Practice of Pediatrics

A program for the participation of parents in the hospital care of fatally ill children is described. Such a program is practical and, in fact, serves useful purposes for patients, parents and staff. The ill children are spared to a large extent from the great difficulty of separation from the parents. This has a maximally beneficial effect upon children less than 6 years of age. For the child 6 to 10 years of age, fear of procedures and of bodily harm seem to take precedence over separation fear, so that parent participation is less helpful. Parent participation is least helpful for the children over 10 years of age, where fear of death itself is the primary problem. There is apparently a maturation of death fear, whereby it evolves from separation fear and mutilation fear. Parents, particularly mothers, are enabled to cope with their own separation anxiety and guilt feelings by participating in the hospital care of the child. This is especially important initially in the course of the child's illness, when the mother's reactions are conspicuously characterized by denial, guilt and hysterical emotionality. Later, when the mother's behavior becomes more rational, her desire to participate is balanced against her desire to support the rest of the family. There is apparently a phasic response in the mother, with an initial emotional and denying reaction and a later more rationally adaptive reaction. Staff personnel, particularly nurses, are largely relieved of the burden of assuming a role of psychologic parentage. An opportunity to identify with a research program is afforded, thus providing constructive purpose. Compensation is also provided by the gratitude of parents who have come to know the staff and to appreciate their efforts and by the satisfaction of aiding in the psychologic rehabilitation of parents.