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

A Comparison of Maternal Attachment between American Adolescent and Adult Mothers of Preschoolers

American adolescent mothers have been viewed as less effective parents than adult mothers. The socioeconomic disadvantages of adolescent mothers should be taken into account. The objectives of this study were to compare maternal attachment between adolescent and adult mothers of preschoolers and to examine changes of adolescents’ maternal attachment over time. A secondary analysis of data from a larger study of maternal employment and low birth weight infant outcomes were used. Data were collected through home visits using structured questionnaires at two different time points. Forty-three pairs of adolescent and adult mothers who could be matched on family structure, maternal race, and child’s gestational status were compared on maternal attachment. The 7-item Attachment subscale of the Parenting Stress Index was used to measure maternal attachment. Results revealed that the adolescent mothers were not less attached to their preschoolers than the adults. This held true when important confounding factors were taken into account using multiple regression

Editorial: Parent, Grandparent, and Sibling Responses to the Death of an Infant or Child in Intensive Care

The death of a child is a devastating event for most parents and other family members1. However, responses to a child’s death vary by culture, generation, and often the age of the deceased child. For the Chinese, child death is a “bad death” and brings shame to the family2. Filipino parents of a deceased child feel severe guilt after their loss3. In some Caribbean cultures young mothers are prevented from attending the child’s funeral or going to the cemetery by women in the previous generation in the belief that if you “take one to the cemetery you will be taking all of your other children there as well.” In other cultures, those who die as children have not sinned, securing their place in heaven4. In the ethnically-diverse US, more than 43,000 children aged 18 and younger die each year5, most in intensive care units6. Friends, relatives, co-workers, and healthcare providers (HCP) often are uncomfortable with the parents after their child’s death, not knowing what to do, what to say, and what would help the deceased’s parents and family members. Many assume that parents and family members want to be left alone after the infant’s or child’s death. As a result, parents, siblings, and grandparents report feeling isolated and abandoned by those close to them when they need them most7–10. Little research has been done with these US family members in the difficult first year after the child’s death. What has been done has shown that studies of parents have been conducted years, even 3–7 decades11, after their infant’s or child’s death. However, many studies have very diverse samples regarding the age of the “child” at death. In some studies, family members are responding to the death of a “child” who died in childhood (≤18 years old) and a “child” who died as an adult (19 and above), sometimes as old as 40, in the same study12. In addition, studies of siblings whose brother or sister died during the sibling’s childhood are often retrospective. Some studies postpone data collection until the sibling reaches adulthood; and some studies recruit bereaved siblings when they are adults. Very few studies have been undertaken with grandparents of the deceased child. With funding from the US NIH National Institute of Nursing Research and the National Institute of General Medical Sciences, a body of research has been conducted on parents’, grandparents’ and siblings’ health and functioning during the first year after the infant’s or child’s death in the neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) to fill our knowledge gap

Predictors of Women\u27s Postpartum Health Status in the First 3 Months After Childbirth

Purpose The purpose of this study was to examine the significant predictors of postpartum health indicated by physical health, mental health, and role performance during the first 3 months postpartum. Methods This study used a correlational survey design. The study subjects were 152 mothers at 6 weeks postpartum (T1) and 131 mothers at 3 months postpartum (T2). At 6 weeks and 3 months postpartum, subjects completed a packet of instruments–measuring physical and mental health, role performance, sense of mastery, social support, and infant temperament. Results Findings indicated that lower family income, more difficult infant temperament, and lower sense of mastery were consistently significant predictors of poorer health outcomes during the postpartum period. Having preterm infants and caring for them was related to higher levels of maternal fatigue in the morning at 6 weeks. Employment did not influence postpartum health. Conclusion The findings suggest that mother and infant\u27s individual factors and environmental context may continue to negatively affect the mother\u27s health outcomes during the postpartum period

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

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

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

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