School Aged Children’s Experiences 7 and 13 Months Following a Sibling’s Death

This study described 6-year to 12-year-old children\u27s responses 7 and 13 months after siblings\u27 NICU/PICU/ED death. Using semi-structured interviews, at 7 months, children were asked about events around their sibling\u27s death. At both 7 and 13 months, children were asked about their thoughts and feelings about the deceased, concerns or fears, and life changes since the death. Thirty one children (58% female), recruited from four South Florida hospitals and Florida obituaries, participated. Children\u27s mean age was 8.4 years; 64.5% were Black, 22.5% Hispanic, 13% White. Interviews were analyzed using conventional content analysis. Resulting themes: circumstances of the death, burial events, thinking about and talking to the deceased sibling, fears, and life changes. Most children knew their sibling\u27s cause of death, attended funeral/memorials, thought about and talked to their deceased sibling, reported changes in family and themselves over the 13 months. Fears (something happening to themselves, parents, other siblings-death, cancer, being snatched away) decreased from 7 to 13 months especially in 7-year to 9-year-olds. Seven-year to 9-year-olds reported the greatest change in themselves from 7 to 13 months. More Black children and girls thought about the deceased and reported more changes in themselves over the 13 months. School aged children thought about and talked with their deceased sibling, reported changes in themselves and their family and their fears decreased over the first 13 months after their sibling\u27s death

Pediatric head trauma: parent, parent-child, and family functioning 2 weeks after hospital discharge

OBJECTIVE: To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge. METHODS: Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission. RESULTS: Mental health after discharge was related to social support and baseline mental health. Mothers\u27 parental distress was related to perceived injury severity and social support. Greater family cohesion was related to baseline mental health, social support, and being in a two-parent family for mothers, and to social support for fathers. CONCLUSIONS: Parents\u27 mental health and social support were important for parent mental health and family cohesion after discharge. Perceived injury severity and parent reactions to hospitalization also played a role

Perinatal and Pediatric Issues in Palliative and End-of-Life Care from the 2011 Summit on Compassionate Care

More than 25,000 infants and children die in US hospitals annually; 86% occur in the NICU or PICU. Parents see the child’s pain and suffering and, near the point of death, must decide whether to resuscitate, limit medical treatment and/or withdraw life support. Immediately after the death parents must decide whether to see and/or hold the infant/child, donate organs, agree to an autopsy, make funeral arrangements, and somehow maintain functioning. Few children and their families receive pediatric palliative care services, especially those from minority groups. Barriers to these programs include lack of services, difficulty identifying the dying point, discomfort in withholding or withdrawing treatments, communication problems, conflicts in care among providers and between parents and providers, and differences in cultural beliefs about end-of-life care. The 2011 NIH Summit on the Science of Compassion provided recommendations in family involvement, end-of-life care, communication, health care delivery, and transdisciplinary participation

Mother’s Mental Health, Mother-Child Relationship, and Family Functioning 3 months after a Preschooler’s Head Injury

Objective Investigate mothers’ mental health, mother-child relationship, and family functioning 3 months after preschool children’s head trauma and hospital discharge. Design Prospective survey. Setting 7 hospitals; families’ homes. Participants Eighty mothers of children (ages 3–6) with head trauma. Measures Perceived injury severity, Mental Health Inventory (MHI), Parental Stressor Scale: PICU 24–48 hours after admission; MHI, Parenting Stress Index, FACES II, Multidimensional Scale of Perceived Social Support 3 months post-discharge. Results Injury severity had negative effects on mothers’ mental health at 3 months after discharge, but not on the mother-child relationship and the family’s functioning. Mothers’ baseline mental health and ongoing support had positive effects on mother-child relationship and family adaptability. Conclusions Mothers with greater stress and poorer mental health during their child’s hospitalization may be at risk for negative mother-child and family outcomes. Interventions that decrease parents’ stress during hospitalization and promote ongoing social support after discharge may diminish this risk

Use of Spiritual Coping Strategies by Gender, Race/Ethnicity and Religion at 1 and 3 months after Infant’s/Child’s Intensive Care Unit Death

Background and purpose In the US, 57,000 children (newborn-18 years) die annually. Bereaved parents may rely on religious or spiritual beliefs in their grief. The study’s purpose was to examine differences in parents’ use of spiritual and religious coping practices by gender, race/ethnicity and religion at one and three months after infant/ICU death. Methods The sample consisted of 165 bereaved parents; 78% minority. The Spiritual Coping Strategies Scale was used to measure religious and spiritual coping practices, separately. One-way ANOVAs indicated that Black non-Hispanic mothers used significantly more religious coping practices at 3 months than White non-Hispanic mothers. Protestant and Catholic parents used more religious coping practices than the “no” and “other” religion groups at 1 and 3 months. Within the 30 mother-father dyads (paired t-tests), mothers reported significantly greater use of religious coping practices at 1 and 3 months and spiritual coping practices at 3 months than fathers. Conclusion Religious coping practices were most commonly used by Black mothers and Protestant and Catholic parents. Within dyads, mothers used more spiritual and religious coping practices than fathers

