The death of a child is likely the most tragic and devastating event any parent can experience. The sudden and unexpected death of a child is life-changing and its impact on the parents, siblings, and other family members is significant. They may have little or no time to say “goodbye” or “I love you” to their child and they may have to explain to other children about the death of their sibling. It is the responsibility of the emergency department (ED) health care team to deliver quality medical care and acknowledge and address psychosocial and spiritual care for parents, siblings, and family members throughout the treatment.

The death of a child in the ED may have a profound effect on those caring for the child as well. Informing parents and family members of their child’s death impacts the entire health care team who may witness multiple traumatic and unexpected deaths of children over the course of their professional careers. Health care providers have to put their own feelings aside to care for the patient, and offer emotional support for the parents and family members. It may be minutes or hours later before the death of a child has an impact upon them and they are afforded time to deal with their own feelings.

Emergency physicians may feel guilty or inadequate after a failed resuscitation, even when they know the child had little to no chance of survival. This feeling may linger throughout the remainder of their entire shift and impact their ability to focus on the care of other patients. Emergency physicians often lack formal training in how to deliver bad news to families on death and dying; especially how to tell parents their child has died.

The American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) collaborated to develop a policy statement^1,2 and technical report.^3,4

The AAP, ACEP, and ENA support the following principles:

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  The ED health care team uses a patient-centered, family-focused, and team-oriented approach when a child dies in the ED.

  
  
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  The ED health care team provides personal, compassionate, and individualized support to families while respecting social, spiritual, and cultural diversity.

  
  
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  The ED health care team provides effective, timely, attentive, and sensitive palliative care to patients with life span–limiting conditions and anticipated death presenting to the ED for end-of-life care.

  
  
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  The ED health care team clarifies with the family, the child’s medical home and promptly notifies the child’s primary care provider and appropriate subspecialty providers of the death, and as appropriate, coordinates with the medical home and primary care provider in follow-up of any postmortem examination.

  
  
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  ED procedures provide a coordinated response to a child’s death.

  
  
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  Emergency medicine, pediatric resident, and emergency nurse training includes specific education regarding the difficulty of issues raised by the death of a child in the ED.

  
  
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  The ED health care team routinely considers care for the bereaved members of the patient’s family that may include information and arrangements for bereavement care services, condolence cards, and follow-up with the family to address any concerns or questions.

Physicians are looked to as the health care team leader and bear responsibility for involving the family in decisions and delivering bad news. In the scenario of an acute resuscitation the physician may not be immediately available to the parents or may be only intermittently available. Another member of the health care team should be available to the family to provide emotional and spiritual support as needed. Due to lack of prior relationships, limited training of physicians, and the unexpectedness of childhood death, it is crucial to include personnel skilled in identifying and addressing the psychosocial and spiritual aspects that arise during the course of these devastating events, such as child life specialists, chaplains, and social workers.⁵

The AAP policy statement, “Family-Centered Care and the Pediatrician’s Role,”^5–7 advocates for a family-centered approach to the care of the dying child. Historically, parental presence in the trauma bay during resuscitation was not encouraged, and was even forbidden. Recent studies have favored and encouraged family presence during resuscitation of the child who presents in cardiopulmonary arrest. The Report on the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures recommendations⁸ includes: (1) consider family presence as an option for families during pediatric procedures and cardiopulmonary resuscitation; (2) offer family presence as an option after assessing factors that could adversely affect the interaction; (3) if the family is not offered the option of family presence, document the reasons why; (4) always consider the safety of the health care team; (5) develop in-hospital transport and transfer policies and procedures for family presence, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff; (6) obtain legal review of policies; (7) education in family presence in all core curricula and orientation for health care providers.

The AAP and the American College of Emergency Physicians support promoting patient dignity, comfort, and autonomy; recognizing the patient and family as key decision-makers in the patient’s medical care; recognizing the patient’s experience and perspective in a culturally sensitive manner; acknowledging the interdependence of child and parent as well as the pediatric patient’s evolving independence; encouraging family-member’s presence; providing information to the family during interventions; encouraging collaboration with other health care professionals; acknowledging the importance of the patient’s medical home; and encouraging institutional policies for patient- and family-centered care.⁹