3 Dying Child Nursing Care Plans

Caring for a dying child is among the hardest work a nurse does, and the family is your patient too. The child is totally dependent and the illness reaches the whole family, so your first move is to build rapport and open, honest communication. That is what lets you control pain, ease fear about impending death, and support the family through anticipatory grieving toward the best quality of life possible.

Nursing Care Plans and Management

The plan gives age-appropriate information about death and dying to ease anxiety, delivers strong pain relief through drug and nondrug methods, walks the child through awareness and acceptance, and supports the family through grieving.

Nursing Problem Priorities

Provide adequate pain relief, and support the family through the grieving process.

Nursing Assessment

See the assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

After assessment, the diagnosis names the specific challenges of caring for a dying child based on clinical judgment and the child's condition. In real settings, diagnostic labels matter less than the rest of the plan: clinical judgment shapes care around each child's priorities.

Nursing Goals

• The child appears relaxed and is not crying, grimacing, or moaning.
• The child experiences less pain.
• The child or parent verbalizes decreased anxiety.
• The child, parents, and family verbalize feelings about grief in a culturally relevant way.
• Parents resolve dysfunctional grieving.
• Parents verbalize understanding of the cause of death.

Nursing Interventions and Actions

1. Managing Pain

A dying child's pain comes from several directions at once: the underlying illness, the treatments and procedures meant to prolong life (surgery, chemotherapy), and the emotional distress of the child and family.

Assess pain intensity, fear of pain medication, anxiety, coping mechanisms, and the ability to rest and sleep. This is the basis for choosing analgesics and tailoring the plan. Developmentally based pain scales give a reliable read of a child's discomfort so you can spot patterns and adjust.

Teach the child and parents the medication route and expected side effects, and that pain is monitored continuously and adjusted as needed. This assures them pain will be controlled whether or not the child can express it.

Support the coping mechanisms of the child and family and adjust analgesics with input from the child, parents, and physician. This promotes comfort, backs coping, and keeps the family in care decisions.

Provide familiar toys and blankets, and encourage parents and significant others to stay with the child at all times. Familiar comfort items cut fear and anxiety in an unfamiliar setting, and a present parent reassures a child who would otherwise feel scared or alone.

Provide nondrug pain strategies: therapeutic touch, soothing baths, massage to painful areas, and distraction (guided imagery, hypnosis, biofeedback, breathing techniques, music, reading, journaling, gentle movement, aroma, humor, prayer, relaxation). These lower pain perception and give a sense of control.

Dim the lights, keep noise down, maintain a clean comfortable bed with loose sheets and clothing, and disturb only for needed care. This removes stimuli that drive anxiety and pain.

Assist with position changes as tolerated, support position with pillows, move slowly with gentle handling, and offer a back rub. These are nondrug measures to reduce pain.

Tell the child and parents that voicing fear and feelings about pain and its control is normal. Naming the fear and inviting expression lowers anxiety.

Administer intermittent or continuous analgesia as prescribed by pain severity, and give it before any painful procedure or care. This covers pain reliably and gives quick relief when dosed intermittently.

Tell parents and child that care and treatment are palliative. This eases the dread of painful interventions.

2. Managing Anxiety and Fear

A dying child may fear the unknown and what comes after death, worry about leaving loved ones, and carry physical discomfort that feeds the anxiety.

Assess the level of anxiety, fears, concerns, ability to express needs, and how the anxiety shows. This guides interventions to ease it.

Have the child rate anxiety as mild, moderate, severe, or incapacitating. The rating tracks whether anxiety is improving or worsening.

Encourage the child to voice fears and ask about the terminal stage, and answer honestly within what the family has been told about the prognosis. Venting reduces anxiety.

Let a family friend or staff member stay with the child during stressful times when parents are away. This comforts and supports the child through anxious moments.

Help the child and family identify at least two coping mechanisms for anxiety (humor, deep breathing, meditation, relaxation, exercise, talking to a spiritual advisor, pleasurable activities). Coping mechanisms blunt the stress, and judicious humor can diffuse tension.

Offer calm reassurance and kindness, and stay available to the child. Presence and warmth reduce anxiety.

Orient family to the physical changes in the child as death approaches. This prepares them to recognize impending death.

Tell the child and parents about expected care and activities. This clarifies the child's needs and limits activity to what is essential.

Include the child and parents in planning and care as much as possible without forcing it. This builds interaction and a caring family attitude.

Let parents communicate with the child and sit or lie near them as they wish. This cuts the child's stress and fear of being alone.

Reassure the child and parents that they are not responsible for the illness or its consequences. This lessens fear and guilt tied to the terminal nature of the illness.

Give parents and family contact numbers and a way to get information about the child. This keeps a line open about the child's condition.

