ABSTRACT
The idea that a child may be in pain is very shocking; this is why the first reaction of adults is to deny that pain exists.3 Sometimes the presence of pain in a child is detected with more sensitivity by the parents than by professional caregivers; doctors and nurses ignore the opinion of parents at their peril. Frequently, however, parents seem unable to perceive their child’s pain and can even go so far as to discontinue analgesia on their own initiative. This may be through fear of the child becoming addicted to the drug, or it may be that to acknowledge his suffering means accepting the child is experiencing something that the parents can neither share nor control. In an interview with the doctor the child sometimes admits to extremities of pain he has not mentioned to his parents - maybe to protect them or maybe through fear of not being believed. In these cases it is better for the parents to share in any discussion on pain control, in order that all their fears may be brought into the open. It is much easier to discuss the future of severely ill children if their present suffering is alleviated, so that parents do not have the added burden of this particular anxiety.
Grief The parents of the dying child need to pass through the process of mourning before they can come to terms with their loss; this process will vary with individual parents and may well be prolonged. Neighbours and friends may fail to understand the profundity of such grief, since the child has had so little time to establish himself in the family. Grieving for the dying child is intensified because of the sense of futility that accompanies it. It is ‘against the natural order of things’ - life is ending before it has begun. The baby is a symbol of creativity, the child a symbol of potential growth.4 The parents of the dying child lose not only their present, but their future as well.In her book On the Death o f a Child,4 Celia Hindmarch discusses the breaking of bad news under five headings: ‘Why’, ‘When’, ‘Who’, ‘Where’ and ‘How’. Let us examine ways to break bad news using these headings, but adding another one: ‘What next?’.