Preschool Children with Head Injury: Comparing Injury Severity Measures And Clinical Care

The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care

Parents’ Reactions at 24–48 Hours after a Preschool Child’s Head Injury

Objectives 1) Compare mothers’ and fathers’ early reactions (stressors, concerns) to the preschool child’s head injury, their perceptions of the child’s injury severity, their social support and mental health; 2) compare families with a child in the pediatric intensive care unit (PICU) vs. general care unit (GCU) on these variables; 3) describe the relationships between parents’ early reactions and perceived and objective injury severity, their social support and mental health. Design Analysis of data collected in the hospital 24–48 hours after the child’s admission as part of a longitudinal study of parent and family functioning after a preschool child’s head injury. Setting 7 tertiary care centers – 3 free-standing children’s hospitals, 4 comprehensive hospitals. Participants 182 mothers and 64 fathers of 183 preschool children (ages 3–6) hospitalized for head injury, half in a PICU. Measurements and Main Results Outcome variable – parent early reactions (stressors, concerns), influenced by parent mental health, social support, objective and perceived injury severity. Mothers reported more stress than fathers regarding the child’s behavior and emotions, communication with staff, and their parental role. Mothers in the PICU group reported more concern about the child’s future and more stress regarding the child’s appearance, sights and sounds of the unit, and procedures done to the child than mothers in the GCU group. Fathers in the PICU and GCU groups reported similar levels of stress and concern. Mothers’ reactions were influenced by objective and perceived injury severity, social support, and psychological distress. Fathers’ reactions were influenced by objective injury severity and psychological distress. Conclusions Although mother-father couples rated their child’s injury severity similarly, mothers experienced more stress than fathers. Social support decreased the stress for mothers but not for fathers. The experience of pediatric head trauma was more stressful for mothers of children in the PICU than mothers of children in the GCU

Psychometric Evaluation of the Spanish and English Versions of the Spiritual Coping Strategies Scale

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study’s purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2–3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test–retest reliability was .84 for the Spanish and .80 for the English version. Spanish and English responses to the SCS items and the resulting score for the subscales and the total scale were not significantly different. Scores on the English and Spanish versions were correlated as expected with time since the stressful event and happiness with family and with spouse or partner, supporting the validity of the Spanish SCS. Study findings support the reliability and validity of the newly translated Spanish SCS

Adolescents’ Experiences 7 and 13 Months Following the Death of a Brother or Sister

This qualitative study used semi-structured interviews to describe adolescents’ responses at 7 and 13 months to siblings’ NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling’s death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 months fears increased including losing someone and thoughts of dying. Adolescents reported more changes in family life and greater life changes in them (more considerate, mature) by 13 months; some felt friends abandoned them after the sibling’s death. Girls had more fears and changes in family life and themselves. Adolescent’s responses to sibling death may not be visually apparent. One recommendation from this study is to ask adolescents how they are doing separately from parents since adolescents may hide feelings to protect their parents, especially their mothers. Older adolescents (14-18 years) and girls may have more difficulty after sibling death

Parent & Child Perceptions of Child Health after Sibling Death

Background Understanding children?s health after a sibling?s death and what factors may affect it is important for treatment and clinical care. This study compared children?s and their parents? perceptions of children?s health and identified relationships of children?s age, gender, race/ethnicity, anxiety, and depression and sibling?s cause of death to these perceptions at 2 and 4 months after sibling death. Methods 64 children and 48 parents rated the child?s health ?now? and ?now vs before? the sibling?s death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children?s Anxiety Scale. Sibling cause of death was collected from hospital records. Results At 2 and 4 months, 45% to 54% of mothers? and 53% to 84% of fathers? ratings of their child?s health ?now? were higher than their children?s ratings. Child health ratings were lower for: children with greater depression; fathers whose children reported greater anxiety; mothers whose child died of a chronic condition. Children?s ratings of their health ?now vs before? their sibling?s death did not differ significantly from mothers? or fathers? ratings at 2 or 4 months. Black fathers were more likely to rate the child?s health better ?now vs before? the death; there were no significant differences by child gender and cause of death in child?s health ?now vs before? the death. Conclusions Children?s responses to a sibling?s death may not be visually apparent or become known by asking parents. Parents often perceive their children as healthier than children perceive themselves at 2 and 4 months after sibling death, so talking with children separately is important. Children?s perceptions of their health may be influenced by depression, fathers? perceptions by children?s anxiety, and mother?s perceptions by the cause of sibling death