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On the death of a child.
  1. ANN GOLDMAN, Senior Lecturer in Palliative Care
  1. Great Ormond Street Hospital
  2. London

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On the death of a child. Hindmarch C. (Pp 242, paperback, £17.95) Oxford: Radcliffe Press, 2000. ISBN 1 85775 445 X

Death is no longer quite the taboo subject that it has been in the past but it is still a difficult topic and one which most people meet only rarely. It is easy to feel uncertain what to do and how to help a family when a child dies. It is impossible to take away their pain and so, as Celia Hindmarch observes, “bereavement work makes everyone feel inadequate and it is always tempting to look for an expert who will do a better job”. Her book sets out to help all those involved in supporting families recognise that each of us can contribute, and give us the skills to do so successfully.

Knowledge enhances confidence in a difficult situation and this is the first way in which the book helps. There is comprehensive epidemiological information about the causes of death in childhood, including stillbirth, acute and chronic illness, accidents, and suicide. The special characteristics and problems of the different situations are highlighted and brought to life by relevant case histories. Many of these focus on examples of good practice and illustrate the increased sensitivity and improvements that have taken place in the health and emergency services in recent years.

Theories of grief and mourning, especially after the death of a child, have also developed since the last edition of the book. In particular, ideas that the end of grief necessitates the severing of bonds with the deceased person have been modified. Recent research has explored the continuing bonds that parents maintain with their dead child, and how the resolution of grief depends on recognising and working with this. These recent ideas, and other models of grief, are described clearly and simply, so they can form a firm theoretical foundation for understanding the feelings and behaviours of families.

Moving from the theory to providing effective practical support for families involves sensitivity and compassion but also skills in listening and communication which can be learnt and developed. The guidelines offered in the second part of the book help us assess our own roles and suggest general principles and practical approaches for supporting families. Themes which families identify themselves and which we can respond to are the need for information, choices, control, and permission to grieve. They also remind us that “listening is more important than talking”, and “being there more important than doing”. Topics which provoke particular anxiety such as working directly with bereaved children, identifying situations where specialist help is needed, suicidal intentions, support for schools, and supervision are all approached thoughtfully and informatively. Finally, the book provides an overview of support services, resources and further reading.

This new edition of On the Death of a Childoffers clear up to date information and immensely practical advice. We can all benefit from Celia Hindmarch's wisdom and experience and hopefully increase our own skills and confidence when we are faced with a child's death.

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