After a child dies, there are certain procedures and policies in place that must be followed. This must be done with great sensitivity and must respect the needs and wishes of each individual family. The procedures and policies to be followed are dependent on whether a child’s death was expected or unexpected. This chapter will focus on care after an expected death but practitioners must also familiarize themselves with procedures in place for unexpected deaths.

• Verification – This is confirmation that the child has died. This can be done by a nurse but can also be done by a medical practitioner or another registered professional who has been deemed competent to do so. It is focusing on the physiological assessment to confirm death, for example, observing for breathing for a good period of time, looking for signs of life and listening for a heartbeat. The family should be supported throughout.
  
• Certification – By law, a medical practitioner has to certify the cause of death. This is a statutory requirement. This is completed by the medical practitioner who was attending to the child or had seen them last. If the child has died at home, this will usually be completed by the child’s General Practitioner. A ‘Medical Certification of Cause of Death’ must be completed, which involves:
  
  
  
  • a statement of the cause of death;
    
  • the date the child died;
    
  • the date the child was last seen alive;
    
  • whether they have seen the body after death.
  
  
• Registration of death – A Medical Certification of Cause of Death is required to register the death. The family can now legally dispose of the child’s body. After registering the death, the family will receive a certified copy of the Death Certificate. This provides them with an explanation of the cause of death and why the child died. This is useful for their family’s medical records.

Caring for a grieving family can be incredibly challenging but it is a very important part of nursing care. Care should be taken to gently guide the family through the activities that need to be done at their own pace. Consideration, however, must be given to the condition of the body and health care professionals must balance this with meeting the needs of the family. It is anticipated that conversations will have taken place about care after death in the cases where death was expected, including where the child’s body will be stored. Parents do not have to adhere to the original plan though, and some parents find that after death they want to deviate from the plan. This must not be discouraged and parents need to understand that whatever they choose is acceptable.

Following the verification of death, the family can be supported to carry out personal care to the child. The optimal time to do this is within two hours as rigor mortis will begin at this time. The limbs should be straightened out and medical devices such as cannulas, tracheostomies and gastrostomies should be removed as per local policy. No devices should be removed if a post mortem is required. Insertion sites and wounds should be cleaned and a dressing applied. If there is likely to be any exudate, the dressing should be waterproof. Jewellery should be removed unless the parents wish otherwise. Legible identity bands in accordance with local policy must be applied to the child’s body. Some parents may want to be present, whereas others may find this too distressing. The nurse can also support families to wash and dress the child and many families appreciate the support in doing this. The child’s body should then be covered with a clean sheet and a toy or flower placed with the child as the parent wish. Some physical changes may happen after death.

As part of advanced care planning, parents (sometimes in discussion with the child) may have decided where they want the body to be kept after death and before the funeral. Options that may be available to families are for the body to be kept at home, at a hospice or at the funeral directors. Not all options will be available to all families, however, and considerations of each option are outlined.

• At home – keeping a child’s body at home may be the preferred option for some families at it means they continue to feel close to the child and family members can visit to say goodbye.
  
• Hospice – most hospices have a designated ‘cool room’ where the child’s body can be kept after death and have an adjoining family suite where the family can stay also. Some families find it useful to have the support of hospice staff after a child’s death and it has been found that parents who had used a hospice cool room reported feeling physically, practically and emotionally supported during this time.
  
• Funeral directors – a child’s body can be stored here until the funeral. The funeral director will manage the condition of the body in a professional and sensitive way.

The death of a child has a profound impact on parents, siblings, grandparents and many more family members and friends. Each individual will grieve and express grief in their own way and this should be respected, but health care workers do have a role in the grieving process and there are certain protective factors that have been offered for ‘successful bereavement’. These include the benefit of adequate information giving and pre-bereavement counselling. Health care professionals may offer signposting to other services to support the grieving process, although their purpose is not to show the family how to grieve, but to support them as necessary and with respect to individual spiritual, cultural and religious needs.

Staff can be greatly affected following end-of-life care and care of the family following death.