that, as a child gets older, the likelihood of death from acute causes (accident, murder, suicide) increases, from 20% in the first year of life to 45% in the toddler-to-school-age years, to 80% in adolescence (Sahler & Others, 2000).
The need for emotional support that accompanies the death of a child has been observed in the clinical setting and has been the subject of reports in the professional literature. Accordingly, this research reviews literature that has as its subject, in whole or in part, the stress that health-care providers and families experience in cases of pediatric death and the implications that such stress may have for optimal family and care-provider functionality.
Dying children have a special set of physical, spiritual, and emotional needs that, without competent professional assistance and ready availability of information regarding resources and support systems, may not be met with appropriate responses from family, friends, or indeed professional caregivers. In recent years, there have been some institutional responses to such needs. One factor contributing to this appears to be the arm's length distance that children's primary-care physicians (pediatricians) often have when a child does die. According to Bowen and Marshall (1998), pediatricians typically certify child deaths in as few as five percent of cases, the plurality of certifications falling to medical examiners (43%), neonatologists (24%), and obstetricians (10%). However, Wessell (2000) encourages pediatrician involvement with bereaved families, including children who either cannot grasp the concept of death or fear their own or their remaining loved ones' deaths from any illness, even from sleep. He sees a primary role for the pediatrician in cases of death as "enhanc[ing] the capacities of parents and children to meet stresses in their lives as effectively as possible."
In a book widely regarded as a modern classic of its kind, Kubler-Ross...