Mike South

When a child dies make sure you notify the following people:

• The child's usual consultant at RCH

• The child's usual paediatrician if from outside RCH

• The paediatrician that referred the patient in to RCH on this occasion (if different)

• The child's GP

• The family's GP (if different)

• The child's Maternal and Child Health Nurse

• The mother's obstetrician

The best method is a telephone call.

It is more than just a matter of courtesy to notify these people. They may know the family well and be in a good position to help support them.

It can be very distressing for a family, and the doctor involved, if they make contact with the doctor who is unaware that the child has died

You will probably find the details you need in the UR, but if not, here are some resources that might help you contact the child's doctors:

• Victorian Human Services Directory (Good for finding GPs)
• White Pages
• Yellow Pages
• List of Victorian Paediatricians
• Maternal and Child Health Nurses

Arrange follow up

It is essential that a firm arrangement is in place to ensure that the family will be offered a chance to discuss their child's death with someone.

The optimal timing can vary a lot according to the family, but making contact at 2-4 weeks is often appropriate.

The best person to do the follow up will vary from case to case. Sometimes it will be you. Think it through and discuss with the others in the extended team. Record the decision in the UR.

Never think that they don't need it, or that they will call if they do. Don't assume someone else is going to arrange it - make sure yourself.

Complete discharge summary

A thorough yet concise discharge summary is particularly important in the case of a death. Many people will rely on it for information.

When writing it, remember that it is likely that a copy will find its way into the hands of the parents. In fact it is often appropriate to include the family on the distribution list for the summary.

Bereavement Support Resources

Discuss with the social worker. More information is available here.

What about some support for yourself?

Fortunately, most RCH staff only occasionally have to deal with the death of one of their patients. Many will find the event stressful and sometimes significantly distressing. This can apply equally to both new and experienced staff. Don't see this as a personal failing, but rather as a marker of the compassion which led you to take up paediatrics as a career.

It is normal to experience grief at the death of a child in your medical care, and it can often be helpful to realise that many of your peers and consultants have experienced similar feelings. It is not a common medical practice to discuss our own feelings in detail, but this can be a helpful process in dealing with grief.

A few suggestions:

• Take some time alone to think about what has happened. It's OK to cry.

• Sit and have coffee and a chat with the others involved in the child's death. It's OK to cry.

• Thank your medical, nursing and social work colleagues for their help in the child's death. Some positive feedback will help everyone.

• Maybe finish your shift early, if practical to do so.

• If you are still disturbed about the situation, talk with your consultant if you feel this will help.

• Make contact with your mentor - he/she may have been through a death of a child in their care and may know how you feel

• Find out about ward de-briefing sessions. These are co-ordinated by the Nurse Unit Manager of the ward the child was on and all staff involved in the child's care are welcome.

• Make contact with someone from the Help list. This is a list of people around the hospital experienced in de-briefing who are keen to support junior medical staff

Back to Death (procedures) flowchart