Bristol

Medico-Chirurgical

Journal

Special Supplement

102 (1a) 1988

Caring for the Dying Child and the Family Curnick fa"v r'stol

Children's Hospital

In

700 children between the ages of 1-14yrs develop eac^ year. 'n the South West Region we expect up ?0 new patients each year, and 25-30 deaths. In the ^ js !sto' Paediatric Oncology Unit our experience is that it etter for most terminally ill children to be cared for at ^ Both parents are usually available, and used to klr>g after their sick child, and the child is often happ. 'n ^am'''ar surroundings, where life can be more

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nor"

ecause management of children with

cancer is highly ar|d it is rare, General Practitioners can have expert knowledge of the subject. The initial symptorn s are often vague, leading to a delay in diagnosis, a can cause 'oss ?f confidence in the G.P. In ^'S add the intensive treatment at the hospital results in g .lt'0n ?se association being formed with the hospital staff ^ a traumatic time. It is especially important theree' *hat the see the hospital and the G.P. working family tQ t0 rest?re their confidence in the primary health Car ? team for the future. families opt for home terminal care they still ret their links with the hospital. The consultant will lnate a clinical assistant, myself and the social work6r | his earn- known to the family, to work with the G.P. and Together we can offer twenty four hour supp0 ^a'n and sYmPtom control, counselling/guidance ?n h W to communicate with the dying child and/or sib| 'n^S' on living what is left of that life to the emPhasis full ' anc' eventually a 'good' death The 'out of hour' calls d0 exclusive|y on the G.P.; hospital staff often their own home telephone numbers for c0nt contact. Every effort is made to cater for the 8S a.nd comf?rt of the child and his family within thej env'ronment. The G.P. needs the additional support / of s

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team, especially if he is single handedly aCtjne9 ^0sPital as 24 hr carer, in addition to his normal duties, y to rr|Un9 children often require high doses of morphine to Pa'n control, and it is not unusual for Presai.^ta'nbetween 25?100 mgs 4 hourly. The oral route is 0ur f if avgj| "hi* c^?'ce' hut suppositories may also be used centra' catheter is inserted, the us

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venous Parent Witf, MS anc^or Patient are taught how to flush the line medi ePSa'? and subsequently how to give the required through the line, if this is the adopted route. Ho^a*'0n es.ty is regarded as the best policy from the time of

the child is old enough, and with the Paren?S's' a9reement, the subject of death and dying might so

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If parents need help to explain death mention two books, which both use to life and death using different forms of imag0st children develop their own ideas on death an early a9e' from experiences such as losing re'at've or Pet, or from school friends or televi-

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Th

^any .ey

don't

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to fear death in the same way as

teenager greatly relieved when he results; red he knew who had already died, this their rTie' ^ad '??ked after him and his sister whilst ot^er she in hospital for operation, '10w 'iked his eggs An0[kSt 6yr old recently asked if there anything

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