Provide pain control before invasive procedures (for example, EMLA cream, a eutectic mixture of local anesthetics, before IV insertion). This promotes comfort and cuts the distress of invasive procedures.

3. Providing Support Through Grieving

Anticipatory grieving starts as loved ones emotionally prepare for the child's death, moving through sadness, fear, and anger. Worked through, it helps them cope and support the child in the final days. Dysfunctional grieving sets in when they cannot grieve in a healthy way: prolonged or intense sadness, anger, or guilt that disrupts daily life and relationships. Unresolved issues, trauma, or mental health problems can drive it.

Assess the grief stage, difficulties, and feelings about the terminal illness and the potential loss. Need for grieving differs across family members when a child's death is anticipated.

Assess parents' feelings and what they believe happened to the infant. This lets anger, guilt, and sorrow surface.

Reassure the child, parents, and family that grieving is normal. Understanding the grief reaction supports coping.

Encourage parents and family to stay with the child as much as they need, and help them read the child's behavior and needs. This lets them feel they are helping their child.

Give the family chances to vent feelings and respond to the child based on their grieving stage. This moves them through grieving.

Provide emotional and spiritual comfort in an accepting setting, and limit discussion that breeds guilt or anger. This meets the family's emotional needs without piling on stressors that are hard to resolve.

Help the child and family recognize and use effective coping mechanisms and accept a situation they cannot control. This supports coping that works for the family.

Provide privacy when needed while staying available. This builds a helping relationship.

Encourage parents to voice their feelings about the possible death, share memories, take family pictures, and build a memory box. This supports coping and acceptance and can ease guilt.

Involve parents in the child's care (treatment, pain control). This heads off feelings of powerlessness.

Teach parents about the child's developmental understanding of death, and encourage children's books to open discussion of the child's understanding and fears. This builds family communication and coping.

Inform parents and family (and the child, if appropriate) of the stages of grieving and what behaviors are acceptable. This helps them understand the feelings and behaviors that grief brings.

Give information about the child's condition, including appearance and changes to expect. This lets parents track the course.

Encourage parents to take part in care, including care they will give if the child goes home to die, and point them to resources for help. This keeps parents involved and lets them share their sadness with the child.

Let the family ask questions and be truthful about their feelings and acceptance of information about death and dying. This keeps the view honest and supports grieving.

Teach the family to maintain their own needs and health through this time. A prolonged terminal period is easier to manage when caregivers care for themselves.

Arrange clergy, social services, hospice care, or discharge home to die as appropriate, and support the family's choices. This provides alternatives and respects their decisions.

Stay with parents and provide privacy; avoid discussion or questions that assign blame or cause guilt. Explain the cause of death, and reinforce that the cause of SIDS is unknown with no sure way to predict or prevent it. This supports without adding to grief and guilt.

Let parents decide how long they hold their infant or child; this varies by culture and individual need. Holding the child and saying goodbye on their own terms supports positive grief resolution.

Prepare the child for parents to view and hold, and stay with them during it. This lets parents say goodbye.

Give parents the chance to inform significant others; if they cannot, staff should call. Other family and friends often support grieving families.

Help parents inform and support siblings, answering children's questions honestly and at their age level. A child's concept of death develops with age, and siblings need help to avoid blame and guilt.

Take pictures of the infant and offer them, and save clothing, ID bracelets, and hats as a memento packet for the parents; if they refuse it, save it for later. This supports positive grief resolution.

Reassure parents they are not responsible for the death. SIDS is an unpreventable, unexplained sudden death of an infant, and no one is to blame.

Answer questions about SIDS and explain the need for an autopsy to verify the diagnosis. This reinforces the physician's explanation.

Correct any misinformation or misconceptions about the death. This helps resolve guilt and grieving.

Help the family identify and use effective coping mechanisms for the situation. Defense mechanisms that worked before move them through grieving.

Obtain a thorough history from parents, including resuscitation efforts and illness history; an experienced or trained staff member should do this given the sensitive nature of the information. This gives the medical examiner accurate information.

Contact the infant's primary care provider. This strengthens the parents' support system and communication.

Explain the stages and importance of grieving and the behavior expected as grief resolves. In a nonjudgmental setting, this allows for the initial shock and disbelief that grief brings.

Use therapeutic communication such as active listening. Encourage parents to verbalize their understanding of the cause of death, their grief, and any concerns about seeking help with grieving. This helps them vent and identify dysfunctional aspects of their grief.

Offer clergy or other support if requested, including baptism or prayer. This provides support and comfort.

Refer the family to counseling, the local SIDS chapter, the community health nursing agency, and grief support groups. This supports them through mourning or chronic grief that can strain family relationships.