Pediatric death: managing the aftermath in the emergency department

Managing the family conference in the emergency department after the sudden death of a child is difficult and, when mishandled, can be deleterious to the patient's family. We surveyed parents of children who died in an emergency department setting in an effort to elicit information that will help emergency physicians tell parents that their child has died. A 24-question survey was distributed to 60 parents identified by the Illinois chapter of the Sudden Infant Death Syndrome Alliance. Results were included if the parents indicated that their child was pronounced dead on arrival or died in an emergency department. If the victim was over 16 years of age, had a terminal illness, or died after hospitalization, results were excluded. Thirty-seven parents completed the survey. Seventy-six percent felt that it was the attending physician's responsibility to inform the family that the child had died. Holding the dead child was helpful for 88%. Seventy-six percent felt that being asked about organ donation would not be offensive. For most parents, having the child's clothes returned was important. Fully 92% of the respondents would have liked a physical memento of the child, such as a print or mold of the child's hand or a lock of hair. Most parents felt that a follow-up telephone call would be helpful, although only a small minority received such a call. Parents whose child died in an emergency department provided some concrete suggestions for emergency physicians regarding informing parents that their child died. Although the majority of children died of sudden infant death syndrome, the results may be applicable to other pediatric deaths.