for your comfort.”

For many children, it is also important to have a goodbye ritual. “Rituals around death are some of the most meaningful ways we have of recognizing someone’s life, but these ceremonies aren’t societally defined for pet death,” Dr. Marks said. Families can create their own rituals, like having a small memorial service, scattering the pet’s ashes, planting a remembrance tree or creating a photo album.

“This is a way to process the loss and to honor the role that the pet had in your family,” Dr. Marks said.

Complete Article HERE!

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