11/7/17

How to Help Your Kids Cope With the Loss of the Family Pet

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Pets are part of the family, so it makes sense that losing one is tough on everyone, including our children. A pet’s death may be the first time they’ve ever experienced a real loss, and as a parent, it can be difficult to know how to start a conversation about life, death, and grieving in a way they can understand, but that won’t heighten their sadness.

Last week, we put our 12-year-old dog to sleep five weeks after he was diagnosed with lymphoma. It was a brief but rapidly debilitating illness, and I wondered if my kids would understand that a dog who was quite healthy only two months ago was now gone. Surprisingly, they took it much better than I did. My 3-year-old gave me a hug, then told me, “I don’t know why you’re crying, Mom. Gus was sick, and now he’s in heaven with grandma’s dog. He’s not sad he died. He’s still happy.”

After briefly wondering if my child was a pet psychic, I realized that his logic was pretty sound. While my son would miss our dog, he knew our pup had been suffering, and he was prepared for the death. He had processed the loss faster and more easily than I did precisely because he was a kid. If you’re dealing with the loss of a family pet, here’s how to help your children process their feelings.

  1. Make sure your child understands what death means. Gently make sure that your child understands that their pet’s death means the animal will never be physically present again. Don’t be alarmed if it takes awhile — even years depending on their age — for your child to understand that means that your pet can no longer breathe, feel, or ever be alive again. If the death was sudden or unexpected, explaining why or how your pet died might be important to help your child understand the permanence of the loss. Of course, consider your child’s age and ability to understand and only give them developmentally appropriate information.
  2. Be honest. Telling your child about the death openly and truthfully lets your child know that it’s not bad to talk about death or sad feelings, an important lesson as they will have to process many other losses throughout their lives.
  3. Follow your child’s lead. Sometimes children are better than adults at accepting loss, especially when they’ve known for some time that their pet had a limited life span or was ill. Don’t attempt to make your child’s grief mirror your own, but do validate any emotions that come up as your child goes through the mourning process, and be ready to talk when they have questions. Age-appropriate books like Sally Goes to Heaven and I’ll Always Love You can also help with communication.
  4. Don’t be surprised if your child grieves in doses. Children often spend a little time grieving, then return to playing or another distraction. This normal, necessary behavior prevents them from becoming overwhelmed and makes the early days of grief more bearable for them.
  5. Say a formal goodbye. Consider having a small memorial service where you can all say goodbye, discuss favorite memories, and thank your pet for being part of the family, even if the service is just in your backyard or around the kitchen table.
  6. Find a way to memorialize your pet appropriately. We often don’t realize how constant our pets were in our lives until they’re gone. By making a photo album, turning a collar into a Christmas ornament, or commissioning personalized art work through Etsy, your whole family will have a positive remembrance of your beloved pet for a lifetime.

Complete Article HERE!

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10/22/17

Disney and Pixar films present opportunities for parents to discuss end-of-life with children

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By Bert Gambini

Bambi’s mother, Mufasa from “The Lion King” and Elsa’s and Anna’s parents in “Frozen” represent some of the characters who die in Disney and Pixar animated films, and these potentially shocking moments for young audiences provide critical opportunities for adults to discuss end-of-life issues with children, according to a new study by a University at Buffalo researcher who specializes in end-of-life communication.

“These films can be used as conversation starters for difficult and what are oftentimes taboo topics like death and dying,” says Kelly Tenzek, a clinical assistant professor in UB’s Department of Communication. “These are important conversations to have with children, but waiting until the end of life is way too late and can lead to a poor end-of-life experience.”

Starting the end-of-life conversation with children early allows the dialogue to continue and develop throughout their lives, and the deaths in these film can actually help children relate to and understand death in ways that otherwise might be very challenging for them.

“We believe that Disney and Pixar films are popular and accessible for children and adults so that a difficult conversation can begin in a less threatening way earlier in life,” says Tenzek.

Tenzek and co-author Bonnie Nickels, a visiting lecturer at the Rochester Institute of Technology, analyzed 57 Disney and Pixar movies in which 71 character deaths occurred.  Four themes emerged from their analysis, each of which can serve as a platform for adults to discuss end-of-life issues with children.

The results of their research appear in Omega-Journal of Death and Dying.

Tenzek says the current study uses categories from research conducted in 2005 on end-of-life depictions in 10 Disney and Pixar films. That earlier research distinguished character’s status, such as antagonist or protagonist (Tenzek and Nickels added side characters to this category); cause of death; whether the death was presented on film or implied; the reactions of other characters; and if the death, within the context of the film’s plot, was permanent or a reversible, fantasy occurrence.

With that template and their expanded list of 57 films, the new analysis yielded four general opportunities, or themes, on which to base an end-of-life discussion:

“First, some of the portrayals of death are unrealistic, such as when the character returns or returns in an altered form,” says Tenzek. “But this is a chance for a child to better understand the difference between fiction and real life.”

Tenzek says managing the end of life, or the emotional response to death, could be helpful for children and adults.

“How the characters portray their responses to dying can help children understand the nature of expressing emotion,” she says. “‘Big Hero 6’ (2014) and ‘Inside Out’ (2015) specifically address emotional responses to death and dying which were not present in earlier films.”

The third and fourth themes dealing with intentions to kill and transformation and spiritual connection, with its moral sub-theme, are more complex. Religious and spiritual content are not always overly present in Disney and Pixar films, however, Tenzek says, the films can still serves as opportunities to discuss religious beliefs and end of life.

“We acknowledge that a child’s psychological development is important when considering these discussions,” says Tenzek. “It’s not our intent to have these conversations with a 3-year-old, but as children mature, then the films fit naturally into that growth.”

Many of the possible benefits arising from these films extends from parents’ power to engage children, according to Tenzek. The films can be a tool to help explain the difficult end-of-life process to children and help them make connections that lead to better understanding.

“I teach end-of-life communication,” says Tenzek. “My goal is to educate and help people become more comfortable with the end of life.

“One way to do that is through these films,” she says.

Complete Article HERE!

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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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